Sex differences in the outcomes of peripheral arterial disease: a population-based cohort study.
BACKGROUND
The role of sex in the outcomes of patients with peripheral arterial disease (PAD) has been poorly studied. We sought to investigate differences in the long-term adverse cardiovascular and limb outcomes between men and women with PAD.


METHODS
We conducted a population-based cohort study with up to 7 years of follow-up using linked administrative databases in Ontario, Canada. Patients aged 40 years or older who visited a vascular surgeon between Apr. 1, 2004, and Mar. 31, 2007 (index date), and carried a diagnosis of PAD comprised the study cohort. The primary outcome was a composite of death or hospital admission for stroke or myocardial infarction. Secondary outcomes included lower limb amputation or revascularization. We used Cox proportional hazards modelling to compute unadjusted hazard ratios (HRs) and HRs adjusted for baseline covariates.


RESULTS
A total of 6915 patients were studied, of whom 2461 (35.6%) were women. No significant differences in the risk of the primary outcome were observed between men and women (adjusted HR 0.99 [95% confidence interval (CI) 0.92-1.05]). Women were less likely than men to undergo minor amputation (adjusted HR 0.73 [95% CI 0.62-0.85]) and arterial bypass surgery (adjusted HR 0.82 [95% CI 0.71-0.94]) but were more likely to be admitted to hospital for acute myocardial infarction (adjusted HR 1.15 [95% CI 1.00-1.31]). There were no sex differences in the rates of major amputation or transluminal percutaneous angioplasty.


CONCLUSIONS
We identified no significant differences in the composite risk of major adverse cardiovascular events between women and men with PAD, although our findings suggest men may be at increased risk for adverse limb events compared with women. Cardiovascular health campaigns should focus on both women and men to promote early diagnosis and management of PAD.
Divisions of Vascular Surgery (Hussain, Al-Omran) and Cardiac Surgery (Verma), St. Michael's Hospital; Li Ka Shing Knowledge Institute of St. Michael's Hospital (Mamdani, Verma, Al-Omran); Department of Surgery (Hussain, Lindsay, Verma, Al-Omran), University of Toronto; Division of Vascular Surgery (Lindsay), Peter Munk Cardiac Centre, University Health Network; Institute of Health Policy, Management, and Evaluation, and Leslie Dan Faculty of Pharmacy (Mamdani), University of Toronto; Applied Health Research Centre (Mamdani), Toronto, Ont.; King Saud University-Li Ka Shing Collaborative Research Program and Department of Surgery (Mamdani, Verma, Al-Omran), King Saud University, Riyadh, Kingdom of Saudi Arabia; Institute for Clinical Evaluative Sciences (Mamdani, Wang), Toronto, Ont.
Mohamad A
MA
Hussain
Divisions of Vascular Surgery (Hussain, Al-Omran) and Cardiac Surgery (Verma), St. Michael's Hospital; Li Ka Shing Knowledge Institute of St. Michael's Hospital (Mamdani, Verma, Al-Omran); Department of Surgery (Hussain, Lindsay, Verma, Al-Omran), University of Toronto; Division of Vascular Surgery (Lindsay), Peter Munk Cardiac Centre, University Health Network; Institute of Health Policy, Management, and Evaluation, and Leslie Dan Faculty of Pharmacy (Mamdani), University of Toronto; Applied Health Research Centre (Mamdani), Toronto, Ont.; King Saud University-Li Ka Shing Collaborative Research Program and Department of Surgery (Mamdani, Verma, Al-Omran), King Saud University, Riyadh, Kingdom of Saudi Arabia; Institute for Clinical Evaluative Sciences (Mamdani, Wang), Toronto, Ont.
Thomas F
TF
Lindsay
Divisions of Vascular Surgery (Hussain, Al-Omran) and Cardiac Surgery (Verma), St. Michael's Hospital; Li Ka Shing Knowledge Institute of St. Michael's Hospital (Mamdani, Verma, Al-Omran); Department of Surgery (Hussain, Lindsay, Verma, Al-Omran), University of Toronto; Division of Vascular Surgery (Lindsay), Peter Munk Cardiac Centre, University Health Network; Institute of Health Policy, Management, and Evaluation, and Leslie Dan Faculty of Pharmacy (Mamdani), University of Toronto; Applied Health Research Centre (Mamdani), Toronto, Ont.; King Saud University-Li Ka Shing Collaborative Research Program and Department of Surgery (Mamdani, Verma, Al-Omran), King Saud University, Riyadh, Kingdom of Saudi Arabia; Institute for Clinical Evaluative Sciences (Mamdani, Wang), Toronto, Ont.
Muhammad
M
Mamdani
Divisions of Vascular Surgery (Hussain, Al-Omran) and Cardiac Surgery (Verma), St. Michael's Hospital; Li Ka Shing Knowledge Institute of St. Michael's Hospital (Mamdani, Verma, Al-Omran); Department of Surgery (Hussain, Lindsay, Verma, Al-Omran), University of Toronto; Division of Vascular Surgery (Lindsay), Peter Munk Cardiac Centre, University Health Network; Institute of Health Policy, Management, and Evaluation, and Leslie Dan Faculty of Pharmacy (Mamdani), University of Toronto; Applied Health Research Centre (Mamdani), Toronto, Ont.; King Saud University-Li Ka Shing Collaborative Research Program and Department of Surgery (Mamdani, Verma, Al-Omran), King Saud University, Riyadh, Kingdom of Saudi Arabia; Institute for Clinical Evaluative Sciences (Mamdani, Wang), Toronto, Ont.
Xuesong
X
Wang
Divisions of Vascular Surgery (Hussain, Al-Omran) and Cardiac Surgery (Verma), St. Michael's Hospital; Li Ka Shing Knowledge Institute of St. Michael's Hospital (Mamdani, Verma, Al-Omran); Department of Surgery (Hussain, Lindsay, Verma, Al-Omran), University of Toronto; Division of Vascular Surgery (Lindsay), Peter Munk Cardiac Centre, University Health Network; Institute of Health Policy, Management, and Evaluation, and Leslie Dan Faculty of Pharmacy (Mamdani), University of Toronto; Applied Health Research Centre (Mamdani), Toronto, Ont.; King Saud University-Li Ka Shing Collaborative Research Program and Department of Surgery (Mamdani, Verma, Al-Omran), King Saud University, Riyadh, Kingdom of Saudi Arabia; Institute for Clinical Evaluative Sciences (Mamdani, Wang), Toronto, Ont.
Subodh
S
Verma
Divisions of Vascular Surgery (Hussain, Al-Omran) and Cardiac Surgery (Verma), St. Michael's Hospital; Li Ka Shing Knowledge Institute of St. Michael's Hospital (Mamdani, Verma, Al-Omran); Department of Surgery (Hussain, Lindsay, Verma, Al-Omran), University of Toronto; Division of Vascular Surgery (Lindsay), Peter Munk Cardiac Centre, University Health Network; Institute of Health Policy, Management, and Evaluation, and Leslie Dan Faculty of Pharmacy (Mamdani), University of Toronto; Applied Health Research Centre (Mamdani), Toronto, Ont.; King Saud University-Li Ka Shing Collaborative Research Program and Department of Surgery (Mamdani, Verma, Al-Omran), King Saud University, Riyadh, Kingdom of Saudi Arabia; Institute for Clinical Evaluative Sciences (Mamdani, Wang), Toronto, Ont.
Mohammed
M
Al-Omran