Skip to main content
Netherlands Heart Journal logoLink to Netherlands Heart Journal
. 2002 Dec;10(12):500–505.

Differential effect of female gender on coronary artery disease and peripheral artery disease

HWO Roeters van Lennep, HT Westerveld, AH Zwinderman, JE Roeters van Lennep, H Bruins Slot, DW Erkelens, EE van der Wall
PMCID: PMC2499819  PMID: 25696054

Abstract

Background

Women are relatively protected against coronary artery disease (CAD). Whether female gender has a similar protective influence on the development of peripheral artery disease (PAD) has not been extensively investigated and was the main subject of our study.

Methods

We analysed 2707 consecutive patients (2008 men and 699 women) who underwent a first diagnostic coronary angiography for suspicion of CAD and 2367 consecutive patients (1426 men and 941 women) who underwent a first ankle arm index measurement because of suspicion of PAD.

Results

We found that a positive diagnosis for CAD and PAD was more common in men compared with women (80.7% vs 57.9%, p<0.0001 and 68.0% vs 60.7%, p<0.0001). Once CAD or PAD was established, severity of disease was similar for men and women, which pleads against a referral bias. Women had a reduced risk of CAD after adjustment for risk factors (odds ratio [OR] 0.32, 95% confidence interval [CI] 0.22-0.46, p<0.0001), but not of PAD (OR 0.82, 95% CI 0.66-1.03, p=NS). In patients with CAD and in those with PAD, women were older, more often had diabetes and hypertension, while men were more likely to be current smokers. Hypertension, smoking and diabetes were associated with CAD in both men and women. Current smoking was associated with PAD in men and women. Hypertension and diabetes were associated with PAD in women but not in men.

Conclusion

After adjustment for risk factors, the female protection for CAD seems to less present for PAD.

Keywords: coronary artery disease, peripheral artery disease, risk factors, men, women

Full text

PDF
500

Selected References

These references are in PubMed. This may not be the complete list of references from this article.

  1. Applegate W. B. Ankle/arm blood pressure index. A useful test for clinical practice? JAMA. 1993 Jul 28;270(4):497–498. [PubMed] [Google Scholar]
  2. Bainton D., Sweetnam P., Baker I., Elwood P. Peripheral vascular disease: consequence for survival and association with risk factors in the Speedwell prospective heart disease study. Br Heart J. 1994 Aug;72(2):128–132. doi: 10.1136/hrt.72.2.128. [DOI] [PMC free article] [PubMed] [Google Scholar]
  3. Brown S. A., Morrisett J. D., Boerwinkle E., Hutchinson R., Patsch W. The relation of lipoprotein[a] concentrations and apolipoprotein[a] phenotypes with asymptomatic atherosclerosis in subjects of the Atherosclerosis Risk in Communities (ARIC) Study. Arterioscler Thromb. 1993 Nov;13(11):1558–1566. doi: 10.1161/01.atv.13.11.1558. [DOI] [PubMed] [Google Scholar]
  4. Criqui M. H., Langer R. D., Fronek A., Feigelson H. S., Klauber M. R., McCann T. J., Browner D. Mortality over a period of 10 years in patients with peripheral arterial disease. N Engl J Med. 1992 Feb 6;326(6):381–386. doi: 10.1056/NEJM199202063260605. [DOI] [PubMed] [Google Scholar]
  5. Davis C. E., Pajak A., Rywik S., Williams D. H., Broda G., Pazucha T., Ephross S. Natural menopause and cardiovascular disease risk factors. The Poland and US Collaborative Study on Cardiovascular Disease Epidemiology. Ann Epidemiol. 1994 Nov;4(6):445–448. doi: 10.1016/1047-2797(94)90003-5. [DOI] [PubMed] [Google Scholar]
  6. Downs J. R., Clearfield M., Weis S., Whitney E., Shapiro D. R., Beere P. A., Langendorfer A., Stein E. A., Kruyer W., Gotto A. M., Jr Primary prevention of acute coronary events with lovastatin in men and women with average cholesterol levels: results of AFCAPS/TexCAPS. Air Force/Texas Coronary Atherosclerosis Prevention Study. JAMA. 1998 May 27;279(20):1615–1622. doi: 10.1001/jama.279.20.1615. [DOI] [PubMed] [Google Scholar]
  7. Fowkes F. G. Aetiology of peripheral atherosclerosis. BMJ. 1989 Feb 18;298(6671):405–406. doi: 10.1136/bmj.298.6671.405. [DOI] [PMC free article] [PubMed] [Google Scholar]
  8. Fowkes F. G., Housley E., Riemersma R. A., Macintyre C. C., Cawood E. H., Prescott R. J., Ruckley C. V. Smoking, lipids, glucose intolerance, and blood pressure as risk factors for peripheral atherosclerosis compared with ischemic heart disease in the Edinburgh Artery Study. Am J Epidemiol. 1992 Feb 15;135(4):331–340. doi: 10.1093/oxfordjournals.aje.a116294. [DOI] [PubMed] [Google Scholar]
  9. Fowkes F. G., Pell J. P., Donnan P. T., Housley E., Lowe G. D., Riemersma R. A., Prescott R. J. Sex differences in susceptibility to etiologic factors for peripheral atherosclerosis. Importance of plasma fibrinogen and blood viscosity. Arterioscler Thromb. 1994 Jun;14(6):862–868. doi: 10.1161/01.atv.14.6.862. [DOI] [PubMed] [Google Scholar]
  10. Friedewald W. T., Levy R. I., Fredrickson D. S. Estimation of the concentration of low-density lipoprotein cholesterol in plasma, without use of the preparative ultracentrifuge. Clin Chem. 1972 Jun;18(6):499–502. [PubMed] [Google Scholar]
  11. Giltay E. J., Hoogeveen E. K., Elbers J. M., Gooren L. J., Asscheman H., Stehouwer C. D. Effects of sex steroids on plasma total homocysteine levels: a study in transsexual males and females. J Clin Endocrinol Metab. 1998 Feb;83(2):550–553. doi: 10.1210/jcem.83.2.4574. [DOI] [PubMed] [Google Scholar]
  12. Jousilahti P., Vartiainen E., Tuomilehto J., Puska P. Sex, age, cardiovascular risk factors, and coronary heart disease: a prospective follow-up study of 14 786 middle-aged men and women in Finland. Circulation. 1999 Mar 9;99(9):1165–1172. doi: 10.1161/01.cir.99.9.1165. [DOI] [PubMed] [Google Scholar]
  13. Kroon A. A., Ajubi N., van Asten W. N., Stalenhoef A. F. The prevalence of peripheral vascular disease in familial hypercholesterolaemia. J Intern Med. 1995 Nov;238(5):451–459. doi: 10.1111/j.1365-2796.1995.tb01223.x. [DOI] [PubMed] [Google Scholar]
  14. Leng G. C., Lee A. J., Fowkes F. G., Lowe G. D., Housley E. The relationship between cigarette smoking and cardiovascular risk factors in peripheral arterial disease compared with ischaemic heart disease. The Edinburgh Artery Study. Eur Heart J. 1995 Nov;16(11):1542–1548. doi: 10.1093/oxfordjournals.eurheartj.a060775. [DOI] [PubMed] [Google Scholar]
  15. Leng G. C., Lee A. J., Fowkes F. G., Whiteman M., Dunbar J., Housley E., Ruckley C. V. Incidence, natural history and cardiovascular events in symptomatic and asymptomatic peripheral arterial disease in the general population. Int J Epidemiol. 1996 Dec;25(6):1172–1181. doi: 10.1093/ije/25.6.1172. [DOI] [PubMed] [Google Scholar]
  16. Lloyd-Jones D. M., Larson M. G., Beiser A., Levy D. Lifetime risk of developing coronary heart disease. Lancet. 1999 Jan 9;353(9147):89–92. doi: 10.1016/S0140-6736(98)10279-9. [DOI] [PubMed] [Google Scholar]
  17. McKenna M., Wolfson S., Kuller L. The ratio of ankle and arm arterial pressure as an independent predictor of mortality. Atherosclerosis. 1991 Apr;87(2-3):119–128. doi: 10.1016/0021-9150(91)90014-t. [DOI] [PubMed] [Google Scholar]
  18. Meijer W. T., Hoes A. W., Rutgers D., Bots M. L., Hofman A., Grobbee D. E. Peripheral arterial disease in the elderly: The Rotterdam Study. Arterioscler Thromb Vasc Biol. 1998 Feb;18(2):185–192. doi: 10.1161/01.atv.18.2.185. [DOI] [PubMed] [Google Scholar]
  19. Mendelsohn M. E., Karas R. H. Estrogen and the blood vessel wall. Curr Opin Cardiol. 1994 Sep;9(5):619–626. doi: 10.1097/00001573-199409000-00018. [DOI] [PubMed] [Google Scholar]
  20. Newman A. B., Siscovick D. S., Manolio T. A., Polak J., Fried L. P., Borhani N. O., Wolfson S. K. Ankle-arm index as a marker of atherosclerosis in the Cardiovascular Health Study. Cardiovascular Heart Study (CHS) Collaborative Research Group. Circulation. 1993 Sep;88(3):837–845. doi: 10.1161/01.cir.88.3.837. [DOI] [PubMed] [Google Scholar]
  21. Njølstad I., Arnesen E., Lund-Larsen P. G. Smoking, serum lipids, blood pressure, and sex differences in myocardial infarction. A 12-year follow-up of the Finnmark Study. Circulation. 1996 Feb 1;93(3):450–456. doi: 10.1161/01.cir.93.3.450. [DOI] [PubMed] [Google Scholar]
  22. Papademetriou V., Narayan P., Rubins H., Collins D., Robins S. Influence of risk factors on peripheral and cerebrovascular disease in men with coronary artery disease, low high-density lipoprotein cholesterol levels, and desirable low-density lipoprotein cholesterol levels. HIT Investigators. Department of Veterans Affairs HDL Intervention Trial. Am Heart J. 1998 Oct;136(4 Pt 1):734–740. doi: 10.1016/s0002-8703(98)70023-7. [DOI] [PubMed] [Google Scholar]
  23. Pomrehn P., Duncan B., Weissfeld L., Wallace R. B., Barnes R., Heiss G., Ekelund L. G., Criqui M. H., Johnson N., Chambless L. E. The association of dyslipoproteinemia with symptoms and signs of peripheral arterial disease. The Lipid Research Clinics Program Prevalence Study. Circulation. 1986 Jan;73(1 Pt 2):I100–I107. [PubMed] [Google Scholar]
  24. Price J. F., Mowbray P. I., Lee A. J., Rumley A., Lowe G. D., Fowkes F. G. Relationship between smoking and cardiovascular risk factors in the development of peripheral arterial disease and coronary artery disease: Edinburgh Artery Study. Eur Heart J. 1999 Mar;20(5):344–353. doi: 10.1053/euhj.1998.1194. [DOI] [PubMed] [Google Scholar]
  25. Roeters van Lennep J. E., Zwinderman A. H., Roeters van Lennep H. W., Westerveld H. E., Plokker H. W., Voors A. A., Bruschke A. V., van der Wall E. E. Gender differences in diagnosis and treatment of coronary artery disease from 1981 to 1997. No evidence for the Yentl syndrome. Eur Heart J. 2000 Jun;21(11):911–918. doi: 10.1053/euhj.1999.1941. [DOI] [PubMed] [Google Scholar]
  26. Schweiger M. J., McMahon R. P., Terrin M. L., Ruocco N. A., Porway M. N., Wiseman A. H., Knatterud G. L., Braunwald E. Comparison of patients with < 60% to > or = 60% diameter narrowing of the myocardial infarct-related artery after thrombolysis. The TIMI Investigators. Am J Cardiol. 1994 Jul 15;74(2):105–110. doi: 10.1016/0002-9149(94)90081-7. [DOI] [PubMed] [Google Scholar]
  27. Simons L. A., Friedlander Y., McCallum J., Simons J. Risk factors for coronary heart disease in the prospective Dubbo Study of Australian elderly. Atherosclerosis. 1995 Sep;117(1):107–118. doi: 10.1016/0021-9150(94)05564-y. [DOI] [PubMed] [Google Scholar]
  28. Steegers-Theunissen R. P., Boers G. H., Steegers E. A., Trijbels F. J., Thomas C. M., Eskes T. K. Effects of sub-50 oral contraceptives on homocysteine metabolism: a preliminary study. Contraception. 1992 Feb;45(2):129–139. doi: 10.1016/0010-7824(92)90047-w. [DOI] [PubMed] [Google Scholar]
  29. Stevenson J. C., Crook D., Godsland I. F. Influence of age and menopause on serum lipids and lipoproteins in healthy women. Atherosclerosis. 1993 Jan 4;98(1):83–90. doi: 10.1016/0021-9150(93)90225-j. [DOI] [PubMed] [Google Scholar]
  30. Strong J. P., Malcom G. T., McMahan C. A., Tracy R. E., Newman W. P., 3rd, Herderick E. E., Cornhill J. F. Prevalence and extent of atherosclerosis in adolescents and young adults: implications for prevention from the Pathobiological Determinants of Atherosclerosis in Youth Study. JAMA. 1999 Feb 24;281(8):727–735. doi: 10.1001/jama.281.8.727. [DOI] [PubMed] [Google Scholar]
  31. Tobin J. N., Wassertheil-Smoller S., Wexler J. P., Steingart R. M., Budner N., Lense L., Wachspress J. Sex bias in considering coronary bypass surgery. Ann Intern Med. 1987 Jul;107(1):19–25. doi: 10.7326/0003-4819-107-1-19. [DOI] [PubMed] [Google Scholar]
  32. Trémollières F. A., Pouilles J. M., Cauneille C., Ribot C. Coronary heart disease risk factors and menopause: a study in 1684 French women. Atherosclerosis. 1999 Feb;142(2):415–423. doi: 10.1016/s0021-9150(98)00252-4. [DOI] [PubMed] [Google Scholar]
  33. Vogt M. T., Cauley J. A., Newman A. B., Kuller L. H., Hulley S. B. Decreased ankle/arm blood pressure index and mortality in elderly women. JAMA. 1993 Jul 28;270(4):465–469. [PubMed] [Google Scholar]
  34. Vogt M. T., McKenna M., Wolfson S. K., Kuller L. H. The relationship between ankle brachial index, other atherosclerotic disease, diabetes, smoking and mortality in older men and women. Atherosclerosis. 1993 Jul;101(2):191–202. doi: 10.1016/0021-9150(93)90116-c. [DOI] [PubMed] [Google Scholar]
  35. Westendorp I. C., in't Veld B. A., Grobbee D. E., Pols H. A., Meijer W. T., Hofman A., Witteman J. C. Hormone replacement therapy and peripheral arterial disease: the Rotterdam study. Arch Intern Med. 2000 Sep 11;160(16):2498–2502. doi: 10.1001/archinte.160.16.2498. [DOI] [PubMed] [Google Scholar]
  36. Westerveld H. T., van Lennep J. E., van Lennep H. W., Liem A. H., de Boo J. A., van der Schouw Y. T., Erkelens D. W. Apolipoprotein B and coronary artery disease in women: a cross-sectional study in women undergoing their first coronary angiography. Arterioscler Thromb Vasc Biol. 1998 Jul;18(7):1101–1107. doi: 10.1161/01.atv.18.7.1101. [DOI] [PubMed] [Google Scholar]

Articles from Netherlands Heart Journal are provided here courtesy of Springer

RESOURCES