Key result
Women with PAD receive ~31% fewer statins than men despite similar 1-year mortality.
Why the study?
The study aimed to explore sex-based incidence and prevalence of peripheral arterial disease, patterns of guideline-directed best medical therapy prescriptions, and their relationship with 1-year all-cause mortality.
Does female sex impact the prescription of guideline-directed therapy and 1-year all-cause mortality in patients with peripheral arterial disease?
Cohort (n=38,601)
Yes
Does female sex impact the prescription of guideline-directed therapy and 1-year all-cause mortality in patients with peripheral arterial disease?
Effect estimate: aHR 0.95 (95% CI 0.87 to 1.03)
p-value: p=0.198
Women with peripheral arterial disease are significantly less likely to receive guideline-directed medical therapy compared to men, highlighting a sex disparity in care, though adjusted 1-year mortality is similar.
Sex disparities in PAD medical therapy warrant clinician attention; leaves open whether equalization affects mortality.
OBJECTIVES: To explore population patterns of sex-based incidence and prevalence of peripheral arterial disease (PAD), guideline-directed best medical therapy prescriptions and its relationship with all-cause mortality at 1 year. DESIGN: A retrospective cohort study. SETTING: Anonymised electronic primary care from 787 practices in the UK, or approximately 6.2% of the UK population. PARTICIPANTS: All registered patients over 40 with a documented diagnosis of peripheral arterial disease. OUTCOME MEASURE: Population incidence and prevalence of PAD by sex. Patterns of guideline-directed therapy, and correlation with all-cause mortality at 1 year (defined as death due to any outcome) in patients with and without an existing diagnosis of cardiovascular disease. Covariates included Charlson comorbidity, sex, age, body mass index, Townsend score of deprivation, smoking status, diabetes, hypertension, statin and antiplatelet prescription. RESULTS: Sequential cross-sectional studies from 2010 to 2017 found annual PAD prevalence (12.7-14.3 vs 25.6 per 1000 in men) and incidence were lower in women (11.6-12.4 vs 22.7-26.8 per 10 000 person years in men). Cox proportional hazards models created for PAD patients with and without cardiovascular disease over one full year analysed 25 121 men and 13 480 women, finding that following adjustment for age, women were still less likely to be on a statin (OR 0.69; 95% CI 0.66 to 0.72; p<0.001) or antiplatelet (OR: 0.87; 95% CI 0.83 to 0.90; p<0.001). Once fully adjusted for guideline recommended medical therapy, all-cause mortality was similar between women and men (adjusted HR (aHR) 0.95, 95% CI 0.87 to 1.03, p=0.198 for all patients, aHR 1.01, 95% CI 0.88 to 1.16, p=0.860 for those with cardiovascular disease). CONCLUSIONS: Women with a new diagnosis of PAD were not prescribed guideline-directed therapy at the same rate as men. However once adjusted for factors including age, all-cause mortality in men and women was similar.
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Benson et al. (2022) conducted a cohort in peripheral arterial disease (n=38,601). Female sex vs. Male sex was evaluated on all-cause mortality at 1 year (aHR 0.95, 95% CI 0.87 to 1.03, p=0.198). Women with PAD were less likely than men to receive statins (OR 0.69) or antiplatelets (OR 0.87), but adjusted 1-year all-cause mortality was similar (aHR 0.95; 95% CI 0.87-1.03; p=0.198).
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