Peripheral artery disease affects millions of adults, but the way it shows up and how soon it gets diagnosed can differ significantly between women and men. While PAD is often associated with older men, current data paints a more complex picture. In fact, women may face a higher risk than previously recognized and experience more challenges with diagnosis and treatment.
Women Often Face Higher Risk Than They Realize
Peripheral artery disease develops when arteries in the limbs become narrowed due to plaque buildup. This restricts blood flow and can cause leg pain, fatigue, or even limb-threatening complications. What many people miss is how often women develop PAD without the typical symptoms.
In one large voluntary screening study, 4.1% of women had an ankle-brachial index (ABI) of 0.9 or lower, the clinical threshold for PAD, compared to just 2.6% of men. Women were also more likely to have “borderline” ABIs between 0.91 and 1.0, suggesting early or subclinical disease.
Why PAD Looks Different in Women
Part of the reason for this difference is biology. Estrogen plays a protective role in younger women by supporting blood vessel health. But after menopause, estrogen levels drop, and the risk for PAD rises. This hormonal shift may also increase inflammation and oxidative stress, which can damage the arteries over time.
Women tend to develop PAD at an older age than men, but their symptoms are often more subtle or unusual. For example, you might feel leg discomfort during daily chores rather than while walking long distances. Many women attribute these signs to aging or arthritis, not circulation problems.
Risk Factors That Hit Women Harder
While men typically have higher smoking rates and more obvious cardiovascular symptoms, women still carry many of the same PAD risk factors. These include:
- Diabetes: Women with diabetes are nearly twice as likely to develop intermittent claudication compared to men with diabetes.
- Hypertension: High blood pressure may lead to more arterial damage in women, especially after menopause.
- Obesity: A waist circumference of 88 cm or more increases cardiovascular risk for women (compared to 102 cm for men).
- Smoking: Although fewer women smoke, the damage from tobacco may have a more intense effect on female vascular health.
There is also evidence that women face more barriers to effective treatment. They are less likely to receive guideline-directed medical therapies, including statins or blood pressure medications, after a diagnosis.
Get Screened if You Are at Risk
You may not notice PAD symptoms right away, especially if you are a woman. That is why screening is so important. If you have risk factors like diabetes, high blood pressure, high cholesterol, or a history of smoking, talk to your doctor about checking your ABI. This simple, painless test compares blood pressure in your ankle to your arm. A low result may reveal a problem before it causes serious harm.
Screening becomes even more important with age. PAD risk increases in your 60s and continues to climb with each passing decade. And since women live longer on average, more women than men will develop PAD over time.
Know When It’s Time to Get Checked
PAD can be serious, but early action makes a real difference. If you are a woman over 50 or if you have any of the risk factors mentioned, ask your provider about screening.
Our team at the Center for Vascular Care at HCA is here to help you take charge of your vascular health. Reach out today to schedule an appointment and explore your treatment options with one of our experienced vascular specialists.