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[1] or stroke[2]. 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[3]. What’s more, between 50% and 90% of women who do have PAD have no symptoms[4], 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[5].

In addition to having diabetes, risk factors for PAD[6] 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[7] (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”[8] or see the scientific statement from the American Heart Association[9] in the journal Circulation. And for more information about peripheral arterial disease, see the article “When Your Legs Ache: Peripheral Arterial Disease and Diabetes,”[10] then try your hand at our quiz on the condition[11].

Want to learn more about peripheral arterial disease? Read “Have Calf Cramps? Strengthening Your Hip Muscles May Help,”[12] watch the video “Peripheral Arterial Disease,”[13] and take the quiz “How Much Do You Know About Peripheral Arterial Disease?”[14]

  1. heart attack:
  2. stroke:
  3. did not consider women as likely to have peripheral arterial disease:
  4. between 50% and 90% of women who do have PAD have no symptoms:
  5. experience no symptoms at all:
  6. risk factors for PAD:
  7. lifestyle modifications:
  8. “Data Lacking on Women and PAD”:
  9. scientific statement from the American Heart Association:
  10. “When Your Legs Ache: Peripheral Arterial Disease and Diabetes,”:
  11. quiz on the condition:
  12. “Have Calf Cramps? Strengthening Your Hip Muscles May Help,”:
  13. “Peripheral Arterial Disease,”:
  14. “How Much Do You Know About Peripheral Arterial Disease?”:

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Diane Fennell: Diane Fennell has been an editor at Diabetes Self-Management magazine since 2003. She is currently the Editorial Director. (Diane Fennell is not a medical professional.)

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