Women and PAD

Why it's essential for women to learn about peripheral artery disease (PAD) and its symptoms

In 2012, the American Heart Association issued a national call to action to raise awareness about a serious disease that occurs at similar rates in men and women, but is underdiagnosed and undertreated in women.

Peripheral artery disease (PAD), or hardening of the arteries, is a form of peripheral vascular disease caused by fatty deposits that build up inside artery walls and restrict blood flow to the limbs. The most common — but not universal — symptoms are burning leg pain and tiredness that happen while walking and subside with rest.

Untreated PAD can cause blockages that result in serious complications such as lack of blood flow to the legs; heart attack; stroke; or, in the most severe cases, gangrene in the legs and feet that could lead to amputation. That's why it's critical for women to know more about PAD.

We asked Proddutur Raghu Reddy, MD, an interventional cardiologist at Rush University Medical Center, to shed light on this common but often misunderstood disease.

1. Women experience PAD at the same rate as men, but physicians don't always look for it.

Reddy points out that it took many years for clinicians to understand that heart disease is as common in women as in men. Clinical studies of heart disease tracked mostly male patients, who often don't have the same symptoms as women — so "classic symptoms" of the disease were considered to be those experienced by men.

The same is true for PAD, he says, although some gender-specific data is becoming available. In one study cited by the AHA, women were more than twice as likely as men to report "atypical" symptoms, including leg pain that began while resting. And in a Swedish study, more women than men were diagnosed with PAD after having no symptoms at all.

2. PAD is not related to varicose veins, spider veins or other vein symptoms.

Although many people confuse the two conditions, Reddy stresses that PAD is not the same thing as venous disease, also known as venous insufficiency.

Venous disease happens when the valves in leg veins don't work properly and blood pools in the veins instead of being pumped back to the heart. This causes leg swelling, achiness and heaviness that feels better when you put your feet up. It also can cause varicose veins and a reddish-brown discoloration on legs or ankles that may become permanent. It's a serious condition, but this is not PAD.

"Women who have leg pain often think it's related to their varicose veins or to being on their feet all day, or that it's simply due to aging," Reddy explains. "Because of that, a lot of women don't even think to report the pain to their primary care doctors even though it can be a sign of PAD."

3. If you're at risk for heart disease, you're also at risk for PAD.

Smoking and diabetes, two major risk factors for heart disease in women, are also risk factors for PAD. Family history is another risk factor both diseases have in common.

While you can't do anything about your family history, making lifestyle changes can help. If you smoke, preventing PAD is one more good reason to quit. And if you have diabetes, keeping it well controlled can reduce your chances of developing PAD.

[Studies have found that] women are more likely than men to report "atypical" symptoms, including leg pain that begins while resting ... or to have no symptoms at all.

4. There's an easy diagnostic test for PAD.

If you have any of the risk factors for PAD, even if you're not experiencing symptoms, ask your primary care doctor to do a quick check of the pulses in your feet during an office visit. If it's difficult to feel a pulse, your doctor may refer you to a specialist for a test called an ABI, or ankle-brachial index.

The ABI compares the blood pressure in the ankle to the blood pressure in the upper arm. If the blood pressure in the leg is lower, that can be an indication of PAD. It's a very fast and simple test, Reddy says, with no needles or invasive procedures involved.

5. If caught early, PAD is highly treatable.

"With early diagnosis, we may be able to offer watchful waiting or medication," Reddy says.

When intervention is needed, most PAD patients can be treated on an outpatient basis with balloons or stents (mesh tubes) placed in the affected arteries through a very fine catheter or tubing.

But because women often don't show PAD symptoms, they're much more likely than men to come to Reddy with advanced cases of the disease. "Minimally invasive procedures like a stent may not be options anymore when PAD is extremely advanced," he says. Those cases may require invasive surgery to bypass blocked arteries.

6. You can help save lives by spreading the word (including sharing this story).

Just as the AHA's "Go Red for Women" campaign aimed to educate physicians and the public about the impact of heart disease on women, "it's really important to raise awareness about how frequently PAD affects women," Reddy says. "Women need to be their own advocates to help make sure that we catch and treat PAD as early as possible."

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