Peripheral Arterial Disease Underrecognized in Women

Peripheral arterial disease, or PAD, is a condition in which arteries leading to the legs, feet, and sometimes the arms become narrowed, blocking blood flow and potentially leading to serious damage, such as heart attack or stroke. But although PAD affects at least as many women as men, there is insufficient research looking at how the condition manifests, is diagnosed, and is treated in women, according to a new scientific statement from the American Heart Association.


An estimated 8 to 12 million Americans have peripheral arterial disease, and women with PAD are two to three times more likely to have a heart attack or stroke than women without it. Having diabetes puts a person at increased risk of developing peripheral arterial disease.

In its statement, entitled “A Call to Action,” the American Heart Association, in collaboration with the Vascular Disease Foundation, recommends that health-care providers increase their rate of screening for PAD in women. A 2002 survey of primary-care doctors indicated that, although they recognized older people and men as being susceptible to the condition, most doctors did not consider women as likely to have peripheral arterial disease. What’s more, between 50% and 90% of women who do have PAD have no symptoms, making screening and diagnosis even less likely.

The statement authors also suggest that, in addition to PAD being underrecognized in women, trials looking at the condition have typically not included enough women to get a clear picture of how PAD is diagnosed and develops in this population; of the trials reviewed by the statement authors, women composed, on average, 27% of the study participants.

“Although PAD is known to affect women and men equally, research in women has lagged far behind that in men. As health-care providers, we must take seriously our responsibility to include women as a key target audience when we work to study, prevent, diagnose and treat PAD,” notes lead statement author Alan T. Hirsch, MD.

Symptoms of peripheral arterial disease include pain in the legs, feet, or toes, which often goes away when resting. The condition may also manifest as heaviness, tiredness, or cramping that occurs in the buttocks, thighs, or calves, or as sores on the legs or feet that take at least 8 to 12 weeks to heal. Additional signs include poor nail growth, decreased hair growth on the legs or toes, or changes in the color of the feet. However, PAD may have no symptoms, particularly in people with diabetes — in fact, almost 50% of people who have diabetes and PAD experience no symptoms at all.

In addition to having diabetes, risk factors for PAD include smoking; obesity; high blood pressure; high cholesterol; an age of 50 or older; a family history of PAD, heart disease, or stroke; and high levels of homocysteine, a type of protein. A test commonly used to screen for the condition is known as the ankle-brachial index, or ABI, which involves having the blood pressure in your ankle compared to the blood pressure in your arm. Treatment for the condition can include lifestyle modifications (such as quitting smoking and controlling blood pressure and cholesterol levels), medicines, and surgery.

For more information, read the piece “Data Lacking on Women and PAD” or see the scientific statement from the American Heart Association in the journal Circulation. And for more information about peripheral arterial disease, see the article “When Your Legs Ache: Peripheral Arterial Disease and Diabetes,” then try your hand at our quiz on the condition.

Want to learn more about peripheral arterial disease? Read “Have Calf Cramps? Strengthening Your Hip Muscles May Help,” watch the video “Peripheral Arterial Disease,” and take the quiz “How Much Do You Know About Peripheral Arterial Disease?”

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  • Angela Guillette

    I found your article very interesting. Perhaps
    at last an answer to my question I’ve been ask-
    ing for some months. It seems froum the iformation above that the cramps in the legs are
    felt during waking hours and go away or are sub-
    dued when resting.

    I will take this information with me for my
    upcoming appointment with my Doctor. However,
    my question was and is ….we all experience
    those cramps in the calf occaionally….but
    new to me…..once in a great while…..two
    or three weeks apart are these excruciating
    cramps (not during waking hours/ in the middle
    of the night) from the knee to the groin….on
    the inner side of the leg. Never experinced
    such hurtful cramps before…..does that fall
    under PAD?????? Thank you!

    (Note: This dosen’t have to be printed if you don’t want to share it with the public….but would you email me the answer, Please!!)

  • Donna

    I have these exact same cramps. The leg will be sore the rest of the day after this happens.

  • Georganne

    I get the same excruciating cramps in my thighs as Angela. They only go away after I put a heat pack on them for about 15 minutes. The pain gets even worse if you try to straighten up, which normally would stretch a muscle out and ease a cramp. This is the first I heard of anybody else having this horrible cramp. Could this be PAD? My cramps started years ago after starting Zocor and then Lipitor for high cholesterol. I switched to Crestor several years ago, and don’t get near as many cramps, but still get the horrible thigh cramps occasionally.

  • Laverne

    I also expeience the same problem at night. I wonder if taking statins have a connection at all. I also get cramps in my rib cage that feel like someone is stabbing me with a sharp knife. Do you think this is possible?

  • Sybil

    I have been having leg cramps for several years. They seem to get more and more painful.They use to just be in the bottom of my legs and now they are above the kneee. I am diabetic and have had a kidney transplant(4 years ago).My right hand has recently gone numb (all but the little finger) which makes it hard to pick up things. My feet and legs are so tired which makes it hard to walk a long way .Just had a chemical stress test and everything looked good. Have tried neurotein.

  • Cindi

    I too, have excruciating spasms starting at the top of the right (only) leg, running down the front of the thigh to the inside of the knee. This occurs when getting up from a sitting position, usually from the bed. I can’t straighten up or bend over, but just hold and squeeze the area until the pain lessens to a level that is bearable. I also have and ongoing ache at the back of the thigh (again on the right leg)behind the knee, and sometimes extending to the the back of the calf. Any ideas or suggestions?

  • teresa

    itoo have some kind of cramps or leg problem. i have sharp pain at my inner thigh and my vaginal left side only. no std itching,no rash,painful at night not so bad doing the day.gynecology say something like not infection related my endrocrinology said has nothing to do with my diabetes.i think it is nerve damage.

  • Pat Weiser

    My dad had PAD, so now I am starting to wonder. However my cramps too, happen in the middle of the night and vary from muscle to muscle, sometimes feet, sometimes thighs, different legs.
    They can be absolutely horrendous and sometimes take many minutes to subside. I have been offered no explanation except ‘You have diabetes’.

  • Vera Sherman

    My “leg pains” are exactly as the author describes…and pretty much as each of the other posters describe. It started occurring only maybe once or twice every week or so last year…but now its progressed to everyday, especially when Isit for 20 to 30 minutes…I literally have to “steady” myself and allow the pain/cramp to subside before I can take a “step”. The strange thing is that I told my doctor (primary) about the unbelievable pain in my legs last year and after several test (not own my legs) of my heart, she said that I didn’t have any heart problems but I might be “pre-diabetic”, and hypertension was a concern. I left with hypertension mediation and that was it. Its obvious that I probably should have been tested for PAD back then. So I think I’ll need to change doctors to get it done.

  • violet

    I also am happy you are discussing this issue. I also suffer from leg pain, It starts in my thigh and like a electric current all the way down my leg and feels like it shoots pain through my foot, This keeps reocurring sometime for hours.
    I have not had a definate diagonose..Although I have had diabetes type one for 25 years. This is very painful. It use to happen when i was laying down now it hits anytime..

  • Angela Guillette

    You will probably laugh…..but I am not the same
    Angela Guillette who wrote in March 2012.
    However, having read all the comments I can only
    say, “Thank You”, for the information because I
    have wondered why I have these horrible cramps on
    the inner thighs from the groin down to the knee.
    You cannot compare these with cramps in the calf
    area. They are so bad that as one person said,
    “you can’t even move…you just freeze in pain
    until it subsides. I am on metformin and take it
    twice a day. 500mg. It’s so hard to change the
    eating habits of a lifetime. But after reading
    this I can clearly see that like it or not…..I
    will be having more situations arising if I don’t
    focus on doing better. Thank you for the infor-

  • It is a fact that PAD mostly affects women and I really appreciate you for posting such a nice and informative blog.