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Relationship Between Lymphedema and Arteriosclerosis: Higher Cardio-Ankle Vascular Index (CAVI) in Lymphedematous
Takumi Yamamoto1, Nana Yamamoto, Marie Yamashita
1From the *Department of Plastic and Reconstructive Surgery, the University of Tokyo, Tokyo, Japan; and †Department of Plastic Surgery, Toranomon Hospital, Tokyo, Japan.
Insights
Higher body mass index (BMI), longer duration of lower extremity lymphedema (LEL), and advanced leg dermal backflow (LDB) stage are linked to increased arterial stiffness in patients with LEL. This study highlights key factors influencing cardiovascular health in this population.
Area of Science:
- Vascular Biology and Medicine
- Oncology and Public Health
Background:
- Arteriosclerosis poses a significant public health challenge, particularly in developed nations, due to its high prevalence and lethal outcomes.
- Existing research suggests a connection between lymphatic vessel dysfunction and the development of atherosclerosis, but clinical evidence remains limited.
- Lymphedema's impact on arteriosclerosis progression warrants clinical investigation.
Purpose of the Study:
- To investigate the relationship between lower extremity lymphedema (LEL) and arterial stiffness, as measured by cardio-ankle vascular index (CAVI).
- To identify risk factors associated with increased arterial stiffness in patients with pelvic cancer-related LEL.
Main Methods:
- Evaluation of 48 limbs from 24 female patients diagnosed with pelvic cancer-related LEL.
- Measurement of cardio-ankle vascular index (CAVI) as an indicator of arterial stiffness.
- Comparative analysis of CAVI based on arteriosclerosis risk factors (age, BMI, hypertension, diabetes, hyperlipidemia, smoking) and LEL-related factors (duration, pelvic irradiation, cellulitis, LEL index, leg dermal backflow stage).
Main Results:
- Univariable analyses showed significant differences in CAVI based on BMI, hypertension, hyperlipidemia, and leg dermal backflow (LDB) stage.
- Multivariable analysis identified higher BMI, longer duration of LEL, and higher LDB stage as independent factors associated with elevated CAVI.
- Specifically, higher BMI correlated with increased arterial stiffness (P < 0.01), as did longer LEL duration (P = 0.04) and higher LDB stage (P = 0.04).
Conclusions:
- Higher body mass index (BMI), prolonged duration of lower extremity lymphedema (LEL), and advanced leg dermal backflow (LDB) stage are independently associated with increased arterial stiffness (CAVI).
- These findings underscore the clinical importance of managing LEL and associated factors to mitigate cardiovascular risk in cancer survivors.
Background:
Arteriosclerosis is one of the most important public health issues because it is very common in developed countries and its sequelae are lethal. Lymphatic vessel insufficiency has been reported to be associated with atherogenesis. Lymphedema seems to affect progression of arteriosclerosis, but no clinical study has been reported.
Methods:
Forty-eight limbs of 24 female patients with pelvic cancer-related lower extremity lymphedema (LEL) were evaluated. Cardio-ankle vascular index (CAVI), an indirect estimate of the arterial stiffness, was measured in each limb. Cardio-ankle vascular index was compared according to known arteriosclerosis risk factors including age (younger than 65 years vs 65 years), body mass index (BMI; <25 vs 25 kg/m), hypertension (HT), diabetes mellitus, hyperlipidemia (HL), and smoking, as well as according to LEL-related factors including duration of LEL (<5 years vs 5 years), pelvic irradiation, leg cellulitis, LEL index (<250 vs 250), and leg dermal backflow (LDB) stage (LDB stage 0/I vs LDB stage II/III/IV/V) using univariable analyses and multivariable analysis.
Results:
Univariable analyses revealed statistically significant differences in CAVI between lower BMI and higher BMI [7.19 (0.75) vs 8.36 (1.24), P < 0.01], HT (-) and HT (+) [7.25 (0.81) vs 8.17 (1.29), P < 0.01], HL (-) and HL (+) [7.19 (0.74) vs 8.06 (1.27), P < 0.01], and lower LDB stage and higher LDB stage [6.87 (0.65) vs 7.76 (1.05), P < 0.01]. Multivariable analysis revealed statistically significant differences in CAVI between lower BMI and higher BMI (P < 0.01), shorter duration of LEL and longer duration of LEL [7.21 (1.04) vs 7.71 (0.97), P = 0.04], and lower LDB stage and higher LDB stage (P = 0.04) CONCLUSIONS: Higher BMI, longer duration of LEL, and higher LDB stage were independent factors associated with higher CAVI in pelvic cancer-related LEL.
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