Sex related differences in therapy and outcome of patients with intermittent claudication in a real-world cohort

L Makowski; J Feld; J Köppe; J Illner; L Kühnemund; A Wiederhold; P Dröge; C Günster; J Gerß; H Reinecke; E Freisinger

doi:10.1016/j.atherosclerosis.2021.03.019

Sex related differences in therapy and outcome of patients with intermittent claudication in a real-world cohort

Atherosclerosis. 2021 May:325:75-82. doi: 10.1016/j.atherosclerosis.2021.03.019. Epub 2021 Mar 25.

Authors

L Makowski¹, J Feld², J Köppe², J Illner³, L Kühnemund³, A Wiederhold³, P Dröge⁴, C Günster⁴, J Gerß², H Reinecke³, E Freisinger³

Affiliations

¹ Dept. of Cardiology I - Coronary and Peripheral Vascular Disease, Heart Failure, University Hospital Muenster, Cardiol., Muenster, Germany. Electronic address: lena.makowski@ukmuenster.de.
² Institute of Biostatistics and Clinical Research, University of Muenster, Muenster, Germany.
³ Dept. of Cardiology I - Coronary and Peripheral Vascular Disease, Heart Failure, University Hospital Muenster, Cardiol., Muenster, Germany.
⁴ AOK Research Institute (WIdO), Berlin, Germany.

PMID: 33901740
DOI: 10.1016/j.atherosclerosis.2021.03.019

Abstract

Background and aims: The prevalence of lower extremity artery disease (LEAD) is increasing worldwide and sex-related differences are a current matter of debate.

Methods: We analysed claims data on unselected patients with in-patient treatment for LEAD with intermittent claudication (IC; Rutherford grade 1-3) from 01.01.2014 to 31.12.2015. Data files included diagnostic and procedural information from two years before index, and a five-year follow-up.

Results: Our analysis comprised 42,197 IC patients, thereof 28,520 (68%) male. Male patients were younger (median: 66.4 years vs. 72.6 years) but presented with higher frequency of cardiovascular risk factors such as diabetes (40% female vs. 46% male), atrial fibrillation (13% vs. 17%), chronic coronary syndrome (41% vs. 53%), chronic heart failure (23% vs. 27%), or chronic kidney disease (29% vs. 32%; all p < 0.001; age adjusted). Revascularisation applied in 80% of patients, thereof endovascular approach predominantly in female and surgery in male patients. Concomitant pharmacotherapy with statins (74% at 2 years) and platelet inhibitors (75% respectively) were long lasting below guideline recommendation, under-use being more pronounced in women. Two years after index, one-third of IC patients had subsequent revascularisation, one-quarter progressed to chronic limb threatening ischemia (CLTI), and 2% underwent amputation. Male sex was an independent risk factor for long-term mortality (female HR 0.75; 95%-CI 0.72-0.79; p < 0.001) and CLTI (female HR 0.89; 95%-CI 0.86-0.92; p < 0.001) during follow-up.

Conclusions: The majority of in-patient treated patients for IC are male, presenting with worse cardiovascular risk profiles. In view of a general under-supply with statins and platelet inhibitors, women received somewhat less often preventive medication. Despite low LEAD stages at index, serious prognosis was observed in the long term. Particularly male patients were at high risk for all-cause mortality and the combined endpoint CLTI and death.

Keywords: Intermittent claudication; LEAD; Outcome research; Overall survival; Sex differences.

Publication types

Research Support, Non-U.S. Gov't

MeSH terms

Aged
Amputation, Surgical
Endovascular Procedures*
Female
Humans
Intermittent Claudication / diagnosis
Intermittent Claudication / epidemiology
Intermittent Claudication / therapy
Ischemia
Lower Extremity
Male
Peripheral Arterial Disease* / diagnosis
Peripheral Arterial Disease* / epidemiology
Peripheral Arterial Disease* / therapy
Risk Factors
Treatment Outcome