Vascular Research Centre, Lifelong Health Theme, South Australian Health and Medical Research Institute, Adelaide, South Australia; Faculty of Health and Medical Sciences, University of Adelaide, Adelaide, South Australia.
Vascular Research Centre, Lifelong Health Theme, South Australian Health and Medical Research Institute, Adelaide, South Australia; Faculty of Health and Medical Sciences, University of Adelaide, Adelaide, South Australia.
J Vasc Surg. 2021 Apr;73(4):1456-1465.e7. doi: 10.1016/j.jvs.2020.09.039. Epub 2020 Nov 6.
Individual studies of peripheral artery disease (PAD) have indicated that gender discrepancies exist in the symptoms, functional status, and treatment usage. It remains uncertain whether these discrepancies result in different long-term outcomes. We examined the potential gender differences in mortality and major adverse cardiovascular events (MACE) in patients with symptomatic PAD.
The PubMed and Embase databases were searched for studies from 2000 to January 2019. After a review of 13,582 citations, 14 articles were analyzed. The reported age-adjusted hazard ratios (HRs) for gender differences in mortality and MACE were included in the meta-analysis. The mortality outcomes were stratified according to the clinical presentation and study context.
Male gender was associated with a greater risk of all-cause mortality (HR, 1.13; 95% confidence interval [CI], 1.10-1.16; P < .001) and MACE (HR, 1.10; 95% CI, 1.06-1.14; P < .001). In a stratified analysis, male gender was associated with a higher mortality risk for patients presenting with either critical limb ischemia (HR, 1.08; 95% CI, 1.05-1.10; P < .001) or mixed clinical presentations (HR, 1.16; 95% CI, 1.11-1.21; P < .001) but not for those with intermittent claudication (HR, 1.13; 95% CI, 0.98-1.30; P = .09). Elevated mortality risk was evident after revascularization (HR, 1.11; 95% CI, 1.04-1.19; P = .003), hospitalization (HR, 1.15; 95% CI, 1.08-1.22; P < .001), and amputation (HR, 1.09; 95% CI, 1.08-1.10; P < .001), although not in outpatient clinics (HR, 1.13; 95% CI, 0.97-1.32; P = .13), in men compared with women.
Greater mortality and MACE rates in men with PAD occurred despite other accepted gender disparities. The mechanisms underlying these gender differences in the outcomes for PAD patients require further investigation.
一些关于外周动脉疾病（PAD）的研究表明，在症状、功能状态和治疗使用方面，性别差异确实存在。目前尚不清楚这些差异是否会导致不同的长期结局。我们研究了有症状的 PAD 患者的死亡率和主要不良心血管事件（MACE）是否存在潜在的性别差异。
从 2000 年至 2019 年 1 月，我们在 PubMed 和 Embase 数据库中搜索了相关研究。在对 13582 条引文进行审查后，分析了 14 篇文章。将报告的性别差异与死亡率和 MACE 相关的年龄调整后的风险比（HR）纳入荟萃分析。根据临床表现和研究背景对死亡率结果进行分层。
男性发生全因死亡率（HR，1.13；95%置信区间[CI]，1.10-1.16；P<0.001）和 MACE（HR，1.10；95% CI，1.06-1.14；P<0.001）的风险更高。在分层分析中，男性发生死亡率的风险更高，无论是患有严重肢体缺血（HR，1.08；95% CI，1.05-1.10；P<0.001）还是混合临床表现（HR，1.16；95% CI，1.11-1.21；P<0.001），但间歇性跛行（HR，1.13；95% CI，0.98-1.30；P=0.09）除外。血管重建（HR，1.11；95% CI，1.04-1.19；P=0.003）、住院（HR，1.15；95% CI，1.08-1.22；P<0.001）和截肢（HR，1.09；95% CI，1.08-1.10；P<0.001）后死亡率风险升高，但在门诊（HR，1.13；95% CI，0.97-1.32；P=0.13）中未见升高。
尽管存在其他公认的性别差异，但 PAD 男性的死亡率和 MACE 发生率更高。PAD 患者结局中这些性别差异的潜在机制需要进一步研究。
