Vascular Disease Among Women and Underserved Communities
September is usually PAD (Peripheral Arterial Disease) Awareness Month, but even with national efforts to educate the masses on PAD, a new study shows that “70% percent of Americans” still have no idea what PAD is.
Peripheral arterial disease is linked to atherosclerosis and occurs when there is an arterial blockage due to the accumulation of plaque in the arterial pathway. This buildup of plaque can cause arteries to become clogged or restrict arterial blood flow, which can cause health complications such as limb loss, stroke, and heart attacks.
What is even more alarming is that people to whom PAD poses the most risk are still in the dark about this vascular disease. Approximately 400 amputations a day can be directly attributed to having peripheral arterial disease.
Awareness among women, unfortunately, continues to be lower, which has led to an increase in at-risk female patients who are not receiving early screenings for PAD. Timely interventions are paramount to the best outcomes. When there are delays in diagnosis and treatment, it elevates the risk for vascular complications. According to the Global Burden of Disease Study, “Compared with men, the prevalence of PAD among women was notably higher, moreover the prevalence of PAD among women aged >40 years is estimated to be between 3–29%; however, even this is likely to be an underestimation.”
This combination of low PAD awareness and few early screenings has demonstrated a negative impact among underserved populations as well.
According to Foluso Fakorede, MD, the CEO of Cardiovascular Solutions of Central Mississippi and co-chair of the Association of Black Cardiologists PAD Initiative, it is critical to increase awareness among racial and ethnically marginalized communities and the providers who serve them to close the gap.”
A study that included data from Medicare patients, known as the Atherosclerosis Risk in Communities (ARIC) Study, concluded that Black Americans had double the chance of developing Peripheral Arterial Disease. It also showed that limb loss risk in Black communities was quadruple that of white patients. Per AHA/ASA Journals, “Hispanic communities present with more progressive PAD leading to worse outcomes including greater risk of amputation.”
But what do these statistics mean? It illustrates the urgent need to provide more education about PAD and utilize early screenings of PAD not just in the aging population but in underserved and affected communities as well.
The underdiagnosis of women may be attributed to the fact that many women often present asymptomatically when they have PAD. Moreover, it is common that symptoms women experience may not present as “typical’’ PAD symptoms. Sadly, studies have shown that women can suffer from worse outcomes when they develop PAD, making it imperative that medical professionals diligently screen patients with atypical risk factors and symptoms. The Global Burden of Disease Study 2019 concluded that the leading cause of death among females was cardiovascular disease.
The most common risk factors for developing PAD are:
over 50
overweight
smoking (even if you quit)
diabetic
high blood pressure or high cholesterol
non-healing wounds
a family history of PAD
Chronic Kidney Disease (CKD)
For women, additional risk factors can also include:
Osteoporosis
Elevated CRP levels
Menopause
Hypothyroidism
Birth control pills
Pregnancy complications, like maternal placental syndrome, which is a combination of exposure to preeclampsia, gestational hypertension, placental abruption, or placental infarction
According to the Lancet Women and Cardiovascular Disease Commission, other cardiovascular risks for women include:
Gestational diabetes
Preterm delivery
Premature menopause
Polycystic ovary syndrome (PCOS)
Many experts agree that more studies and research are needed on vascular disease and women’s health. However, doctors can do their part by collaborating with other medical professionals to screen patients and provide patient education and awareness to prevent devastating outcomes for people afflicted with PAD. Understanding the risk factors and differences between the sexes can optimize early detection. Patient awareness can also bring empowerment and self-advocacy.
When screening women for PAD, the provider should note that women may often present with no or atypical PAD symptoms. Characteristically, PAD symptoms commonly include leg pain when patients are exercising, which subsides at rest. However, many female PAD patients may not experience leg pain—or they may describe pain while at rest and while walking.
It is crucial to have a complete and detailed medical history of female patients when assessing for vascular or cardiovascular risks. If we understand the unique risk factors for women, we will be able to screen sooner and improve outcomes. Every patient is unique; understanding medical histories and differences can help doctors better serve all patients, especially those communities that are underdiagnosed.
If you have any of the risk factors for PAD listed above, the best way to advocate for yourself is to set up a PAD screening. Trust a vascular surgeon like Dr. David Nabi to properly assess and provide care that will optimize your vascular health so you can live your best life.