Prevalence of lesions and risk factors in patients with lower extremities atherosclerosis referred for surgical intervention: gender differences

Background. Atherosclerotic disease of the arteries of the lower extremities or peripheral arterial disease (PAD) affects both men and women. PAD can be combined with the damage of other vascular regions, which is defined as multifocal atherosclerosis (MFA) and suggests the most severe course of the disease and an unfavorable prognosis of patients. The high risk of cardiovascular complications determines the importance of active secondary prevention in patients with PAD and MFA. Data on the frequency of MFA, characteristics of risk factors (RF) and their treatment depending on gender are limited in the literature.

Objective. To study the prevalence of atherosclerotic lesions, RF for atherosclerosis and their treatment at out-patient stage in men and women with PAD referred for surgical treatment. Design and methods. According to medical records analyzed the results of a survey of 65 men and 26 women consecutively admitted to the department of cardiosurgery of the Almazov National Medical Research Center from January 2018 to January 2019 for surgical treatment. All patients underwent duplex scanning (DS), X-ray or CT-angiography of the arteries of the lower extremities, 49 patients underwent coronary angiography, and 72 patients underwent DS or CT-angiography of the brachiocephalic arteries (BCA).

Results. The average age of men and women did not differ significantly. The most common RF were hypertension and current smoking or the PAD. Smoking was observed less frequently in women. Data on lipid profile were available in 62 patients (68 %), the level of low-density lipoproteins (LDL) was determined in 22 subjects (24 %). The incidence of dyslipidemia and diabetes mellitus did not differ significantly in both groups, however, fasting hyperglycemia was found in 9 women without diabetes mellitus (50 %). The target LDL level was achieved only in 3 men. Two or more RF were detected in 87 % of patients; the groups of men and women did not differ in the number of RF. Signs of involvement of one arterial region were found in 18% of patients, two regions — in 48%, three regions — in 28% without differences in men and women (p > 0,05). In combination with PAD, men were more likely to have coronary artery (CA) disease than women (p < 0,05); the incidence of BCA lesions did not differ significantly (p = 0,02). Women less often, although not significant, received statins (69% versus 84%), beta-blockers (46% versus 66%), antiplatelet agents (77 % versus 84,6%).

Conclusions. Both men and women hospitalized for surgical treatment of PAD have multiple RF of comparable frequency, with the exception of smoking. Regardless of gender, the majority of patients show signs of MFA with predominant CA disease in men. The absence of significant differences in the number of RF and the frequency of MFA in men and women may be associated with the presence of comparable severe clinical manifestations of PAD, which determine the indications for revascularization of the lower extremities. The evaluation of patients is inadequate: not all patients have controlled cholesterol and LDL levels, tests are not performed in women with fasting hyperglycemia to exclude diabetes mellitus and prediabetes. There is a clear trend towards less active secondary prevention in women.

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