Sex-Based Disparities in Statin Use and Intensity Among Women With Peripheral Artery Disease: A Systematic Review.

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.