Gender Disparities in CLI Patients

Written by Cynthia Laufenberg, MA

Presented by Anahita Dua, MD, FACS

At Wednesday’s session “The Amputation Epidemic: Impact on Minority & Underserved Populations,” Dr. Anahita Dua of Massachusetts General Hospital/Harvard Medical School discussed gender disparities in patients with peripheral arterial disease (PAD) and critical limb ischemia. The prevalence and burden of PAD is equal, if not higher, in women as compared with men. And when prevalence is high, outcomes are worse.

One big factor in gender disparities is that women are understudied. “Women are notably underrepresented in existing PAD studies,” Dr. Dua noted. “There’s a significant knowledge gap regarding the etiology and natural history of female-specific disease.” What is known is paradoxical: Traditional cardiometabolic risk factors are less prevalent in women, and at the same time women are more sensitive than men. There’s an emerging consensus that there may be ineffectively measured or yet unidentified key risk factors for PAD in women.

Dr. Dua presented information from “Sex Differences in Peripheral Artery Disease,” an article by Pabon et al published in Circulation Research in February 2022. She also mentioned new studies to help overcome these gender disparities, including Utilization of Platelet Mapping to Assess Sex Dimorphism, a prospective pilot study that showed female patients were less comorbid and had higher platelet reactivity despite similar antiplatelet management, so platelet mapping may provide targetable health information.

Dr. Dua concluded that PAD is a condition that affects women as often or more commonly than men, and sex-based differences in pathophysiology and risk factors may contribute to the later-onset and often atypical presentation of women with PAD. “While underdiagnosis and undertreatment of PAD affects the quality of care and outcomes for all patients,” she said, “these challenges are especially profound for women, with data consistently demonstrating less frequent use of evidence-based therapies in women compared with men.” She indicated that sex-specific analyses from translational PAD studies along with clinical trial findings reported by sex will help address this persistent unmet need.