Artikel
Geschlechtsbedingte Einflüsse auf Therapie und klinischen Ausgang der peripheren arteriellen Verschlusskrankheit
Suche in Medline nach
Autoren
-
Eva Freisinger
- Universitätsklinikum Münster, Abteilung für Angiologie, Department für Kardiologie und Angiologie, Münster, Deutschland
-
Michael Unrath
- Universität Osnabrück, FB Humanwissenschaften, LE Gesundheitswissenschaften, Fachgebiet New Public Health, Osnabrück, Deutschland
-
Nasser Malyar
- Universitätsklinikum Münster, Department für Kardiologie und Angiologie, Abteilung für Angiologie,, Münster, Deutschland
-
Holger Reinecke
- Universitätsklinikum Münster, Abteilung für Angiologie, Department für Kardiologie und Angiologie, Münster, Deutschland
| Veröffentlicht: | 28. September 2016 |
|---|
Gliederung
Text
Background: Few data discuss the impact of gender on diagnostic and therapeutic procedures and outcome parameters of patients with peripheral artery disease (PAD).
Aims:
We sought to examine gender differences in patients with PAD with respect to risk profiles, applied procedures, in-hospital outcome and outcome at 1-year follow-up on a large scale.
Methods: We obtained in- and outpatient data on 41,873 patients with PAD between 2009 – 2011 (including a 1-yr follow-up) from the largest public health insurance (BARMER GEK) in Germany. Propensity Score Matching (PSM) on n= 30,594 patients (covering 83.2% of female patients) was performed to evaluate the impact of gender on procedures, complications, in-hospital and long-term outcome.
Results: Of 41,873 PAD patients, there were 18,591 (44.4%) female and 23,282 (55.6%) male. Female patients were older (75 ± 12 years vs. 69 ± 11 years in males; p<0.001) but had lower cardiovascular risk profiles compared to male PAD patients, e.g. less obesity (6.5% vs 8.0%), dyslipidemia (28.1% vs 33.2%), smoking (9.2% vs 12.9%), coronary artery disease (19.5% vs 29.4%), or diabetes (28.1% vs 35.8%; each p<0.001). Frequency of overall revascularization procedures did not significantly differ between male and female patients, and in-hospital complication rates were similar. PSM accounting for the up-mentioned risk factors and stratified for Rutherford categories did not show relevant differences in clinical endpoints such as amputation or in-hospital death between male and female PAD patients. However, male gender turned out to be an independent risk factor for amputation (HR 1.284; p<0.001) and death (HR 1.155; p<0.001) during follow-up (see Figure 1 [Fig. 1]).
Discussion: Male gender was particularly associated with worse long-term outcome in patients with PAD irrespective of risk profiles, age, and stage of PAD. In contrast to other reports we did not find women to be more frequently amputated compared to men.
Practical implications: Our analysis shows the impact of gender on the actual healthcare situation of patients with PAD on a large scale. Male patients have worse risk profiles and worse long-term outcome, implying the need for intensified preventive measures particularly in male patients with PAD.
