Cardiovascular disease in women: peripheral artery disease.

Peripheral artery disease (PAD) is a common vascular disease in women that is underrecognized. It is most strongly associated with smoking and diabetes. Women with PAD are more likely to have atypical or no symptoms compared with men. The classic symptoms of claudication are seen in some, but not all, patients. The most useful initial test for PAD is the ankle-brachial index. The American College of Cardiology Foundation/American Heart Association guideline recommends that it be obtained for all patients with exertional leg symptoms; patients 50 years or older with diabetes; patients 50 years or older who smoke; all patients older than 65 years; and any patient with known coronary artery disease. Other tests, such as Doppler ultrasonography, magnetic resonance angiography, and computed tomography angiography, should be reserved for patients in whom the diagnosis of PAD is unclear. Exercise programs improve symptoms. Aspirin and statins are recommended for all patients with PAD, whereas surgery is reserved for patients who do not benefit from medical therapy.