Highlights
- •Once deemed a male-dominated disease, peripheral arterial disease (PAD) is a significant and often underrecognized cause of morbidity and mortality among women.
- •Emerging evidence indicates that sex-specific risk factors for PAD pose additional threats for women and include adverse pregnancy outcomes and menopause.
- •The pathophysiology of sex-specific risk factors for PAD, coupled with the cardiometabolic implications of adverse pregnancy outcomes, oral contraceptive use, and menopause, necessitate that health care providers capture data related to both the traditional risk factors for PAD as well as a woman’s reproductive history.
Abstract
The average life expectancy in the United States fell for the second straight year.
Attributed mostly to COVID-19 and unintentional injuries (driven by drug overdoses),
the third most prevalent cause of death is heart disease. Peripheral arterial disease
(PAD) is an often-unrecognized global pandemic affecting more than 220 million. Since
early 2000, the incidence of PAD has increased by 25% globally, Once considered a
male-dominated disease, PAD is a significant cause of morbidity and mortality among
women. This article provides a comprehensive review of the sex-linked risk factors
for PAD that pose additional threats for women. Implications for practice are provided.
Keywords
To read this article in full you will need to make a payment
Purchase one-time access:
Academic & Personal: 24 hour online accessCorporate R&D Professionals: 24 hour online accessOne-time access price info
- For academic or personal research use, select 'Academic and Personal'
- For corporate R&D use, select 'Corporate R&D Professionals'
Subscribe:
Subscribe to The Journal for Nurse PractitionersAlready a print subscriber? Claim online access
Already an online subscriber? Sign in
Register: Create an account
Institutional Access: Sign in to ScienceDirect
References
- Centers for Disease Control. Provisional life expectancy estimates for 2021. U.S. Department of Health and Human Services, National Vital Statistics System, Vital Statistics Rapid Release.(Report No. 23. 2022)
- Diagnosis and management of peripheral arterial disease.Br Med J. 2012; 345: 36-41
- Peripheral arterial disease (PAD) fact sheet.
- Peripheral arterial disease: its adverse consequences with and without CKD.Am J Kidney Dis. 2020; 75: 705-712https://doi.org/10.1053/j.ajkd.2019.08.028
- AHA statement calls attention to risk of peripheral artery disease in women.JAMA. 2012; 307: 1474-1475
- Prediction rule for cardiovascular events and mortality in peripheral arterial disease patients: data from the prospective Second Manifestations of ARTerial disease (SMART) cohort study.J Vasc Surg. 2009; 50: 136-1376https://doi.org/10.1016/j.jvs.2009.07.095
- A call to action: women and peripheral disease scientific statement from the American Heart Association.Circulation. 2012; 125: 1449-1472https://doi.org/10.1161/CIR.0b013e31824c39ba
- Gender differences in peripheral vascular disease.Semin Interven Radiol. 2018; 8: 9-16https://doi.org/10.1055/s-0038-1636515
- Women and peripheral arterial disease.Women Health. 2009; 5: 669-683https://doi.org/10.2217/whe.09.60
- The Lancet Women and Cardiovascular Disease Commission: reducing the global burden by 2030.Lancet. 2021; 397: 2385-2438https://doi.org/10.1016/S10140-6736(21)00684-X
- Women’s health. Report of the Public Health Service Task Force on women’s health issues.Public Health Rep. 1985; 100: 73-106
- Randomized comparison of everolimus-eluting versus bare-metal stents in patients with critical limb ischemia and infrapopliteal arterial occlusive disease.J Vasc Surg. 2012; 55: 390-398https://doi.org/10.1016/j.jvs.2011.07.099
- Short-term results of a randomized trial comparing remote endarterectomy and supragenicular bypass surgery for long occlusions of the superficial femoral artery [The REVAS Trial].Eur J Vasc Endovasc Surg. 2009; 37: 66-76https://doi.org/10.1016/j.ejvs.2008.09.014
- Underrepresentation of peripheral artery disease in modern cardiovascular trials: systematic review and meta-analysis.Int J Cardiol. 2013; 168: 4875-4876https://doi.org/10.1016/j.ijcard.2013.07.050
- Population screening and intervention for vascular disease in Danish men (VIVA): a randomized controlled trial.The Lancet. 2017; 390: 2256-2265https://doi.org/10.1016/S0140-6736(17)32250-X
- Clinical benefit, harm, and cost effectiveness of screening men for peripheral artery disease: a Markov model based on the VIVA Trial.Eur J Vasc Endovasc Surg. 2021; 61: 971-979
- Improving maximum walking distance in early peripheral arterial disease: randomised controlled trial.Austr J Physiother. 2002; 48: 269-275
- Women and NCDs: overcoming the neglect.Global Health Action. 2014; 723742https://doi.org/10.3042/gha.v7.23742
- Doing Harm: The Truth About How Bad Medicine and Lazy Science Leave Women Dismissed, Misdiagnosed, and Sick.HarperCollins, 2018: 775-785
- Sex differences in peripheral artery disease.Circulation Res. 2022; 130: 496-511https://doi.org/10.1161/CIRCRESAHA.121.320702
- Decline in endothelial function across the menopause transition in health women is related to decreased estradiol and increased oxidative stress.GeroScience. 2020; 42: 1699-1714
- Role of endothelial dysfunction in atherosclerosis.Circulation. 2004; 109: 1127-1132https://doi.org/10.1161/01.CIR.0000131515.03336.f8
- Early age at menarche associated with cardiovascular disease and mortality.Journal of Clinical Endocrinology Metabolism. 2009; 94: 4953-4960https://doi.org/10.1210/jc.2009-1789
- The association between parity and subsequent cardiovascular disease in women the Atherosclerosis Risk in Communities Study.J Women Health. 2019; 28: 721-727https://doi.org/10.1089/jwh.2018.7161
- Risk of cardiovascular disease among postmenopausal women with prior pregnancy loss: the Women’s Health Initiative.Ann Fam Med. 2014; 12: 302-309https://doi.org/10.1370/afm.1668
- Women’s reproductive factors and incident cardiovascular disease in the UK Biobank.Heart. 2018; 104: 1069-1075https://doi.org/10.1136/heartjnl-2017-312289
- Cardiovascular disease risk in women with premature ovarian insufficiency: a systematic review and meta-analysis.Eur J Prev Cardiol. 2016; 23: 178-186https://doi.org/10.1177/2047487314556004
- Age at menopause as a risk factor for cardiovascular mortality.Lancet. 1996; 347: 714-718https://doi.org/10.1016/S0140-6736(96)90075-6
- Cardiovascular disease-related morbidity and mortality in women with a history of pregnancy complications: systematic review and meta-analysis.Circulation. 2019; 139: 1069-1079https://doi.org/10.1161/CIRCULATIONAHA.118.036748
- Relation of pregnancy loss to risk of cardiovascular disease from parous postmenopausal women (from the Women’s Health Initiative).Am J Cardiol. 2019; 123: 1620-1625https://doi.org/10.1016/j.amjcard.2019.02.012
- Prenatal biochemical screening and long-term risk of maternal cardiovascular disease: population-based cohort study.BMJ. 2018; 362: k2739https://doi.org/10.1136/bmj.k2739
- Influence of hormonal contraceptives on peripheral vascular structure in premenopausal females: a review.Am J Physiol Heart Circulatory Physiol. 2021; 320: H77-H89https://doi.org/10.1152/ajpheart.00614.2020
- Epidemiology of oral contraceptives and cardiovascular disease.Ann Int Med. 1998; 128: 467-477https://doi.org/10.7326/0003-4819-128-6-199803150-00008
- Investigation of deaths from pulmonary, coronary, and cerebral thrombosis and embolism in women of child-bearing age.BMJ. 1968; 2: 193-199https://doi.org/10.1136/bmj.2.5599.193
- Oral contraceptives and cardiovascular disease.New Engl J Med. 1981; 305: 612-618https://doi.org/10.1056/NEJM198109103051104
- Combined oral contraceptives, smoking, and cardiovascular risk.J Epidemiol Commun Health. 1998; 52: 775-785
- Tobacco-related cardiovascular risk in women: new issues and therapeutic perspectives.Arch Cardiovasc Dis. 2021; 114: 694-706
- The RATIO study: oral contraceptives and the risk of peripheral arterial disease in young women.J Thromb Haemost. 2003; 1: 439-444
- Association between progestin-only contraceptive use and cardiometabolic outcomes: a systematic review and meta-analysis.Eur J Prev Cardiol. 2018; 25: 1043-1053https://doi.org/10.1177/20474873i8774847
- HRT may protect against peripheral vascular disease.BMJ. 2000; 321: 723
- Randomized trials of estrogen plus progestin for secondary prevention of coronary disease in postmenopausal women: for the Heart and Estrogen/progestin Replacement Study (HERS) Research Group.JAMA. 1998; 280: 60-613https://doi.org/10.1001/jama.280.7.605
- Risks and benefits of estrogen plus progestin in healthy postmenopausal women: principal results from the Women’s Health Initiative Randomized Controlled Trial.JAMA. 2002; 288: 321-333https://doi.org/10.1001/jama.288.3.321
- Sex/gender differences in cardiovascular disease prevention: what a difference a decade makes.Circulation. 2011; 124: 2145-2154
- Duration of lactation and risk factors for maternal cardiovascular disease.Obstetr Gynecol. 2009; 113: 974-982
- Duration of lactation and incidence of myocardial infarction in middle to late adulthood.Am J Obstetr Gynecol. 2009; 200: 138e1-138e8
- Breastfeeding history and risk of stroke among parous postmenopausal women in the Women’s Health Initiative.J Am Heart Assoc. 2018; 7e008739https://doi.org/10.1161/JAHA.118.008739
- Breastfeeding and later maternal risk of hypertension and cardiovascular disease: the role of overall and abdominal obesity.Prev Med. 2018; 114: 140-148
- Breastfeeding and cardiovascular disease hospitalization and mortality in parous women: evidence from a large Australian cohort study.J Am Heart Assoc. 2019; 8https://doi.org/10.1161/JAHA.118.011056
- Breastfeeding and the risk of maternal cardiovascular disease: a prospective study of 300,000 Chinese women.J Am Heart Assoc. 2017; 6e006081https://doi.org/10.1161/JAHA.117.006081
- Breastfeeding duration and the risk of coronary artery disease.J Women Health. 2019; 28: 3-36
- Parity, breastfeeding, and risk of coronary heart disease: a pan-European case-cohort study.Eur J Prev Cardiol. 2016; 23: 1755-1765
- Alternatives to hormone replacement therapy in postmenopausal women.J Adv Med Med Res. 2015; 8: 816-828https://doi.org/10.9734/BJMMRRrrrr/2015/18412
- Is black cohosh a safe and effective substitute for hormone replacement therapy?.JAAPA. 2009; 22: 54-55
Borrelli F, Ernst E. Black cohosh (Cimicifuga racemose): a systematic review of adverse events. Am J Obstet Gynecol. 199(5), 455-466.
- Low-dose estradiol and the serotonin-norepinephrine reuptake inhibitor venlafaxine for vasomotor symptoms: a randomized clinical trial.JAMA Int Med. 2014; 174: 1058-1066
- Effects of bazedoxifene/conjugated estrogens on the endometrium and bone: a randomized trial.J Clin Endocrinol Metab. 2014; 99: E189-E198
- Hormone therapy for postmenopausal women.Reprod Endocrinol. 2020; : 100-106
- Effects of oral vs transdermal estrogen therapy of sexual function in early postmenopause: ancillary study of the Kronos Early Estrogen Prevention Study (KEEPS).JAMA Int Med. 2017; 177: 1471-1479
- Pregnancy and reproductive risk factors for cardiovascular disease in women.Circ Res. 2022; 130: 652-672
Biography
Jennifer Lemoine, PhD, DNP, NNP-BC, is a professor and interim associate dean, Graduate Faculty, College of Nursing and Health Sciences, University of Louisiana at Lafayette.
Biography
Barbara L. Wilson, PhD, RN, is emeritus associate professor at the University of Utah College of Nursing and can be contacted at [email protected]
Article info
Publication history
Published online: February 02, 2023
Footnotes
In compliance with standard ethical guidelines, the authors report no relationships with business or industry that would pose a conflict of interest.
Identification
Copyright
© 2022 Elsevier Inc. All rights reserved.
