Correlation Between Small Dense Low-Density Lipoprotein and Tissue Perfusion in Diabetic Foot

Small dense low-density lipoprotein (sdLDL) is recognized as a reliable predictor of atherosclerotic vascular diseases and is also associated with the severity of diabetes. Vascular status directly affects tissue perfusion, indicating that sdLDL could serve as a potential marker for tissue perfusion in diabetic feet. However, an alternative possibility exists. In patients with diabetes, discrepancies can occur between vascular status and actual tissue perfusion due to complications related to diabetes such as neuropathy and hematologic changes in red blood cells. In such instances, sdLDL may not consistently correlate with tissue perfusion. Tissue perfusion is a crucial element in managing diabetic foot conditions. Despite acknowledging its importance, no studies to date have explored the relationship between sdLDL levels and tissue perfusion in diabetic feet. This prospective study seeks to explore this correlation.

Fifty patients with diabetes were enrolled in the study. Tissue perfusion was assessed by measuring the foot's transcutaneous oxygen pressure (TcPO₂). SdLDL levels were determined based on the mean low-density lipoprotein (LDL) particle size, proportion of sdLDL as a percentage of total LDL, and LDL subfraction score. Correlations between TcPO₂ and each variable were evaluated through scatter plots, and correlation coefficients (R) with corresponding P values were calculated. Statistical analyses were conducted for all participants and further stratified into two subgroups based on a TcPO₂ threshold of ≥ 40 mmHg and < 40 mmHg.

In the overall analysis (n = 50), no statistically significant relationships were detected between TcPO₂ and sdLDL size, sdLDL percentage, or LDL subfraction score. Nevertheless, in the TcPO₂ ≥ 40 mmHg subgroup (n = 29), a statistically significant positive correlation was found between mean LDL particle size and TcPO₂ (R = 0.414, P = 0.026). In contrast, statistically significant negative correlations emerged between sdLDL percentage and TcPO₂ (R = -0.415, P = 0.025), as well as between LDL subfraction score and TcPO₂ (R = -0.419, P = 0.024).

This study identified a significant correlation between sdLDL levels and tissue perfusion in diabetic feet with TcPO₂ ≥ 40 mmHg, but no significant correlation in those with TcPO₂ < 40 mmHg.