Women are Different
The risk of leg artery disease, also called peripheral artery disease (PAD) is increasing. This is especially so with increasing levels of diabetes and obesity. Other important risk factors are age, smoking, cholesterol levels, blood pressure, kidney disease and depression.
Being female, or identifying as female gender to a lesser extent, has its own set of risks for developing and treating PAD. These risks include the effect of menopause on arteries, different experience of PAD symptoms, generally poorer risk factor control and contacts with health systems.
Overall, PAD is more common in men at first but over time, women catch up to men and will overtake them.
Why are Women Different?
Biology and hormones play a major role. Before menopause, oestrogen, and some other factors in the walls of arteries, have a protective effect against PAD. As a result of this effect, women tend to get PAD about 10-20 years after men. After menopause, this protective effect is lost and, overtime, women catch up to men. Women then overtake men because they live longer.
Women who have PAD are much less likely than men to have symptoms, such as leg pain on walking, also called intermittent claudication. When women do have symptoms, most will still have claudication but are also more likely to have atypical symptoms. These may be confused with arthritis, back pain or nerve pain. As a result of this, women often first seek medical advice when their symptoms and PAD are worse.
Also, if women smoke, they are less likely to be able to stop smoking. Control of other risk factors, such as obesity, high blood pressure, cholesterol, kidney disease and diabetes, is also less optimal than for men. Some of this may relate to gender influences in society, such as roles, expectations, marketing and social media.
Trans-females are subject to many of the same society and gender role influences, even if the addition of oestrogen therapy in this group provides some protection against PAD.
What about smoking when talking leg artery disease?
It is worth noting that smoking is by far the biggest risk for developing PAD, in both women and men. Smokers are, on average, seven times more likely to develop PAD than non-smokers. Research shows that, on average, it is harder to get women to stop smoking than men, even after going on courses to help a person give up smoking.
Diabetes and leg artery disease?
In women who have not yet gone through menopause, having diabetes cancels out the protective effect of oestrogen on arteries. One of the reasons for this is that high levels of blood sugar change the lining in the arteries, which in turn causes artery disease to progress faster.
A high cholesterol level increases a person’s risk of PAD. In women who have gone through menopause, cholesterol levels tend to rise once the protective effect of oestrogen lowers. Of interest, taking hormone replacement therapy (HRT) does not seem to reduce this risk. However, cholesterol-lowering medications, called statins, do reduce this risk in people who already have PAD.
People with kidney disease are prone to more rapid development of PAD. This is a result of damage to the artery lining, which causes inflammation and progressive PAD. More women live with chronic kidney disease. This is probably owing to the longer life expectancy of women.
Women are more at risk of depression than men. Depression increases the risk of PAD and causes reduced walking ability and more leg symptoms after treatment. Studies show that depression is one of the strongest stand alone risk factors for PAD in women but not in men.
Treatment Differences in Women with Leg Artery Disease
The first line of treatment for PAD is often stopping smoking, increasing exercise, eating healthily and optimising medications. Research shows that women are slower to get all of these treatments in place. Maori, Pacific Peoples and women in lower socioeconomic groups are more vulnerable.
Women have smaller arteries than men. This may lead to more complications with minimally invasive stent and surgical treatments. These include bleeding, artery blockages or infections. Once the treatment has been done, the longer-term outcomes are similar between women and men.