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Lipid risk factors in patients requiring arterial reconstruction
J M Seeger1, S H Silverman, T C Flynn
1Department of Surgery, University of Florida, Gainesville.
Insights
Lipid risk factors for peripheral atherosclerosis differ from coronary artery disease. Low high-density lipoprotein cholesterol (HDL-C) and high very-low-density lipoprotein cholesterol (VLDL-C) predict peripheral atherosclerosis, especially below the inguinal ligament.
Area of Science:
- Vascular Biology and Atherosclerosis Research
Background:
- Progressive peripheral atherosclerosis frequently causes bypass graft failure.
- Lowering blood cholesterol can slow coronary atherosclerosis, suggesting a similar approach may benefit peripheral atherosclerosis.
Purpose of the Study:
- To identify specific lipid risk factors contributing to peripheral atherosclerosis.
- To differentiate lipid profiles associated with peripheral atherosclerosis from those of coronary atherosclerosis.
Main Methods:
- Studied 144 patients with peripheral atherosclerosis and 61 age-matched controls.
- Measured fasting lipid and lipoprotein levels, including cholesterol, triglycerides, HDL-C, LDL-C, and VLDL-C.
- Assessed incidence of hypertension, diabetes mellitus, tobacco use, and atherosclerosis severity and location.
Main Results:
- Patients with peripheral atherosclerosis exhibited higher VLDL-C and lower HDL-C compared to controls; total cholesterol and LDL-C were similar.
- Diabetes mellitus, low HDL-C, and tobacco use were significant predictors of peripheral atherosclerosis, with diabetes being the strongest.
- Peripheral atherosclerosis distal to the inguinal ligament was associated with low HDL-C and high VLDL-C, but not elevated cholesterol or LDL-C.
Conclusions:
- Lipid risk factors for peripheral atherosclerosis are distinct from those for coronary artery disease.
- Interventions to reduce lipid levels for limiting late bypass graft failure should target VLDL-C and HDL-C.
Abstract:
Progressive peripheral atherosclerosis commonly leads to failure of a bypass graft. Lowering blood cholesterol retards coronary atherosclerosis and similar treatment might limit peripheral atherosclerosis. To identify lipid risk factors for peripheral atherosclerosis, 144 patients with peripheral atherosclerosis (98 with severe disease and 46 with stable claudication) and 61 age-matched control subjects were studied. Fasting lipid (cholesterol and triglycerides) and lipoprotein (high-density lipoprotein [HDL], low-density lipoprotein [LDL], and very-low-density lipoprotein [VLDL] cholesterol [C]) levels were measured. The incidence of hypertension and diabetes mellitus, amount of previous tobacco use, and location and severity of the peripheral atherosclerosis were also determined. Patients with peripheral atherosclerosis had higher VLDL-C and lower HDL-C levels than controls had, but serum cholesterol and plasma LDL-C levels were similar. Patients with peripheral atherosclerosis also had a higher incidence of diabetes mellitus and hypertension. Predictors of peripheral atherosclerosis by regression analysis were diabetes mellitus, low HDL-C levels, and tobacco use, with diabetes mellitus being the strongest variable. Peripheral atherosclerosis below the inguinal ligament was strongly predicted by low HDL-C and increased VLDL-C levels but not by increased cholesterol or LDL-C levels. Thus lipid risk factors for peripheral atherosclerosis are different, and attempts at limiting late graft failure by lowering lipid levels should be directed toward these lipoproteins.