AHA Statement: Gender Gaps in Peripheral Vascular Disease Hinder Women's Diagnosis and Care

The American Heart Association released a scientific statement this week documenting a troubling pattern: women with peripheral vascular disease—conditions that narrow or damage blood vessels outside the heart—are systematically underdiagnosed, undertreated, and more likely to suffer severe complications than men with the same conditions. The statement, published in Circulation, synthesizes current research across multiple types of vascular disease and identifies specific ways that sex differences in disease presentation, risk factors, and outcomes have been overlooked or mishandled by the medical system.

Peripheral artery disease, which restricts blood flow to the limbs, affects men and women at roughly equal rates overall. Yet women experience it differently. They are more likely to have no symptoms at all or to report atypical warning signs that doctors may not recognize as PAD. When symptoms do appear, women tend to walk more slowly and cover shorter distances than men with the same condition—a measure of functional decline that should prompt urgent intervention. Instead, women with PAD are less likely to receive treatments recommended by clinical guidelines or to be enrolled in supervised exercise programs that could improve their mobility and quality of life. The disparity is even starker for Black women, who have a lifetime risk of PAD of 27.6 percent compared to 19 percent for white women, yet receive evidence-based treatment less often.

Aortic disease presents an even more dramatic picture of delayed recognition and worse outcomes. Women tend to be diagnosed later in the course of their disease, when it has already progressed to a more severe stage. While estrogen offers some protective effect against certain aortic conditions like aneurysms, that protection comes with a hidden cost: when women do develop aneurysms, they rupture more easily and at smaller sizes. In a major clinical trial conducted in the United Kingdom, women were three times more likely than men to experience rupture at the same aneurysm size. Thirty percent of aneurysm ruptures in women occurred in vessels smaller than five centimeters, compared to just eight percent in men. Even when women undergo minimally invasive surgical repair, they face higher mortality rates in both the short and long term, plus an increased risk of stroke. In acute aortic emergencies—dissections, blood collections within the aortic wall, and penetrating ulcers—in-hospital mortality for women reaches 30 percent versus 21 percent for men.

Other vascular conditions show similarly stark sex-based patterns. Fibromuscular dysplasia, a condition that causes abnormal cell growth in artery walls, occurs five to nine times more often in women than men. Women are also three times more likely than men to develop chronic mesenteric ischemia, a reduction in blood flow to the intestines. Takayasu arteritis, an autoimmune inflammation of large arteries, strikes women five times more frequently than men and carries twice the mortality rate. Women with giant cell arteritis who receive only prednisone as treatment are five times more likely to experience treatment failure than men receiving the same therapy.

Dr. Esther S.H. Kim, chair of the writing group and director of the Center for Women's Cardiovascular Health at Atrium Health in Charlotte, North Carolina, emphasized that the problem extends beyond individual conditions. "Peripheral vascular disease is often under-recognized and understudied in women," she said. While cardiologists and patients have become increasingly aware of sex differences in heart disease, equivalent attention to blood vessel diseases outside the heart remains scarce. The result is a system that misses diagnoses, delays treatment, and leaves women with worse health outcomes than men.

The statement calls for concrete changes. Clinical trials need to enroll more women and analyze results separately by sex to understand whether treatments work differently for women than for men. Doctors need training to recognize atypical presentations of vascular disease in women. Screening guidelines need refinement to account for women's unique risk factors and disease patterns. Current thresholds for when to repair aortic aneurysms, for instance, are already lower for women than men, but the statement suggests even these may not fully capture women's actual risk. Most fundamentally, the medical system needs to remove barriers that prevent women from accessing treatments that guidelines already recommend.

The statement represents a shift in how the cardiovascular field thinks about sex differences—moving beyond the assumption that disease works the same way in everyone and toward recognition that biology, symptom presentation, and treatment response can vary significantly. Whether that recognition translates into changed practice, better outcomes, and equitable care remains to be seen.