Peripheral Artery Disease (PAD) and Women

Medically Reviewed by James Beckerman, MD, FACC on February 11, 2024
4 min read

Peripheral artery disease (PAD) is a condition that happens when your arteries harden and narrow. PAD affects the arteries that carry blood to your arms and legs. It’s the third most common type of cardiovascular disease (CVD). Only coronary artery disease (CAD) and stroke are more common.

Experts believe that PAD affects 20%-30% of women over the age of 70, but it’s underdiagnosed and undertreated in women.

For decades, doctors didn’t realize the impact that coronary heart disease had on women. Cardiovascular studies didn’t include many people with PAD. And of those with PAD, most of them were men. Even in studies on PAD itself, women were underrepresented. In more than half of these studies, women made up less than 35% of the participants.

Today, experts know more about PAD and women, and that allows for more people to take control of their health.

In the United States alone, PAD affects around 8 million people over the age of 40. Both men and women can have PAD, but the symptoms, risks and concerns for women are different:

Women may not show signs. Women have higher rates of asymptomatic or subclinical disease. This means that women are less likely to have symptoms of PAD in their legs, or they may not have severe enough symptoms for a doctor to classify as PAD.

They may have atypical symptoms. Women are more likely to have atypical PAD symptoms. Typically, a person with PAD may have pain when they walk, something called claudication. But women with PAD are more likely to have leg symptoms both at rest and while exercising, which can make it harder for a doctor to identify.

PAD affects women’s mental health. When compared to females without PAD and men with PAD, women with the condition have higher rates of depression. One study found that 21% of women with PAD had depression, while only 13% of men showed symptoms. This study also found that people who have a vascular condition (like PAD) could have a tougher recovery if they also have depression.

Women get diagnosed later in life. Females present symptoms of PAD on average 10-20 years later than men, making diagnosis come later.

Risk factors are higher for women. While the overall risk factors for men and women are similar for PAD, some are more intense for females. Studies show that diabetes and hyperlipidemia (two risk factors of PAD) make women’s risk of claudication go up four times.

PAD is associated with conditions or situations that mostly affect women such as osteoporosis, hypothyroidism, the use of birth control pills, and a history of pregnancy complications.

Ethnicity can play a role. Non-Hispanic Black women over the age of 70 are at the highest risk for developing PAD. Experts aren’t sure why the risk is higher for this group.

Certain risks might relate to pregnancy. Experts have linked vascular issues related to pregnancy with a higher risk of PAD. A Cardiovascular Health After Maternal Placental Syndrome (CHAMPS) study showed that the risk of PAD went up three times in people with maternal placental syndromes (preeclampsia, gestational hypertension, placental abruption, and placental infarction). The risk for coronary artery and cerebrovascular disease went up twice for women with these syndromes. Experts aren’t sure why this happens.

Women often don’t get the same care as men. The treatment of risk factors for PAD varies by gender. The Reduction of Atherothrombosis for Continued Health (REACH) Registry found that men were twice as likely to receive better risk factor prevention than women, even though some risk factors (diabetes, high blood pressure, and high total cholesterol) are more common in women.

The CHAMPS study also found that women weren’t as likely to get guideline-directed medical therapy for PAD as men. Also, men were more likely to get all PAD treatments (antiplatelets, statins, and angiotensin enzyme inhibitors) than women were.

Women don’t respond as well to lifestyle changes. An exercise program can benefit those with PAD. Studies show that it reduces pain and helps people walk more comfortably. But women with PAD, especially those with diabetes, don’t respond as well to exercise. Studies show that after 1 year of exercise therapy, improvements in walking distance were a lot lower in women than in men. Women also self-reported less progress in walking. Experts believe this is because some women have lower hemoglobin saturation while walking, poorer leg strength, more inflammation, a higher level of oxidative stress, and insulin resistance.

Women may have a lower quality of life. Multiple studies have shown that women with PAD have a lower health status and health-related quality of life than men with PAD.

Everyone, regardless of gender, needs to be aware of PAD risk factors and to pay attention to any leg problems they may notice. There’s no cure for PAD, but it’s important to understand what you can do to maintain your health.

People who are at the highest risk for PAD include:

  • Smokers
  • People who have high blood pressure, atherosclerosis, diabetes, or high cholesterol
  • People older than 60

You can lower your risk if you:

  • Quit smoking
  • Exercise regularly
  • Limit fat and eat a healthy diet
  • Manage other risk factors like diabetes, high cholesterol, and high blood pressure