Sex-related differences in Japanese patients with peripheral arterial disease
Introduction
Sex-related differences in clinical characteristics and risk factors have yet to be clarified for some cardiovascular diseases, but there are apparent disparities between men and women in clinical symptoms, risk factors, treatment and outcomes [1], [2], [3], [4]. Peripheral arterial disease (PAD) is an atherosclerotic disease with coexisting systemic cardiovascular disease and multiple atherosclerosis risk factors [5], [6], [7]. Several studies have reported sex-related differences in the clinical characteristics and risk factors of patients with PAD in Western countries [8], [9]. However, it is unclear if similar sex-related differences are present in Japanese patients with PAD. Moreover, the prevalence of patients with PAD differs between men and women in Western countries and in Japan. Therefore, the purpose of the present study was to clarify the sex-related differences in clinical status and risk factors in Japanese patients with PAD.
Section snippets
Patients
The subjects were 730 consecutive patients who were referred to the Cardiovascular Hospital of Central Japan between January 1st, 2005 and December 31st, 2010. All patients had an ankle brachial pressure index (ABI) <0.90 at their first visit for treatment of PAD. The final diagnosis of PAD was based on clinical symptoms and iliac or femoro-popliteal artery stenosis of ≥70% on angiography or ultrasound. Classification of clinical stages in PAD was defined using the criteria of Fontaine stages
Patient characteristics
The subjects were 730 patients with PAD (582 men and 148 women) aged 41–98 years old (mean: 71.4 ± 9.8 years old). The characteristics of the patients, including complications and risk factors, are shown in Table 1. Women were older and more frequently had CLI and diabetes mellitus compared to men, but drank alcohol and smoked less frequently than men. The proportion of women aged ≥75 years old was higher than that for men. The prevalence of hypertension and renal dysfunction showed a tendency to
Discussion
This is the first study to show sex-related differences in Japanese hospital-based patients with PAD. The major findings of the study were as follows. First, the ratio of men to women was 4:1 and the mean age of women with PAD was higher than that of men. Second, clinical symptomatic states represented by prevalence of CLI or Fontaine stages were more severe in women than in men, and positive correlations were found between Fontaine stages and age, diabetes, cerebral infarction and women.
Conclusion
Symptomatic conditions were more severe in women, including more frequent diabetes mellitus and hyperlipidemia. The prevalence of iliac artery lesions was lower and BK lesions were more severe in women. The frequency of medical treatment was higher in women than in men. The results of the study show that significant sex-related disparities remain in clinical status, risk factors and regional characteristics in patients with PAD.
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