[Obliterating arterial disease of the legs in women].
The widespread use of the ankle-brachial index (ABI) enabled to reveal the high prevalence of lower extremities peripheral arterial disease (PAD) in women, even higher than in men in several series. Nonetheless, the use of a same ABI threshold for men and women may overestimate the prevalence of subclinical PAD in women. Conversely, the clinical manifestations of PAD are more often atypical in women, with as a result, a delayed diagnosis and management. The level of association between cardiovascular disease risk factors and PAD is similar in both genders. To date, there is no evidence for any association between PAD and different hormonal events in women. Despite an inverse association between hormonal replacement therapy (HRT) after menopause and PAD in epidemiological studies, the trials failed to evidence any protective effect of HRT to prevent PAD. Women with PAD are advised to discontinue HRT in case of limb revascularization. The long-term local and functional prognosis of PAD seems more severe in women, but this is partly explained by a delayed onset of the disease, occurring at a later age. Similarly, the general cardiovascular prognosis PAD is also poorer in women than in men.
Aboyans
Victor
V
Service de chirurgie thoracique et cardiovasculaire et angiologie, Hôpital universitaire Dupuytren, CHU de Limoges, F-87042 Limoges Cedex, France. victor.aboyans@unilim.fr
Salazar
Johanna
J
Lacroix
Philippe
P
D017677:Age Distribution; D017668:Age of Onset; D055109:Ankle Brachial Index; D001162:Arteriosclerosis Obliterans / Q000150:complications*; D057210:Delayed Diagnosis; D015914:Estrogen Replacement Therapy; D005260:Female; D006801:Humans; D007866:Leg / Q000098:blood supply; D016491:Peripheral Vascular Diseases / Q000175:diagnosis / Q000453:epidemiology / Q000209:etiology / Q000628:therapy; D015995:Prevalence; D011379:Prognosis; D012307:Risk Factors; D012720:Severity of Illness Index; D012727:Sex Characteristics; D017678:Sex Distribution; D016387:Women's Health