Women may be more likely than men to have undiagnosed peripheral artery disease (PAD) at the time of screening, despite meeting similar risk criteria, according to new data from a community-based screening program targeting underserved populations.
The study analyzed participants in the CHAMPIONS initiative, a program designed to deliver free cardiovascular and limb-focused screening in vascular deserts, or areas where access to specialty care is limited.
“Sex-based disparities in vascular disease are not new,” said Leigh Ann O’Banion, MD, senior author on the study and associate clinical professor of surgery at the University of California, San Francisco Fresno. “They are consistently described in registry, claims and health system data, where females with PAD are more likely to be diagnosed later, present with less typical symptoms and experience worse functional and limb outcomes. The limitation is that most of those datasets capture patients only after they have entered the health care system.”
The retrospective analysis included 736 participants screened between 2022 and 2025. Investigators used guideline-based criteria to classify participants as at risk for PAD and performed toe brachial index (TBI) testing in those individuals. The primary objective was to evaluate whether sex was associated with being labeled at risk and with having PAD detected through objective hemodynamic testing.
The program was designed with a prevention-focused approach rather than identifying candidates for procedures. “None of these participants were being screened to determine whether they needed invasive intervention,” said O’Banion. “The goal is prevention: to detect atherosclerotic disease earlier, identify cardiovascular risk and intervene with education, medical therapy and risk factor modification to halt progression — long before late-stage disease and revascularization enter the picture.”
The most notable finding was a disconnect between risk classification and actual disease detection. “Males and females were similarly likely to meet guideline-based criteria for being at-risk for PAD,” said Guistinna Tun, first author on the study. “Yet, among those who were tested and at risk, females were more likely to have PAD based on TBI. PAD was confirmed in 10.9% of at-risk females versus just 2.8% of at-risk males. It’s a stark difference.”
The findings also highlight the role of socioeconomic disadvantage, which was more prevalent among women and may contribute to delayed diagnosis. “Females in this cohort carried substantial socioeconomic disadvantages,” said Tun. “They were less likely to be employed. Even if they were employed, they made the least annual income compared to men. They were more likely to report grade school as being their highest level of education. This matters because social risk and access barriers shape whether risk factors are being treated early and whether symptoms lead to testing.”
O’Banion said the data suggest a need to rethink how PAD risk is evaluated in women, particularly those who present with atypical symptoms. “Females are more likely to have leg symptoms that do not fit the classic claudication story and those symptoms are more likely to be attributed to nonvascular causes,” she said. “The result is a lower index of suspicion, fewer objective tests and a longer runway before diagnosis. Our data suggest that even when males and females meet similar risk-based screening thresholds, females may already have more established atherosclerotic disease when objective testing finally happens.”
Community-based screening programs like CHAMPIONS may help address these disparities by improving access to early detection. “In vascular deserts, the barriers are not subtle: geographic distance to specialty care, limited access to noninvasive testing, language barriers, financial insecurity and inconsistent primary care access,” said O’Banion. “When the system requires multiple steps before a patient reaches objective testing, the patients most likely to fall through are the ones with the fewest resources.”
Tun said the findings ultimately reinforce the importance of early detection and prevention. “We need better strategies for earlier detection in females, whether it be through education or reshaping how clinicians interpret leg symptoms and how our community understands PAD,” she said. “We also need more community screenings. In terms of taking the extra step, it would be being able to partner with a reliable bridge to longitudinal care. Something that often comes up is that we get screening results, there’s something wrong, but what do we do next? How do we ensure that our patients are being connected with care and that they’re being taken care of beyond the day of the screening?”
