Women and Hispanics with vascular disease fare worse than men and non-Hispanics, respectively, according to two studies by researchers at Weill Cornell Medical College (WCMC). And the disparities, which extend to treatment rates and outcomes, may be the result of socio-economic, cultural and genetic factors -- all of which deserve more attention, the researchers say.

The studies, published in recent issues of the Journal of Vascular Surgery, took separate looks at the two groups through existing medical literature and patient records.

The first, led by Ageliki G. Vouyouka, assistant professor of surgery at WCMC and a vascular surgeon at NewYork-Presbyterian Hospital, found that doctors often overlook signs of arterial vascular disease in older American women.

"For years, cardiovascular research has focused almost exclusively on males, so in many cases we simply don't understand the true prevalence or level of threat women face from vascular disease," said Vouyouka.

Vouyouka and colleagues looked at arterial vascular disease, which involves the gradual closure of arteries throughout the body. They found that while women's arteries are much smaller than men's and therefore more easily blocked, carotid plaque is more stable in women -- making the risk of stroke significant as arteries get increasingly blocked.

For lower-extremity arterial occlusive disease, in which blood flow to the legs is restricted, the researchers found that women's risk rises quickly after menopause and with such risk factors as osteoporosis and hormone replacement therapy (HRT).

Rates of wound complications after bypass surgery are also higher among women, the researchers noted. And because women seek medical help later than men, they are more likely to require amputation.

"Many of these findings remain tenuous, however, because we simply do not have enough women participating in clinical trials to firmly establish their risk factors, disease prevalence, indications for intervention or treatment outcomes," Vouyouka said. "For that reason, we urge the creation of more randomized trials focused on women, a closer look at the impact of risk factors such as osteoporosis and HRT on women's vascular health, and studies examining the role that social isolation plays in older women's ability to receive care."

In the second study, researchers looked at Hispanic and non-Hispanic patients with regard to three common vascular surgery procedures: lower extremity revascularization (LER), carotid revascularization and abdominal aortic aneurysm (AAA) repair.

They found that Hispanic patients, compared with non-Hispanic whites, had higher rates of amputation following LER (a surgical procedure to restore blood supply to a body part or organ) and greater risk for death following elective AAA repair.

Hispanic patients frequently wait until their disease is more advanced before seeking treatment, the study found. They also spend more time in the hospital recovering.

"These are significant disparities, and the reasons for them must be determined in order to make improvements," said Nicholas J. Morrissey, director of clinical trials and a vascular surgeon at NewYork-Presbyterian Hospital/Columbia University Medical Center, assistant professor of surgery at WCMC and the study's lead investigator.

"One explanation may be socio-economic factors, particularly insurance status, which could impede Hispanic patients' access to proper preventive and diagnostic care," Morrissey added.

Consistent with previous studies, the researchers also found elevated rates of diabetes, renal failure and hypertension among Hispanic patients.

"The Hispanic population represents the fastest-growing minority in the United States. As the population grows and ages, the vascular surgery community will be providing increasing amounts of care to this diverse group," Morrissey said.