Peripheral Arterial Disease

Peripheral arterial disease (PAD) carries a significant health and economic burden with an estimated prevalence of 8.5 million Americans over the age of 40 and > ?200 million adults worldwide. PAD is often associated with polyvascular (the presence of more than one affected vascular bed) disease and confers up to a threefold increase in all-cause and cardiovascular mortality. Despite this, PAD remains underrecognized and undertreated compared to coronary artery and cerebrovascular disease. Significant sex differences exist in epidemiology, clinical presentation, treatment, and prognosis of PAD. Women comprise more than half of the total population affected by PAD. However, studies suggest women receive less optimal medical therapy and fewer endovascular or surgical revascularizations compared to men. Women often present with atypical or asymptomatic disease, are older with more comorbidity, have polyvascular or more advanced disease, and suffer from more functional impairment and cardiovascular and procedural mortality. This may be due to a combination of biological differences, diagnostic delays, and undertreatment. Greater enrollment of women in large clinical trials, specific focus of cardiovascular research on sex and gender differences in PAD, and reinforcement of preventative strategies, especially in women, are warranted.