Kansul Fouzul, Crichton Alexander B, Pomozi Enikő, Roy Trisha L
College of Engineering, Texas A&M University, College Station, TX, USA.
DeBakey Heart and Vascular Center, Houston Methodist Hospital, Houston, TX, USA.
Curr Atheroscler Rep. 2025 Sep 15;27(1):91. doi: 10.1007/s11883-025-01330-x.
Peripheral artery disease (PAD) is a leading cause of cardiovascular morbidity and mortality. Despite its growing clinical burden, the disease remains relatively understudied and underdiagnosed relative to other cardiovascular diseases, especially in female patients. While PAD prevalence is similar in males and females, sex-based disparities have been noted in the presentation, diagnosis rates, treatment methods, and clinical outcomes of PAD patients. This article serves to provide an overview of existing knowledge on sex-based differences in the epidemiology, pathophysiology, clinical presentation, management, and patient outcomes of PAD.
Female patients with PAD remain underdiagnosed and undertreated, with females receiving lower referral rates to supervised exercise therapy and guideline-directed medical therapy despite observing similar benefits from treatment as males. Surgical interventions also see conflicting outcomes in male and female patients, with females now seeing improved outcomes despite prior studies indicating worsened quality of life. Cardiovascular risk factors such as history of smoking, chronic kidney disease, and diabetes also place females at heightened risk of PAD compared to male patients. There are also physiological disparities observed that affect the presentation and diagnosis rates of PAD, with female patients seeing increased platelet reactivity and aggregation yet receiving later diagnoses at more severe stages due to postmenopausal effects. In addition, female patients remain underrecruited in clinical research studies for cardiovascular disease, highlighting a need for further research focused on female patients and sex disparities in PAD. This article identifies key disparities between male and female patients with PAD, with inequities noted in the epidemiology, pathophysiology, risk factors, clinical presentation, and treatment approaches and outcomes. Further research is warranted to better understand sex-based differences in PAD and better inform patient treatment decisions.
外周动脉疾病（PAD）是心血管疾病发病和死亡的主要原因。尽管其临床负担日益加重，但相对于其他心血管疾病，该疾病的研究和诊断仍相对不足，尤其是在女性患者中。虽然PAD在男性和女性中的患病率相似，但在PAD患者的表现、诊断率、治疗方法和临床结果方面已注意到基于性别的差异。本文旨在概述关于PAD在流行病学、病理生理学、临床表现、管理和患者结局方面基于性别的差异的现有知识。
患有PAD的女性患者仍未得到充分诊断和治疗，尽管女性从治疗中获得的益处与男性相似，但她们接受监督运动疗法和指南指导药物治疗的转诊率较低。手术干预在男性和女性患者中也有相互矛盾的结果，尽管先前的研究表明女性生活质量恶化，但现在女性的结局有所改善。与男性患者相比，吸烟史、慢性肾病和糖尿病等心血管危险因素也使女性患PAD的风险更高。还观察到生理差异会影响PAD的表现和诊断率，女性患者血小板反应性和聚集增加，但由于绝经后效应，在更严重阶段才得到诊断。此外，女性患者在心血管疾病临床研究中的招募人数仍然不足，这凸显了需要进一步开展针对女性患者和PAD中性别差异的研究。本文确定了PAD男性和女性患者之间的关键差异，在流行病学、病理生理学、危险因素、临床表现以及治疗方法和结局方面都存在不平等现象。有必要进行进一步研究，以更好地了解PAD中基于性别的差异，并为患者治疗决策提供更好的信息。
