Abstract
Atherosclerotic peripheral artery disease (PAD) is associated with functional limitations
and an increased risk of poor cardiovascular outcomes. Although men are traditionally
viewed at higher risk of PAD than women, the true prevalence and incidence is inconsistent
among available reports. Some of this variability is due to differences in PAD-related
symptoms among women as well as sex-based differences in diagnostic tests, such as
the ankle-brachial index, and it is critical for future epidemiologic studies to account
for these differences. Generally, women with PAD experience greater functional impairment
and decline then men and are less likely to receive guideline-directed medical therapy.
In some settings, women are also more likely to present at later stages of disease
and more often undergo lower limb amputation than men. Animal data exploring the biological
underpinnings of these sex differences are limited, but several mechanisms have been
postulated, including differential plaque morphology, alterations in the immune response,
and hormonal variation and protection. Epidemiologic data suggest a link between inflammation
and PAD and also reveal sex differences in lipid profiles associated with risk of
PAD. In this review, we discuss available data on sex differences in PAD with additional
focus on potential biological explanations for these differences. We also emphasize
important knowledge gaps in this area, including under-representation of women in
PAD clinical trials, to help guide future investigations and eliminate sex disparities
in PAD.
Résumé
La maladie artérielle périphérique (MAP) d’origine athéroscléreuse entraîne une baisse
des capacités fonctionnelles et un risque accru de résultats cardiovasculaires défavorables.
Bien que les hommes soient d’habitude considérés comme exposés à un risque plus élevé
de MAP que les femmes, les rapports disponibles ne sont pas unanimes quant à la prévalence
et à l’incidence réelles des MAP. Cette absence de consensus est en partie attribuable
à des différences dans les symptômes des MAP chez les femmes ainsi qu’à des différences
liées au sexe qui influent sur les tests diagnostiques, comme l’indice de pression
systolique; il sera donc essentiel de tenir compte de ces différences dans les futures
études épidémiologiques. En général, les femmes atteintes d’une MAP présentent un
déficit et une détérioration des capacités fonctionnelles plus sévères que les hommes,
et sont moins susceptibles de recevoir un traitement médical fondé sur des lignes
directrices. Dans certains contextes, les femmes sont également plus susceptibles
de consulter aux stades plus avancés de la maladie, et subissent plus souvent que
les hommes l’amputation d’un membre inférieur. Il existe peu de données tirées d’études
chez l’animal explorant les fondements biologiques de ces différences entre les sexes,
mais plusieurs hypothèses ont été avancées pour les expliquer, notamment la morphologie
différente des plaques, les altérations de la réponse immunitaire, les variations
hormonales et la protection d’origine hormonale. Les données épidémiologiques laissent
entrevoir un lien entre l’inflammation et les MAP, et révèlent des différences entre
les sexes quant aux profils lipidiques associés au risque de MAP. Dans cette revue,
nous analysons les données disponibles sur les différences entre les sexes en ce qui
a trait aux manifestations de la MAP et nous présentons des explications biologiques
plausibles de l’origine de ces différences. Nous soulignons également les grandes
lacunes en matière de connaissances dans ce domaine, notamment en ce qui a trait à
la sous-représentation des femmes dans les essais cliniques sur les MAP, afin d’orienter
les études ultérieures et d’éliminer les disparités entre les sexes dans l’étude des
MAP.
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Article info
Publication history
Published online: February 26, 2022
Accepted:
February 22,
2022
Received:
January 27,
2022
Footnotes
See page 608 for disclosure information.
Identification
Copyright
© 2022 Canadian Cardiovascular Society. Published by Elsevier Inc. All rights reserved.
