Sex related differences in therapy and outcome of patients with intermittent claudication in a real-world cohort
| Autor: | P Dröge, Jannik Feld, Jeanette Köppe, C Günster, Holger Reinecke, Joachim Gerß, A Wiederhold, J Illner, Eva Freisinger, L Kühnemund, L Makowski |
|---|---|
| Rok vydání: | 2021 |
| Předmět: |
Male
0301 basic medicine medicine.medical_specialty Disease 030204 cardiovascular system & hematology Amputation Surgical Peripheral Arterial Disease 03 medical and health sciences 0302 clinical medicine Ischemia Risk Factors Internal medicine Diabetes mellitus medicine Humans Aged business.industry Endovascular Procedures Atrial fibrillation Sex related Intermittent Claudication medicine.disease Intermittent claudication Treatment Outcome 030104 developmental biology Lower Extremity Heart failure Cohort Female medicine.symptom Cardiology and Cardiovascular Medicine business Kidney disease |
| Zdroj: | Atherosclerosis. 325:75-82 |
| ISSN: | 0021-9150 |
| DOI: | 10.1016/j.atherosclerosis.2021.03.019 |
| Popis: | The prevalence of lower extremity artery disease (LEAD) is increasing worldwide and sex-related differences are a current matter of debate.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.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.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. |
| Databáze: | OpenAIRE |
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