April J. Boyd
Vascular Surgery, Health Sciences Centre, Winnipeg, MB, Canada.
OBJECTIVES: Despite similar risk factors, women have lower prevalence of PAD in the premenopausal period compared with age-matched men. The prevalence of PAD increases from 3-4% up to 29% in women after menopause. By the 7th to 8th decades, the prevalence is comparable in men and women. Little is known about the factors that protect women from PAD prior to the onset of menopause. The purpose of the study was to retrospectively review the ABI and risk factor data in premenopausal (<53 years of age) women referred for ABI testing in the province of Manitoba between 1993 and 2010.
METHODS: In Manitoba, a province of 1.1 million, virtually all ABI tests are performed at two hospitals by trained technicians. Both sites also collect risk factor data. ABI were considered to be abnormal if less than 0.9. Risk factors included were smoking, coronary arterial disease, obesity, diabetes, hypertension, hypercholesteremia, cerebrovascular disease, and chronic renal failure.
RESULTS: Between 1993 and 2010, 928 women under the age of 53 underwent ABI testing (4.2% of all women in the database). Of these, 260 had abnormal ABI (2.6%). Eighty-five percent were between the ages of 41-52 and 27.9% had critically low ABI. The most prevalent risk for premenopausal PAD in this population was current or former smoking (85%). In most cases multiple coexisting risk factors such as hypertension (57%), diabetes (55%), and hyperlipidemia (55%) were present; however, no risk factor other than smoking was present in 9.1% of women. In premenopausal non-smokers, PAD did not develop unless 3 or more risk factors were present.
CONCLUSIONS: The development of premenopausal PAD is unusual and does not develop without multiple combined risk factors. Current and former smoking was most associated with the development of premature PAD. ABI testing in premenopausal women without multiple combined risk factors, including smoking, is unlikely to be of value.
AUTHOR DISCLOSURES: A. J. Boyd, Nothing to disclose.
Posted April 2012