title: Female patients with atherosclerotic lesions of the lower limbs. Not all are alike.
abstract: BACKGROUND
  Data on female patients with atherosclerotic peripheral arterial disease (PAD) are scarce, and limited primarily to the elderly population with multilevel disease. In this longitudinal observational study we compare female patients below 60 years of age with isolated lesions at the aortic bifurcation or focal superficial femoral artery disease.
  
  
  METHODS
  Analysis is based on consecutive series of 43 female patients with PAD limited to the aortoiliac bifurcation (n = 28, group I) or an isolated femoral segment at the adductor channel (n = 15, group II) seen in a tertiary referral center between 1998 and 2000. The first assessment provided baseline data, with follow up data obtained at this study. Traditional risk factors, carotid artery disease and clinical outcome (mortality, cardiovascular events, vascular re-intervention rate, PAD progression) were evaluated over an interval of 5 (2 to 8) years.
  
  
  RESULTS
  Female patients with aortic disease [group I] were younger (51.8 +/- 7.7 vs. 56.7 +/- 7.6 years in group II; p = 0.048), presented a more masculine phenotype, and smoked significantly more often (82% vs. 40%; p = 0.007). Arterial hypertension and diabetes mellitus were more common in group II, though it missed statistical significance (p = 0.068 and p = 0.085). Cardiovascular and limb outcome were comparable in both groups of female patients, while carotid artery disease was more severe in group I (i.e., carotid plaques in 71 vs. 53%).
  
  
  CONCLUSIONS
  Our data support previous findings that cigarette smoking is a stronger risk factor for aortic disease as compared to femoral disease in younger female patients, with the strongest effect of smoking on a localized region of the aortic bifurcation.
authors.affiliation: Division of Angiology, Swiss Cardiovascular Center, Inselspital, University Hospital of Bern, Switzerland.
authors.forename: B M
authors.initials: BM
authors.lastname: Heuberger
authors.forename: N
authors.initials: N
authors.lastname: Diehm
authors.forename: M
authors.initials: M
authors.lastname: Husmann
authors.forename: Ch
authors.initials: Ch
authors.lastname: Kalka
authors.forename: I
authors.initials: I
authors.lastname: Baumgartner
mesh_terms: D000367:Age Factors; D001011:Aorta; D050197:Atherosclerosis / Q000150:complications / Q000209:etiology* / Q000628:therapy; D002318:Cardiovascular Diseases / Q000209:etiology; D002340:Carotid Artery Diseases / Q000209:etiology*; D048909:Diabetes Complications / Q000209:etiology; D018450:Disease Progression; D005260:Female; D005263:Femoral Artery; D005500:Follow-Up Studies; D006801:Humans; D006973:Hypertension / Q000150:complications; D007083:Iliac Artery; D008137:Longitudinal Studies; D035002:Lower Extremity / Q000098:blood supply*; D008875:Middle Aged; D016491:Peripheral Vascular Diseases / Q000150:complications / Q000209:etiology* / Q000628:therapy; D012307:Risk Factors; D012907:Smoking / Q000009:adverse effects; D013997:Time Factors; D016896:Treatment Outcome