Key result
Female sex in symptomatic PAD is linked to ~23% lower MACE risk compared to males.
Why the study?
Patients with peripheral artery disease have an elevated risk of major adverse cardiovascular events, but sex-specific differences in cardiovascular and limb events warranted evaluation.
Do women with symptomatic peripheral artery disease have different risks of major cardiovascular and limb events compared to men?
Cohort (n=13,885)
Yes
Do women with symptomatic peripheral artery disease have different risks of major cardiovascular and limb events compared to men?
Hazard Ratio: 0.77 (95% CI 0.68–0.88)
Absolute Event Rate: 9.5% vs 11.2%
p-value: p=<0.001
In patients with symptomatic PAD, women have a lower risk of MACE and all-cause mortality compared to men, despite having a higher burden of baseline cardiovascular risk factors, while the risk of major adverse limb events is similar.
BACKGROUND Patients with peripheral artery disease (PAD) have a higher risk of major adverse cardiovascular events (MACE) compared with those without PAD. OBJECTIVES The aim of this post hoc analysis was to evaluate sex-specific differences in MACE and limb events in the EUCLID (Examining Use of Ticagrelor in PAD) trial. METHODS Cox proportional hazards models were used to compare time-to-event outcomes stratified by sex. Covariates were introduced after adjusted model selection. RESULTS EUCLID enrolled 13,885 patients with PAD (28% women [n = 3,888]). PAD severity and medical treatment were comparable between sexes, whereas prior lower extremity revascularization was reported less frequently in women (54.8% vs. 57.3%; p = 0.006). Women were older (mean ± SD age: 67.8 ± 8.9 vs. 66.1 ± 8.2 years; p < 0.001) and more likely to have diabetes mellitus (p = 0.004), hypertension, hyperlipidemia, and chronic kidney disease (all p < 0.001). Over a mean follow-up of 30 months, women had a lower risk of MACE (9.5% vs. 11.2%; adjusted hazard ratio: 0.77; 95% confidence interval: 0.68 to 0.88; p < 0.001) and all-cause-mortality (7.6% vs. 9.7%; adjusted hazard ratio: 0.61; 95% confidence interval: 0.53 to 0.71; p < 0.001). In contrast, risk for major adverse limb events (2.6% vs. 3.0%) and hospitalization for acute limb ischemia (1.6% vs. 1.7%) were not different by sex. CONCLUSIONS Although women with PAD are at lower risk for MACE and all-cause mortality, risk for limb events was similar between sexes over a mean follow-up of 30 months. Understanding sex-specific differences and dissociation between baseline cardiovascular risk and subsequent cardiovascular events requires further investigation. (A Study Comparing Cardiovascular Effects of Ticagrelor and Clopidogrel in Patients With Peripheral Artery Disease [EUCLID]; NCT01732822).
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Haine et al. (2020) conducted a cohort in Symptomatic Peripheral Artery Disease (n=13,885). Female sex vs. Male sex was evaluated on Major adverse cardiovascular events (MACE) (adjusted HR 0.77, 95% CI 0.68-0.88, p=<0.001). Female sex in patients with symptomatic peripheral artery disease was associated with a lower risk of MACE compared to male sex (9.5% vs. 11.2%; adjusted HR 0.77; 95% CI 0.68-0.88; P<0.001).