THE SAGE GROUP Raises PAD Awareness During National PAD Awareness Month
Peripheral artery disease (PAD) continues to be underrecognized and undertreated despite its substantial impact on limb health, cardiovascular outcomes and mortality, according to Mary L. Yost, president of THE SAGE GROUP. Yost highlighted persistent disparities in PAD diagnosis and treatment, particularly among women and racial and ethnic minority populations, during a review of the disease burden and consequences associated with advanced peripheral Artery vascular disease.
Yost described the unequal likelihood of undergoing a major amputation as an “Amputation Lottery,” emphasizing that amputation risk can vary according to a range of demographic, socioeconomic and healthcare-related factors. These include age, race, sex, socioeconomic status, hospital type and geographic location.
The disparities are particularly pronounced among African American patients, according to Yost. Compared with White patients, African Americans with PAD are more likely to require hospitalization and face a greater risk of major amputation. This includes both primary amputations and amputations performed after revascularization procedures.
Yost said the difference in amputation risk cannot be explained solely by disease severity or by the higher prevalence of PAD and critical limb ischemia (CLI) in African American populations. The observation highlights the potential influence of differences in diagnosis, treatment, access to specialized vascular care and management of cardiovascular risk factors.
Advanced PAD Can Lead to Limb-Threatening Ischemia
Peripheral artery disease occurs when narrowed or blocked arteries reduce blood flow to the limbs, most commonly the legs. As the disease progresses, insufficient blood supply can cause significant pain, wounds and tissue damage.
Critical limb ischemia, commonly referred to as CLI, represents an advanced stage of PAD. The condition is characterized by symptoms such as ischemic rest pain, nonhealing ulcers and gangrene. The term critical limb-threatening ischemia (CLTI) is also widely used to describe this severe stage of peripheral arterial disease.
When blood flow cannot be restored through revascularization, tissue damage may progress to the point where major amputation becomes necessary. Early recognition and intervention are therefore important components of efforts to preserve limb function and reduce complications.
According to Yost, Black race is independently associated with increased risk of major amputation, with the risk reported as approximately one to four times higher in Black patients in the cited analyses. She further highlighted particularly high risk among Black women, reporting that their risk of amputation may be nearly eight times that of White women in certain comparisons.
These disparities underscore the importance of examining PAD outcomes across different patient populations rather than considering the disease burden as uniform.
PAD Remains Underdiagnosed in Women
Yost said that the medical community has recognized for decades that PAD is frequently underestimated, underdiagnosed and undertreated. Despite greater awareness of vascular disease, she argued that these problems remain significant, particularly among women.
The issue may be especially important for Black, Hispanic and Native American women, who can face multiple barriers related to diagnosis and access to treatment.
PAD symptoms may not always be recognized as signs of vascular disease. Some patients may experience leg pain, weakness or changes in walking ability that are attributed to aging, arthritis or other conditions. Peripheral Artery As a result, diagnosis can be delayed until the disease has become more advanced.
Women may also experience different symptom patterns and clinical presentations than men, potentially complicating recognition. When PAD is not diagnosed early, opportunities to address the disease and associated cardiovascular risk factors may be missed.
Yost emphasized that delayed diagnosis can have consequences beyond the affected limb. Advanced PAD is associated with a greater risk of amputation, cardiovascular complications and death, while severe disease can also increase healthcare utilization and costs.
PAD Is a Systemic Cardiovascular Disease
Although PAD often becomes apparent through symptoms affecting the legs, the disease reflects a broader problem involving the circulatory system. Atherosclerosis that affects peripheral arteries can coexist with disease in the coronary and cerebral circulation.
“PAD is not just a leg problem. It is also a heart and a brain problem, particularly for women,” Yost said.
She reported that women with PAD face a twofold to fourfold higher risk of cardiovascular events and death. Peripheral Artery This underscores the importance of managing PAD as a systemic cardiovascular condition rather than focusing exclusively on symptoms affecting the lower extremities.
Patients with PAD frequently have additional cardiovascular risk factors, including smoking, diabetes, hypertension and abnormal cholesterol levels. Appropriate management of these risk factors can form an important part of comprehensive PAD care.
However, Yost said cardiovascular risk-factor treatments remain underused among people with PAD overall. She further noted that undertreatment is more common among women than men and can be even more pronounced among Black women compared with White women.
The gap in preventive treatment adds another dimension to the disparities observed in PAD outcomes. Patients may receive treatment for leg symptoms while important underlying cardiovascular risks remain insufficiently addressed.
Amputation Risk Is Higher Among Women in Several Settings
Yost also highlighted sex-based differences in amputation outcomes. According to her review, women with PAD can face a higher risk of amputation than men, including a particularly elevated risk of above-the-knee amputation.
The consequences can extend beyond the surgical procedure itself. Women may also experience higher mortality following amputation, adding to the already substantial health burden associated with advanced PAD.
Major limb amputation can have profound effects on mobility, independence and quality of life. It can also require extensive rehabilitation, prosthetic care and long-term medical support. For healthcare systems, advanced PAD and amputation can result in substantial costs, particularly when diagnosis and intervention occur late in the disease course.
The disparities described by Yost therefore have implications not only for clinical outcomes but also for healthcare resource utilization and the economic burden associated with PAD.
Awareness Gaps Can Delay Diagnosis
One of the challenges in reducing PAD-related disparities is limited awareness among both the general public and healthcare professionals who do not specialize in vascular medicine.
Yost said public and nonspecialist physician awareness of PAD remains low. This can contribute to underdiagnosis, delayed diagnosis and misdiagnosis, particularly among women.
A lack of recognition can mean that patients do not seek evaluation when symptoms first appear, while clinicians may not immediately consider PAD when symptoms are atypical or overlap with other common conditions.
Delayed recognition can allow disease progression before patients receive appropriate vascular evaluation. By the time PAD reaches the CLI or CLTI stage, the options for preserving the affected limb may be more limited.
Yost argued that earlier diagnosis and appropriate treatment could help prevent some amputations and deaths while reducing the costs associated with advanced disease.
Racial and Ethnic Disparities Remain an Important Concern
The disparities identified in PAD extend across racial and ethnic groups. Yost particularly emphasized the experience of Black, Hispanic and Native American women, who may experience gaps in diagnosis and treatment.
For Black patients, the increased risk of amputation is not necessarily explained solely by differences in disease prevalence or severity. This raises broader questions about differences in healthcare access, referral patterns, treatment utilization, socioeconomic factors and other determinants of health.
Understanding these differences is important for developing strategies that can improve outcomes across patient populations. Greater awareness among primary care providers and other nonspecialists may help identify patients earlier, while appropriate vascular assessment can support timely diagnosis and intervention.
Addressing cardiovascular risk factors is another key component. Since PAD is associated with systemic cardiovascular disease, management needs to extend beyond treatment of the affected limb.
Earlier Intervention May Help Reduce the Disease Burden
The information highlighted by Yost points to several areas that could influence PAD outcomes: earlier recognition, accurate diagnosis, timely vascular treatment and more consistent management of cardiovascular risk factors.
Early-stage PAD may be managed differently from advanced limb-threatening disease, making timely identification particularly important. Once patients progress to severe ischemia, the risks of tissue loss, infection, amputation and mortality can increase substantially.
Greater awareness could also encourage patients with risk factors or symptoms to seek medical evaluation earlier. At the clinical level, improved recognition of PAD among nonspecialists could support more appropriate referral for vascular assessment.
For women, addressing the historical underrecognition of cardiovascular disease is particularly relevant. The data highlighted by Yost suggest that PAD should be considered as part of women’s broader cardiovascular health rather than treated exclusively as a condition affecting the legs.
THE SAGE GROUP Focuses on Peripheral Vascular Disease
THE SAGE GROUP is a research and consulting company specializing in peripheral Artery vascular disease and related healthcare and economic issues. Its areas of focus include chronic venous disease, venous thromboembolism (VTE), PAD and critical limb ischemia, as well as the economic costs and consequences associated with these conditions.
The Peripheral Artery company’s work examines clinical and market factors affecting vascular disease, including disparities in diagnosis and treatment and their Artery potential impact on patient outcomes and healthcare spending.
The observations highlighted by Yost reinforce the continuing need for greater recognition of PAD, particularly among populations experiencing disproportionate risks. While PAD can affect both men and women, the cited evidence points to important differences in diagnosis, treatment, amputation and mortality outcomes among women and racial and ethnic minority populations.
Ultimately, PAD represents more than a condition that affects mobility or causes leg symptoms. Its association with cardiovascular events and mortality makes it an important systemic health concern. Improving awareness, identifying disease earlier, providing appropriate treatment and addressing cardiovascular risk factors could all play roles in reducing the burden of advanced PAD and its potentially devastating consequences, including major amputation and premature death.