Arterial Vascular Disease Underdiagnosed, Undertreated in Older U.S. Women

Though arterial vascular disease is widespread and often deadly among older American women, doctors too often fail to spot and treat it, according to a new report by a team of vascular surgeons from the Columbia University Medical Center and Weill Cornell Medical College campuses of NewYork-Presbyterian Hospital.

“Much of that is due to the fact that for years, cardiovascular research has focused almost exclusively on males, so in many cases we simply don’t understand the true prevalence or level of threat women face from vascular disease,” says the study co-author, Dr. Ageliki G. Vouyouka, assistant professor of surgery in the Department of Vascular Surgery at Weill Cornell Medical College, and a vascular surgeon at NewYork-Presbyterian Hospital. “Obviously, we need more trials focused on the vulnerability of women to these crippling and even lethal conditions.”

She and co-author Dr. K. Craig Kent—the Greenberg-Starr Professor of Surgery at Weill Cornell Medical College, professor of surgery at Columbia University College of Physicians and Surgeons, and chief of vascular surgery at NewYork-Presbyterian Hospital—published their review, titled “Arterial Vascular Disease in Women,” in a recent issue of the Journal of Vascular Surgery.

Arterial vascular disease is an umbrella term for diseases involving the gradual closure of arteries throughout the body, including carotid stenosis (blockage of the arteries that supply blood to the brain), aortic aneurysmal disease (plaque and blockages in the aortic artery leading from the heart to the lower body), and lower-extremity arterial occlusive disease, which involves poor blood flow within the legs.

For decades, these forms of vascular disease were thought primarily as “men’s diseases.”

“That’s because the risk of vascular trouble increases greatly for women after menopause,” Dr. Kent explains. “In years past when lifespans were shorter, women simply didn’t live long enough to develop serious vascular illness. That’s all changed because the average American woman now lives well into her 80s.”

Other factors have conspired to keep women with arterial vascular disease off of doctors’ radar. Women typically outlive their male partners and are then left alone—either isolated at home or placed in nursing homes. They often have fewer financial resources and caregiver support to draw on, as well. “This means they often don’t get the care they deserve,” Dr. Vouyouka says.

In their paper, the two researchers pored over the existing literature on women and arterial vascular disease, breaking the findings down into the three main disease subtypes. Some of their findings:

For carotid stenosis:

• Women’s carotid and vertebral arteries are markedly smaller than those of men, so it takes less plaque buildup to cause severe restrictions in blood flow. However carotid plaque is more stable in women and therefore the risk of stroke becomes significant at higher degree of stenosis as compared to men.• Plaque composition within the artery appears to differ between the sexes, and certain risk factors—such as high blood levels of C-reactive protein, use of hormone replacement therapy (HRT) and osteoporosis—may be unique to women.• Women were under-represented in all major trials for carotid endarterectomy (surgery to correct the blockage of the neck arteries-CEA) and therefore the outcome of the procedure on women is not well analyzed. However it appears that carotid endarterectomy (CEA) probably carries a higher rate of complications for women, including stroke and therefore the procedure should be done for higher degree of stenosis in women, compared to men.