Gender inequality in the treatment of peripheral artery disease  

Gender inequality in the treatment of peripheral artery disease
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According to new research published by the European Society of Cardiology, peripheral artery disease is underdiagnosed and mistreated in women. 

According to the review, the development of treatment for peripheral artery disease was largely focused on male patients and, therefore, less effective in women. 

“Greater understanding is needed about why we are failing to address the health outcome gap between genders,” said author Mary Kavurma, an associate professor at the Heart Research Institute, Australia. 

The paper, ‘A hidden problem: peripheral artery disease in women‘, has been published in the European Heart Journal – Quality of Care and Clinical Outcomes.

What is peripheral artery disease?

Peripheral artery disease causes arteries in the legs to clog, restricting blood flow and increasing heart attack risk. It is estimated that the condition affects over 200 million people globally. Despite research suggesting that the condition affects women more frequently than men, women still have worse health outcomes. 

The report outlines biological, clinical, and societal factors that may be responsible for gender-related disparities in treating the disease. 

Women are less likely than men to present symptoms of the disease, which makes them more difficult to diagnose. Typical symptoms include pain and cramping in the legs and gangrene and ulcers in severe cases. As well as this, women tend to show typical symptoms post-menopause, which may lead to misdiagnosis. 

Treatment for peripheral artery disease usually involves a combination of medication, exercise, and surgery. Treatment aims to reduce the risk of ulceration, amputation, heart attack and stroke. However, women are less likely to be recommended for medication and are less likely to respond to exercise therapy. Women also have lower surgery rates than men and are more likely to die after amputation or open surgery. 

Several biological factors may contribute to disparities in health outcomes. For example, women have a higher risk of blood clots and smaller blood vessels, which can cause the disease. Some researchers have also suggested that oral contraceptives and pregnancy complications could increase the risk of peripheral artery disease. 

Clinical factors, such as how patients engage with healthcare services, their relationships with doctors and the diagnostic and therapeutic processes for the disease, may affect outcomes. 

The researchers highlighted a lack of peripheral artery disease awareness among women and healthcare professionals as a potential cause of the disparity. According to their research, healthcare professionals are less likely to recognise the disease in women, and women are more likely to be misdiagnosed with musculoskeletal disorders. 

Women are still underrepresented in clinical research

In the last ten years, only one-third of participants in clinical trials of peripheral artery disease were female. The researchers believe this may be because many clinical trials seek to include participants with intermittent claudication, which is less common in women. 

The review also cited several potential societal factors. Lower socioeconomic status was associated with an increased likelihood of peripheral artery disease and subsequent hospitalisation. 

The disease is more common in low- and middle-income countries, and rates increase for women. The authors emphasised that in most nations, women have a lower socioeconomic standing than men due to reduced income, lower education levels, and caring responsibilities. 

“The higher poverty and socioeconomic disparities experienced by women globally may contribute to increased rates of the disease in women,” wrote the authors. 

The researchers also highlighted the low proportion of female vascular surgeons and underrepresentation in leadership roles surrounding the diseases and on teams that inform peripheral artery disease policy. There is also some evidence that female patients respond better if they are treated by female clinicians. 

“Whilst we are working on encouraging women to train as vascular surgeons, the current shortfall means that female patients are unlikely to see a surgeon of the same gender, and research, publications and policies may not fully represent the perspectives of women,” concluded associate professor Sarah Aitken, a vascular surgeon and Head of Surgery at the University of Sydney. 

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