How a pain in your leg could be just as fatal as a pain in your chest

A leading scientist at the Heart Research Institute (HRI) is concerned about the sharp increase in the prevalence of peripheral arterial disease (PAD) in women, which is caused by the buildup of fatty plaque in the artery, leading to a narrowing or blockage of blood vessels in the limbs.

Associate Professor Mary Kavurma, Group Leader of the Vascular Complications Group at HRI undertook a scoping review, finding this silent killer is now affecting more women than men, with women also at greater risk of needing an amputation and at greater risk of cardiovascular mortality.

“Historically, studies show the incidence of PAD was a disease predominantly affecting men, however more recent epidemiological studies show the opposite is true,” Assoc Prof Kavurma said.

PAD affects almost one in every five Aus­tralians, with about 50 per cent of peo­ple with PAD show­ing no symp­toms, lead­ing to under-diagnosis.

While PAD is not immediately life threatening, a person with the condition is up to six times more likely to have a heart attack or stroke.

“There’s also a risk that reduced blood flow to the limbs can lead to the limb developing gangrene, where it starts to decay and die, and the only treatment option is to amputate the affected limb to prevent the gangrene from spreading further in the body,” Assoc Prof Kavurma said.

A per­son has an arm or leg ampu­tat­ed from PAD every two to three hours in Australia.

“Unfortunately, PAD is the poor cousin of heart health and cardiovascular disease. It’s where there’s a blockage or narrowing of the vessels in the legs or lower extremities that carry blood from the heart to the limbs, but it’s a type of cardiovascular disease that doesn’t get enough attention,” Assoc Prof Kavurma said.

“When you think of the heart you think about heart attack and stroke. No one ever worries about the narrowing or blockage of the blood vessels in limbs, but it is a very big concern because it could result in your leg being amputated, significantly affecting quality of life. It can even result in early death.

“PAD is a silent problem in women. Women tend to have atypical or not obvious symptoms, making diagnosis difficult. It often starts with a pain or cramping in your calf, which women usually ignore and put down to their busy lifestyle. They don’t think it’s anything serious. Awareness of PAD risks are poor among women and healthcare providers.”

Assoc Prof Kavurma said not enough is known about the differences in the disease between men and women and this is having a detrimental effect on women’s overall survival. It is not just biology that needs to be considered. Clinical and societal factors also play a role.

“In 2012 the American Heart Association called for a global call to action on gender parity. A decade later nothing has changed, with women still under-diagnosed and understudied, despite the increased prevalence in women.

“We think the disease might be different in women pre-menopause and then more like men after menopause, but we don’t know for sure.

“What we do know is women have higher mortality rates following amputation or open surgery and also have greater in-hospital complications after endovascular surgery, including higher rates of bleeding, vessel access site complications, haematoma, or pseudoaneurysm.

“Women also present with more com­plex lesions and comor­bidi­ties than men, as well as greater pain inten­si­ty in dai­ly activ­i­ties fol­low­ing limb loss.”

The major risk factors for PAD include hypertension, raised serum cholesterol, diabetes mellitus, chronic kidney disease and cigarette smoking.

The condition currently affects an estimated 200 million people globally, with results from the International Diabetes Federation predicting prevalence to rise as much as 50 per cent by 2045.

“The treatment is similar to preventing a heart attack (myocardial infarction) – minimise the risk of myocardial infarction and stroke as well as lowering cholesterol and improving exercise levels,” Assoc Prof Kavurma said.

In the media

ABC Health & Wellbeing, 2 June 2023, Peripheral artery disease is a ‘silent killer’ that is underdiagnosed in women

Nine News, 2 June 2023, There’s a silent disease affecting millions of Australians, and it’s on the rise – particularly in women

Header image: Assoc Prof Mary Kavurma and members of the Vascular Complications Group

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