Is PAD More Common in Men or Women?

For many years, peripheral artery disease was framed as a condition that primarily affected men. Current evidence no longer supports that view. Multiple large-scale studies, including the Multi-Ethnic Study of Atherosclerosis and the Life Line Screening program data, now show that PAD prevalence is similar between men and women, or in some populations, higher in women.^[1][2]

The earlier belief that PAD was more common in men stemmed, in part, from diagnostic patterns. Men are more likely to present with classic claudication, which is muscle cramping in the calves during exercise that disappears with rest. This textbook symptom is easier for clinicians to recognize. Women, by contrast, are more likely to present with atypical or no symptoms at all, which has historically led to fewer diagnoses rather than fewer cases.^[1]

What this means practically: both men and women face meaningful risk, and neither group should assume PAD is not relevant to them based on gender alone.

How PAD Symptoms Differ in Women vs. Men

Common PAD Symptoms in Men

Men with peripheral artery disease are more likely to develop intermittent claudication (IC), the defining symptom of PAD. This shows up as a predictable aching, cramping, or heaviness in the calves, thighs, or buttocks that appears during walking or physical activity and eases within minutes of rest. Because this pattern is well-recognized, men with claudication are more likely to receive a timely vascular evaluation.

Other PAD symptoms men may notice include:

1. Weak or absent pulse in the feet or legs
2. Skin that appears pale, shiny, or discolored on the lower limbs
3. Slow-healing sores or wounds on the feet or ankles
4. Coolness in one leg compared with the other
5. Slowed nail or hair growth on the legs

PAD Symptoms Women Often Experience

Research from the Women’s Health and Aging Study found that only 14% of women with confirmed PAD had a history of classic claudication, and 64% were entirely asymptomatic as far as typical limb symptoms were concerned.^[3] When women do experience symptoms, they tend to be subtler and more varied.

Women with PAD may notice:

1. Vague leg fatigue or heaviness without a clear activity trigger
2. Discomfort or aching that occurs at rest, not only during exercise
3. Leg pain that seems to shift or does not fit a predictable pattern
4. Sensations that resemble musculoskeletal or joint-related pain

These atypical presentations make it harder for both patients and clinicians to connect symptoms to arterial disease. Women are also more likely to be older at the time of PAD diagnosis than men, which means the disease may have had more time to progress.^[2]

Why Women Are More Likely to Be Misdiagnosed

Because women’s PAD symptoms frequently resemble other conditions, misdiagnosis is common. Leg discomfort, heaviness, and fatigue are often attributed to arthritis, osteoporosis, or venous insufficiency. Over 80% of women with lower-extremity PAD are either asymptomatic or have atypical leg pain.^[3] Without classic claudication to guide clinical suspicion, PAD may not appear on the differential diagnosis.

This delay has real consequences. Women are more likely to be diagnosed at more advanced stages of PAD than men, and to have multi-vessel arterial disease identified when they do receive evaluation.^[1] Learning more about the early signs of peripheral artery disease may help patients of both sexes recognize when leg symptoms deserve more than a wait-and-see response.

PAD Risk Factors: What Men and Women Share (and What Differs)

Shared Risk Factors for All Adults

Peripheral artery disease is primarily caused by atherosclerosis, the buildup of plaque inside the arterial walls. Several risk factors accelerate this process in men and women equally:

1. Smoking (current or past)
2. Type 2 diabetes
3. High blood pressure (hypertension)
4. High LDL cholesterol
5. Age over 50
6. Family history of cardiovascular disease
7. Physical inactivity
8. Obesity

Race and ethnicity also play a role. Black Americans have a significantly higher prevalence of PAD than other groups, a risk pattern that holds across genders.^[4]

Risk Factors That Affect Women Differently

For women, hormonal changes may contribute meaningfully to PAD risk in ways that differ from men. Estrogen helps maintain healthy cholesterol levels and reduces inflammation in the blood vessel walls. When estrogen levels decline during perimenopause and menopause, typically in a woman’s 40s and 50s, cholesterol profiles can shift toward higher LDL levels and the protective effect on blood vessels diminishes. For a closer look at how hormonal changes may influence vascular health, see our article on how hormones affect your vascular system.

Diabetes is also a disproportionate risk factor for women with PAD. Research shows that diabetes has a stronger association with coronary artery disease in women with PAD than in men, and women with diabetes may develop vascular complications at a faster rate.^[2] Women with PAD are also more likely to present with high total cholesterol and hypertension compared with men at diagnosis.^[1]

Risk Factors That Affect Men Differently

Men have historically had higher smoking rates than women, and smoking remains one of the strongest modifiable risk factors for PAD. Smoking damages the lining of the arteries and significantly increases the likelihood of plaque buildup. Men are also more likely to develop type 2 diabetes earlier, with fewer warning signs, which may contribute to earlier PAD onset and the higher rate of classic claudication observed in men. Understanding the full range of risk factors for peripheral artery disease is an important step for anyone wanting to assess their personal level of risk.

The Diagnostic Gap: Why Women With PAD Often Wait Longer

The gap between when PAD develops and when it is diagnosed tends to be wider in women. Several factors contribute:

• Atypical presentation. Because women often do not develop classic claudication, there is less to prompt a clinician to order vascular testing.
• Misattribution of symptoms. Leg fatigue, heaviness, and pain that varies by position are common symptoms in conditions like venous disease or arthritis, both of which are more prevalent in women. Symptoms that fit those patterns may not trigger an arterial workup.
• Diagnostic bias. Research has found that men are more likely to receive guideline-directed medical therapy for PAD and are more likely to receive lipid-lowering therapy, antiplatelet medications, and statin prescriptions than women with the same diagnosis.^[4]

The primary diagnostic tool for PAD is the ankle-brachial index (ABI) test, which compares blood pressure at the ankle with blood pressure at the arm. An ABI below 0.9 indicates arterial narrowing. This test is non-invasive, takes only a few minutes, and can be performed in an outpatient clinic. For anyone with risk factors or unexplained leg symptoms, the ABI can provide clarity quickly. Our article on how PAD is diagnosed walks through the full evaluation process in detail.

PAD Complications and What the Data Show by Sex

One of the most clinically significant findings in the gender-PAD literature is that women are more likely to present with critical limb ischemia (CLI) at the time of first vascular evaluation than men.^[2] CLI is the most severe stage of PAD, characterized by rest pain, non-healing sores, and tissue loss that may require amputation if untreated.

This is a direct consequence of the diagnostic gap: when PAD is not caught at an earlier stage, it progresses. Women who do receive revascularization tend to have more extensive multi-vessel arterial disease, and some studies report higher rates of access site complications in women compared to men at the time of the procedure.^[1][2]

Long-term limb salvage rates are broadly similar between men and women, which underscores that effective treatment is possible for both sexes when evaluation happens in time. The critical variable is timing. Getting evaluated before symptoms reach the CLI stage changes the range of available options considerably. See our overview of PAD complications for a full picture of what untreated disease can lead to.

When Should You Get Evaluated for PAD?

Whether you are a man or a woman, the decision to seek a PAD evaluation should not hinge on whether your symptoms match the textbook description. Given that women’s PAD often presents without classic claudication, any of the following may be a reason to consult a vascular specialist:

• Persistent leg fatigue or heaviness without a clear cause
• Leg discomfort at rest, particularly in the feet at night
• Slow-healing wounds on the feet or lower legs
• Coldness or color difference in one leg vs. the other
• A known risk factor such as smoking history, diabetes, or high blood pressure over age 50

An ABI test can be completed in an outpatient setting and provides a rapid, non-invasive look at arterial blood flow. If you are unsure whether your symptoms warrant attention, a vascular evaluation is a straightforward way to get clarity. For a full breakdown of what to watch for, visit our guide to the first signs of peripheral artery disease.

Annual vascular screenings are particularly valuable for individuals with multiple PAD risk factors. Early detection expands treatment options, from lifestyle modifications and medication to minimally invasive outpatient procedures, such as angioplasty, stent placement, or an atherectomy.