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PORTRAIT: Quality of life, function poorer for women with PAD
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Women with peripheral artery disease had lower health status, including function and quality of life, compared with men, according to a study in Vascular Medicine.
To determine the health status differences between men and women with new or worsening claudication, researchers conducted the PORTRAIT study, a multicenter, international prospective study, with 1,274 patients. The group included both men (n = 793; mean age, 67 years) and women (n = 481; mean age, 68 years) who presented with symptoms to a vascular outpatient clinic and had a resting ankle-brachial index 0.9. Men and women had similar baseline characteristics such as education, ankle-brachial index and medical history.
Patients completed a 20-item Peripheral Artery Questionnaire (PAQ) to assess symptoms, physical limitations caused by claudication, recent changes in symptoms, social functioning, treatment satisfaction and quality of life.
Baseline characteristics
Compared with men, women were less often married (44.9% vs. 68.2%; P < .001) and employed full-time (6.3% vs. 19.8%; P < .001), and more likely to live alone (36.2% vs. 23.6%; P < .001). More men had health insurance (79.3% vs. 73.2%; P = .011), and 17% of women reported to avoid medical care due to cost vs. 12.3% of men (P = .018). Former (5.2% vs. 3.5%) and current depression (12.3% vs. 5.4%) were reported more often in women than men.
Despite similar ankle-brachial index values (mean, 0.7 in both groups; P = .052), women had lower PAQ scores for physical functioning (adjusted mean difference, –8.4; P < .001), social functioning (adjusted mean difference, –6.8; P < .001) and quality of life (adjusted mean difference, –6.7; P < .001) compared with men. Scores for treatment satisfaction were not different between men and women (adjusted mean difference, –0.2; P = .904).
“We believe that the impaired triangle of physical, socioeconomic and psychological functioning may help provide explanations as to why we observe a poorer [quality of life] in women with PAD,” Mazen Roumia, MD, cardiologist at St. Vincent Hospital in Worcester, Massachusetts, and colleagues wrote. “However, because we only saw a partial attenuation of the association between female sex and worse health status outcomes after adjusting for these factors, future efforts should further identify factors that may help to explain the sex disparities in PAD-specific health status that were documented in patients presenting with new or worsening of PAD symptoms.”
Moving forward
“Given the complexity driving the health status of women PAD patients, different health care disciplines may need to be consulted to appropriately achieve improvements in outcomes,” Ryan J. Mays, PhD, MPH, MS, assistant professor of adult and gerontological health cooperative at the University of Minnesota School of Nursing in Minneapolis, and Judith G. Regensteiner, PhD, professor in the divisions of internal medicine and cardiology and director of the Center for Women’s Health Research at the University of Colorado School of Medicine in Aurora, wrote in a related editorial. “Thus, simply restoring function may be inadequate where socioeconomic and/or psychosocial factors also play a role. In addition, we still need to better identify the causes of the greater impairments in health status in women than in men with PAD to more effectively target treatments.” – by Darlene Dobkowski
Disclosure: Mays, Regensteiner and Roumia report no relevant financial disclosures. Please see the full study for a list of the other researchers’ relevant financial disclosures.
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