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Comparative study of risk factors in patients undergoing coronary or femoropopliteal artery bypass grafting
1Laboratoire de Biochimie A, Plateau technique CHU-Hôtel Dieu, Nantes, France.
Insights
This study found that lipid and apoprotein disturbances differ based on bypass site in advanced atheroma patients. Smoking significantly impacts femoropopliteal bypass patients, while obesity is a lesser factor in coronary bypass patients.
Area of Science:
- Cardiovascular Medicine
- Epidemiology
- Biochemistry
Background:
- Advanced atheroma necessitates surgical intervention like coronary or femoropopliteal artery bypass grafting.
- Understanding risk factor variations across different vascular disease localizations is crucial for targeted prevention and treatment strategies.
Purpose of the Study:
- To compare risk factors in patients undergoing coronary artery bypass grafting (CABG) versus femoropopliteal artery bypass grafting (FPBG).
- To elucidate the differing roles of risk factors in the localization of vascular disease.
Main Methods:
- Cross-sectional epidemiological study involving 464 men undergoing CABG, 74 men undergoing FPBG, and 204 controls.
- Measurement of lipid and lipoprotein concentrations, alongside assessment of major risk factors (smoking, hypertension, obesity, diabetes).
- Statistical analysis included analysis of covariance, chi-squared test, and logistic discriminant analysis for comparisons.
Main Results:
- Both patient groups exhibited dyslipidemia, with greater disturbances in the coronary artery bypass grafting group for specific lipid ratios (R1, R2).
- A higher prevalence of smokers was observed in the femoropopliteal bypass group compared to the coronary bypass group.
- Logistic discriminant analysis identified smoking, the apolipoprotein AI to apolipoprotein B ratio (R2), and obesity as key differentiating factors.
Conclusions:
- Lipid and apoprotein concentration disturbances vary significantly depending on the bypass surgical site.
- Smoking emerged as a primary accelerator of the atherogenic process in femoropopliteal artery bypass grafting patients.
- Obesity played a less pronounced, but still notable, role in the progression of disease for coronary artery bypass grafting patients.
Objective:
To compare risk factors in two populations of patients with advanced atheroma requiring coronary or femoropopliteal artery bypass grafting to try to account for the different localisations of vascular disease.
Design:
Cross sectional epidemiological study.
Setting:
Cardiovascular surgery department of a university hospital.
Subjects:
464 men (mean age 59.25 (SD 8.57) years) undergoing coronary artery bypass grafting; 74 men (mean age 56.28 (13.3) years) undergoing femoropopliteal artery bypass grafting; and 204 control men (mean age 45.07 (6.59) years) who had been recruited in a preventive medicine department.
Interventions:
Blood samples were drawn 24 hours before surgery.
Methods:
Lipid and lipoprotein concentrations were measured for each patient and with adjustment for age were compared by analysis of covariance. The main risk factors (smoking, arterial hypertension, obesity, and diabetes) were determined by a standardised history, and the chi 2 test was used to compare the results in the two patient groups. Pairwise comparisons between the three populations were performed by logistic discriminant analysis.
Results:
Both patient groups showed a significant rise in triglyceride concentration and in the ratio of total cholesterol to high density lipoprotein cholesterol (R1) and a drop in apolipoprotein AI and high density lipoprotein cholesterol concentrations. Disturbances were greater in patients undergoing coronary artery bypass grafting than in those undergoing femoropopliteal artery bypass grafting for the R1 ratio, apolipoprotein B concentration, and the ratio of apolipoprotein AI to apolipoprotein B (R2). A higher proportion of smokers was found in the femoropopliteal bypass group than in the coronary bypass group, whereas were often obese. Logistic discriminant analysis with adjustment for age and with the coronary bypass as the reference group selected three factors: smoking, the R2 ratio, and obesity.
Conclusion:
Disturbances in lipid and apoprotein concentrations varied with respect to bypass site. Other risk factors played a part in accelerating the atherogenic process, especially smoking in patients undergoing femoropopliteal artery bypass grafting and, to a lesser degree, obesity in patients undergoing coronary artery bypass grafting.