Female patients with vascular disease receive less medical optimization despite more health care utilization.

Lowenkamp MN, Nassereldine H, Iams A, Tzeng E, Reitz KM. Female patients with vascular disease receive less medical optimization despite more health care utilization. Journal of Vascular Surgery. 2026 Feb 1; 83(2):614-622.e2, DOI: 10.1016/j.jvs.2025.09.054.

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Abstract:

OBJECTIVE: Despite optimal medical therapy (OMT) being a cornerstone of vascular care, female patients are less likely to receive it in comparison with males. This study aimed to quantify preoperative access to care and hypothesized that women would have lower documented OMT prescription rates while controlling for health care use. METHODS: This retrospective cohort study used a single-center, multihospital dataset of all adults undergoing index, elective, operative interventions for carotid, aortic, or lower extremity disease (2016-2024). The primary outcome was documented OMT (statin, antiplatelet, and nonsmoking). Multivariable logistic regression evaluated the association between documented OMT and sex, adjusting for comorbidities and health care use. RESULTS: Among 18,673 patients, 8135 (43.6%) were female. Females more frequently saw a primary care physician (PCP) (42.0% vs 40.5%; P = .042) with more visits on average (3.3 ± 7.4 vs 2.9 ± 7.0; P < .001). Females were less likely to see a cardiologist (28.9% vs 38.7%; P < .001). Despite increased PCP exposure, females were less frequently prescribed OMT (23.0% vs 28.2%; P < .001). They were more frequently prescribed pain medications (50.5% vs 42.9%; P < .001). On multivariable modeling, female sex had lower odds of preoperative OMT (adjusted odds ratio [aOR], 0.80; 95% confidence interval [CI], 0.75-0.6; P < .001). A PCP visit (aOR, 1.63; 95% CI, 1.52-1.75; P < .001) or cardiology visit (aOR, 1.73; 95% CI, 1.60-1.87; P < .001) were both associated with an increased rate of achieving documented OMT. CONCLUSIONS: Female patients were less likely to have documented OMT despite increased health care access in the form of PCP visits. Our findings highlight a potential provider bias leading to an undertreatment of females with vascular disease.