Like many other CVDs, PAD is far more commonly asymptomatic than symptomatic; the former accounts for 40% and the latter for only 10% of all cases. When it comes to women, studies have indicated that they are more likely to have asymptomatic PAD then men. Additionally, women are more likely to present with atypical symptoms that could be attributed to other medical conditions, delaying accurate diagnosis despite possible inclusion in risk groups.
The main risk factors identified for PAD (old age, diabetes mellitus, smoking and hypertension) are the same for men and women but do not necessarily impact them equally. Female smokers are, for example, at up to 20 times greater risk for the disease than females who have never smoked.
There are, however, specifics regarding comorbidity with other CVDs in women. Namely, prior diagnosis of coronary artery disease (CAD), myocardial infarction (MI), stroke or transient ischaemic attacks (TIAs) is indicative of possible PAD. Women, on the other hand, are more likely to have only PAD in the absence of other CVDs. Compounded with common asymptomatic presentation, this leads to a greater chance of missed diagnosis and delayed treatment.
Women often don’t even receive a simple screening, despite the simplicity and low cost of some diagnostic methods.
How is PAD diagnosed in women?
There are several methods of diagnosing PAD, some more appropriate for use in general practice than others and varying in accuracy and reliability. The most accurate and reliable one is angiography, boasting a very high detection (between 89% and 100%), and specificity (between 92% and 100%), but it is too expensive for general screening and requires specialised equipment.
In practice, many patients aren’t receiving proper treatment. Studies have found that patients with only PAD were less likely to receive treatment with either statins, ACE inhibitors, or antiplatelet agents than those with both PAD and CAD. In those cases, women were even less likely than men to receive those drugs. The situation is no better at the severe disease end of the spectrum since females who undergo lower extremity revascularisation are usually older and have more severe disease compared to men.
Women, especially older ones, are at greater risk of PAD-related morbidity and mortality due to the frequently asymptomatic nature of the disease and consequently delayed diagnosis. Possible solutions are increased screening of elderly patients, particularly those in risk groups, and aggressive treatment and risk factor modification in those with a positive diagnosis.