SLR - December 2012 - Piper

Women with Peripheral Arterial Disease Experience Faster Functional Decline than Men with Peripheral Arterial Disease

Reference: McDermott M, Ferrucci L, Liu K, Guralnik J, Tian L, Kibbe M, Liao Y, Tao H, Criqui M. Women with Peripheral Arterial Disease Experience Faster Functional Decline Than Men with Peripheral Arterial Disease. Journal of the American College of Cardiology, 57(6), 707-714; 2011.

Scientific Literature Review

Reviewed by: Daniel Piper, DPM
Residency Program: University Hospitals Richmond Heights, Richmond Heights, OH

Podiatric Relevance: 
Peripheral arterial disease is a common affliction encountered in podiatric medicine. Thus, podiatrists should be thoroughly educated in the disease in order to provide the most complete and appropriate care for their patients. As this article states, previous studies have shown that women with PAD have greater functional impairment and poorer lower extremity strength than men. However, rates of functional decline and changes in calf muscle characteristics over time have not been investigated. This information could help to serve as a guideline in making the appropriate referrals to decelerate the progression of this debilitating disease, as well as to assist a podiatrist in assessing a patient’s overall wellbeing and long term prognosis.

Methods:
Three hundred eighty patients with PAD were assessed for mobility disability, completed a six minute walk, and were measured for 4-m walking velocity at baseline and annually for up to four years. Computed tomography was used to assess calf muscle characteristics and was measured biannually. Patients who became unable to walk for a quarter mile or to walk up and down one flight of stairs without assistance, who originally could, were defined as having mobility loss. Age, race, body mass index, physical activity, the ankle brachial index, co-morbidities, and other confounders were all factored into the results.

Results:
This study showed that women were more likely to become unable to walk for six min continuously (hazard ratio: 2.30, 95 percent confidence interval: 1.30 to 4.06, p = 0.004), more likely to develop mobility disability (hazard ratio: 1.79, 95 percent confidence interval: 1.30 to 3.03, p = 0.030), and had faster declines in walking velocity (p = 0.022) and the distance achieved in the six minute walk (p = 0.041) compared with men at four years follow-up. After additional adjustment for baseline sex differences in calf muscle area, the overall functional decline between sexes was reduced.

Conclusions:
PAD affects men and women to a varying degree. Women displayed a faster functional decline and greater mobility loss. A smaller baseline calf muscle area among women with PAD may be to blame.

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