Sex related differences in therapy and outcome of patients with low-stage LEAD in a real-world cohort. (25th November 2020)

• Record Type: Journal Article
• Authors: Makowski, L.-M; Feld, J; Koeppe, J; Illner, J; Kuehnemund, L; Wiederhold, A; Gerss, J; Reinecke, H; Freisinger, E
• Is Part Of: European heart journal. Volume 41:(2020)Supplement 2
• Publication Date: 2020-11-25
• Subjects: Peripheral Artery Disease; Cardiology -- Periodicals; Heart -- Diseases -- Periodicals; 616.12005
• DOI: 10.1093/ehjci/ehaa946.2399
• Languages: English
• ISSNs: 0195-668X

Abstract

Abstract: Background: During the last decades, the prevalence of lower extremity artery disease (LEAD) strongly increased worldwide in both, males and females. Sex-related differences relating to therapy and outcome events are a current matter of debate. Purpose: Aim of our study was to examine patients with low-stage LEAD in an unselected "real-world" cohort with regard to risk profiles, therapeutic approach and its impact on the progression to chronic limb threatening ischemia (CLTI) and death. Methods: We analyzed 42, 197 unselected patients of the AOK (Allgemeine Ortskrankenkasse) health insurance that were hospitalized between 01.01.2014–31.12.2015 for a main diagnosis of LEAD at Rutherford stage 1–3. Data files included a baseline period of 2 years previous index hospitalization and a follow-up period of up to 5 years. Results: In our dataset, one third of the LEAD patients were female (32.4% female vs. 67.6% male), being 6 years older (median age: 72.6 years female vs. 66.4 years male). Male patients had higher ratio of diabetes mellitus (40.1% female vs. 42.4% male), nicotine abuse (40.8% female vs. 50.7% male) and chronic coronary syndrome (40.6% female vs. 48.2 male). On the other hand, hypertension (90.3% female vs. 86.9% male), obesity (26.7% female vs. 24.9% male) and chronic kidney disease (29.2% female vs. 26.1% male; all p<0.001) was more often co-prevalent in females. Previous vascular procedures of the lower limbs (LL) (10.2% female vs. 11.8% male) and the receipt of guideline-recommended medication (statins: 45.9% female vs. 50.3% male; blood thinner: 37.1% female vs. 42.7% male; all p<0.001) at baseline was higher in male patients. During index hospitalization, revascularization was performed in 82.8% of all patients, while carried out more often in male patients (81.8% female vs. 83.3% male, p<0.001). After adjustment for risk profiles, female sex was associated with decreased adjusted long-term mortality (HR 0.76; 95%-CI 0.72–0.80). Moreover, male gender was linked with an increased risk of the combined endpoint of CLTI (Rutherford stage 4–6 or amputation of the LL or death; HR 0.89; 95%-CI 0.86–0.93). Interestingly, the prescription of guideline-recommended medication (statins: 63.8% female vs. 65.8% male; blood thinner: 60.2% female vs. 63.5% male; all p<0.001) and performed vascular procedures (33.1% female vs. 36.4% male; p<0.001) was increased in male patients during follow-up. Conclusion: Female patients with low stage LEAD are older and show less rate of revascularization procedures of the LL and prescription of guideline-recommended medication at baseline and during follow-up. Nevertheless, male gender was an independent risk factor for all-cause mortality and the combined endpoint CLTI during 5 years of long-term follow-up. Further analyses with focus on sex-related differences on health-services supply and outcome quality are needed to correspond to the individual needs of male and female LEAD patients. Funding Acknowledgement: Type of funding source: Public grant(s) – National budget only. Main funding source(s): National grant