Ann Vasc Surg. 2026 Oct 6:S0890-5096(26)00692-8. doi: 10.1016/j.avsg.2026.09.042. Online ahead of print.
ABSTRACT
BACKGROUND: Peripheral artery disease (PAD) is a manifestation of systemic atherosclerotic cardiovascular disease and is associated with substantial cardiovascular and limb-related morbidity. High-intensity statin therapy is recommended for patients with PAD, yet statin treatment remains underused, and sex-based differences in lipid-lowering therapy may further contribute to inequities in secondary prevention. This systematic review evaluated sex-based disparities in statin use and statin intensity among adults with PAD.
METHODS: A systematic search of PubMed/MEDLINE and Cochrane CENTRAL was performed from database inception through June 6, 2026. Eligible studies included adults with PAD, reported PAD-specific statin or lipid-lowering outcomes, and compared outcomes by sex. The primary outcome was high-intensity statin use among women versus men with PAD. Secondary outcomes included any statin use, no statin therapy, guideline-concordant lipid-lowering or vascular-protective therapy, and LDL-C goal achievement. Findings were synthesized narratively because of heterogeneity in study design, PAD definition, clinical setting, and outcome reporting.
RESULTS: Eleven observational studies met inclusion criteria. Only two studies reported high-intensity statin use by sex, and both found lower use among women than men. In the Medicare cohort of patients with critical limb ischemia, high-intensity statin use was lower among women than men. Similarly, in the Veterans Affairs cohort, women with PAD had lower rates of high-intensity statin use, any statin use, and statin adherence. Across studies reporting secondary lipid-lowering outcomes, women were generally less likely than men to receive statins or guideline-concordant vascular-protective therapy, including in primary care, hospital discharge, revascularization, administrative claims, and vascular registry settings. LDL-C goal achievement was not reported in the included studies.
CONCLUSION: Women with PAD are less likely than men to receive statin therapy and guideline-concordant vascular-protective treatment, and the limited available evidence suggests lower use of high-intensity statins among women when statin intensity is reported. These findings highlight a persistent sex-based gap in secondary prevention for PAD. Future studies should report statin intensity, adherence, LDL-C goal achievement, treatment escalation, and standardized measures of statin tolerance or intolerance separately by sex. Quality-improvement efforts should also focus on improving statin prescribing for women with PAD.
PMID:42838480 | DOI:10.1016/j.avsg.2026.09.042