Millions of Women Are Unaware They Have Arterial Disease

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Peripheral Artery Disease in Women Underdiagnosed and Understudied

By Salynn Boyles
WebMD Health News

Reviewed by Laura J. Martin, MD

Feb. 15, 2012 -- Between 4 million and 5 million women in the United States have peripheral artery disease, or PAD, but few are diagnosed and even fewer receive adequate treatment.

In a special report released at the midpoint of American Heart Month, the American Heart Association is calling for greater efforts to identify and diagnose women at risk for the condition that commonly affects the leg arteries, and is also calling for more women to be involved in PAD studies.

A major goal is to raise awareness about a disease that millions of women have, but few know about, says University of Minnesota Medical School professor of medicine, epidemiology, and community health, Alan T. Hirsch, MD, who was the lead author of the statement.

"The rate of death and the health-care costs associated with PAD are at least comparable to those of heart disease and stroke," he says.

PAD Raises Heart, Stroke Risk

Peripheral artery disease occurs when arteries that supply blood to the body's extremities become narrowed or clogged with fatty plaque, restricting blood flow. PAD most commonly affects the arteries of the legs and pelvis.

Hirsch says few people realize that damage to the arteries in the legs can be as serious as damage to those that lead directly to the heart and brain.

Among the key findings in the report:

• Women with PAD are two to three times more likely to have a stroke or heart attack than women without the condition. If left untreated, PAD can sometimes lead to amputation.
• Age is a major risk factor for PAD for women and men, with people aged 50 or older being at increased risk and those over age 80 at highest risk.
• PAD appears to impact a woman's ability to get around more than men, and this is especially true for African-American women.

"Damage to the arteries in the legs and damage to those leading to the brain or heart carry comparable risk for future heart attack, stroke, or death," Hirsch says.

PAD Is Often a Silent Disease

Classic symptoms of peripheral artery disease include leg pain and cramping when walking or exercising, but most people with the condition do not have these warning signs.

Hirsch says the low rate of symptoms helps explain why so few people with PAD receive adequate treatments, which can include drug therapies, supervised exercise, and surgery to restore blood flow to narrowed or blocked arteries.

In addition to advanced age, risk factors for PAD include smoking, diabetes, high blood pressure, high cholesterol, obesity, sedentary lifestyle, and having a family history of the condition.

Cardiologist Suzanne Steinbaum, DO, director of Women and Heart Disease at Lenox Hill Hospital in New York, says adequate treatment is important because women with PAD tend to experience very rapid functional declines.

She agrees that at-risk women should be screened for PAD and that more gender-specific research is needed to better understand the course of PAD and other diseases of the artery in women.

"If you are a woman who has any problem with your arteries, we don't know enough to tell you what is going to happen," she says. "We do know that outcomes among women with peripheral artery disease and coronary artery disease tend to be bad."

Hirsch hopes that programs like the American Heart Association's "Go Red for Women" campaign can raise awareness about PAD.

"Not too long ago, most women didn't know that their primary risk was heart disease," he says, adding that now it is common knowledge that more women die from heart disease than from all cancers combined.

"We would like to see a similar effort to make women aware of their risk for PAD," he says.

SOURCES: Hirsch, A.T. Circulation, published online, Feb. 15, 2012.Alan T. Hirsch, MD, FAHA, professor of medicine, epidemiology, and community health, Lillehei Heart Institute, University of Minnesota Medical School, Minneapolis, Minn.Suzanne Steinbaum, DO, director of women and heart disease, Lenox Hill Hospital, New York, N.Y.News release, American Heart Association.

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