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A Methodological Approach to Non-invasive Assessments of Vascular Function and Morphology
Published on: February 7, 2015
Lipids and other risk factors selected by discriminant analysis in symptomatic patients with supra-aortic and
G B Vigna1, M Bolzan, F Romagnoni
1Institute of Medical Pathology, University of Ferrara, Italy.
Insights
Risk factors for atherosclerosis in the legs and neck differ by gender and location. Lipid levels, especially HDL-C, are key extracoronary risk factors, confirming their importance in peripheral atherosclerosis.
Area of Science:
- Cardiovascular Medicine
- Vascular Biology
- Atherosclerosis Research
Background:
- Atherosclerosis research has predominantly focused on coronary artery disease.
- Extracoronary atherosclerosis, affecting supra-aortic trunks and lower limbs, requires further investigation regarding its specific risk factors.
Purpose of the Study:
- To investigate and compare vascular risk factor profiles in patients with atherosclerosis of the supra-aortic trunks and lower limbs.
- To identify key differentiating risk factors based on gender and affected vascular territory.
Main Methods:
- Univariate and multivariate discriminant analyses were performed on 169 patients with angiographically proven supra-aortic or lower limb atherosclerosis.
- Risk factors, including lipid parameters (total cholesterol, triglycerides, HDL cholesterol subfractions), were assessed.
- A control group of 140 age- and sex-matched individuals was included for comparison.
Main Results:
- Smoking was strongly associated with peripheral atherosclerosis, while higher blood pressure indicated supra-aortic disease.
- Unrecognized diabetes mellitus was common in peripheral atherosclerosis patients.
- Hyperlipidemia was four times more prevalent in patients, characterized by higher triglycerides and lower HDL cholesterol (HDL-C, HDL2-C, HDL3-C).
- Discriminant analysis achieved high correct classification rates (89-96%) using specific risk factor combinations for different patient subgroups (e.g., HDL-C, smoking, blood pressure for men with peripheral disease).
Conclusions:
- Risk factor profiles for atherosclerosis in the supra-aortic trunks and lower limbs vary significantly with gender and the specific vascular district affected.
- Lipid parameters, particularly HDL-C, HDL2-C, and the TC/HDL-C ratio, are confirmed as crucial extracoronary risk factors.
Background:
Different patterns of risk factors might be related to the involvement of specific vascular districts by atherosclerosis. In this sense, many investigations have addressed coronary artery disease, whereas extracoronary atherosclerosis has received less extensive attention.
Methods And Results:
Vascular risk factors, with particular attention to lipid parameters (total cholesterol [TC]; triglycerides; high density lipoprotein cholesterol [HDL-C], HDL2 and HDL3 cholesterol [HDL2-C, HDL3-C]), were evaluated by means of univariate and multivariate (discriminant) analysis in a group of 169 patients (128 men and 41 women; mean ages, 58 +/- 7 and 62 +/- 7 years, respectively) with clinically and angiographically demonstrated atherosclerosis of the supra-aortic trunk and/or lower limbs. Patients with coronary artery disease were excluded from this study. The control group consisted of 140 age- and sex-matched individuals. By univariate analysis, smoking was more closely associated with peripheral atherosclerosis, whereas blood pressure was higher in patients with supra-aortic disease. Unrecognized diabetes mellitus was a frequent finding in patients with peripheral disease. The percentage of hyperlipidemias was fourfold higher in patients than in control subjects, with differences consisting of higher triglycerides and lower HDL-C, HDL2-C, and HDL3-C concentrations. By discriminant analysis, high correct classification (CC) rates were achieved in the various patient subgroups on the basis of variables selected from the statistical function. In male patients with peripheral disease, the variables HDL-C, smoking, diastolic blood pressure, uric acid, and glucose, in that order, yielded a CC in 90.4% of the cases; in female patients, smoking, TC/HDL-C, and body mass index gave a CC rate of 95.9%. In men with cerebral disease, the selected variables TC/HDL-C, diastolic blood pressure, and TC yielded a CC of 90.7%; in women, uric acid, TC/HDL-C, and fibrinogen levels produced a CC rate of 89.2%.
Conclusions:
Risk profiles in atherosclerosis of the supra-aortic trunks and lower limbs seem to differ in relation to gender and circulatory district involved. The importance of lipid parameters, in particular HDL-C, HDL2-C, and TC/HDL-C, as extracoronary risk factors is further confirmed.
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