Researchers at the University of New South Wales have highlighted a troubling finding: risk factors for atherosclerosis in the leg arteries hit women harder. The study, published in PLOS One, emphasizes that smoking, high blood pressure, excess weight, and related conditions pose a greater threat to women when it comes to peripheral artery disease PAD and its most severe form, painful or dangerous issues in the leg arteries.
Peripheral artery disease affects more than 235 million people worldwide. It involves the buildup of atherosclerotic plaques in arteries that supply the limbs, most often the legs, which can impair blood flow. The consequences are serious and often more severe in women. The research notes that PAH surgery in women carries a higher risk of complications and mortality compared with men, underscoring the need for gender-aware prevention and treatment strategies.
The study pooled data from over 500,000 participants with an average age around 57, drawn from the UK Biobank. The follow-up period extended roughly 13 years. In that time frame, more than 2,500 women and about 5,000 men progressed to severe PAH that required hospitalization or led to death. These figures point to meaningful sex differences in how PAD progresses and in the outcomes of its most serious manifestations.
Across the board, established risk factors for PAD were confirmed, including smoking, overweight status, high blood pressure, diabetes of either type 1 or type 2, and a prior history of stroke or heart attack. Notably, the same risk factors were more dangerous for women, which helps explain the observed disparity in disease severity and outcomes between the sexes.
On the protective side, higher levels of high-density lipoprotein cholesterol, the so called good cholesterol, were linked to better outcomes. Each 1 mmol/L increase in HDL was associated with a 44 percent reduction in PAH risk for women and a 20 percent reduction for men. This highlights the importance of lipid health as a potential lever to reduce risk, especially for women who appear more vulnerable to the other risk factors.
These findings reinforce the call for stronger prevention efforts targeted at women. Clinicians are advised to be vigilant for PAD symptoms in women, recognizing that leg discomfort or claudication may present atypically or be delayed in its recognition. Early detection and risk-factor management can alter the disease trajectory, reducing the likelihood of severe PAH that necessitates hospitalization or carries a higher mortality risk.
Researchers also note that the disease may manifest differently in men and women, which could influence both diagnosis and treatment decisions. In men, PAD symptoms often emerge as clear leg pain with activity, while women may experience subtler signs that lead to later identification. This gender gap in presentation underscores the need for awareness campaigns and clinician education to shorten diagnostic timelines for women.
Additional evidence from prior studies shows gender differences in the risks of stroke, heart attack, and dementia tied to the same risk factors, suggesting that sex-specific strategies are essential across cardiovascular and vascular health. The latest work calls for integrating sex as a biological variable in future PAD research and in public health messaging, aiming to reduce preventable damage and improve outcomes for women around the world.
As the science advances, healthcare providers are encouraged to focus on comprehensive risk reduction, including smoking cessation, weight management, blood pressure control, diabetes prevention and management, plus encouraging HDL-friendly lifestyle choices. The goal is to empower patients with women-centered care that recognizes unique patterns of risk and disease progression while offering clear paths to prevention and earlier intervention.
Citations: This summary references the PLOS One study on gender differences in PAD risk factors and outcomes and related analyses from the UK Biobank dataset. These sources provide a broader picture of how vascular health scales with sex and age across populations.