Risk Factors for Progression of Peripheral Arterial Disease in Large and Small Vessels

Abstract

Background-Data on the natural history of peripheral arterial disease (PAD) are scarce and are focused primarily on clinical symptoms. Using noninvasive tests, we assessed the role of traditional and novel risk factors on PAD progression. We hypothesized that the risk factors for large-vessel PAD (LV-PAD) progression might differ from small-vessel PAD (SV-PAD). Methods and Results-Between 1990 and 1994, patients seen during the prior 10 years in our vascular laboratories were invited for a new vascular examination. The first assessment provided baseline data, with follow-up data obtained at this study. The highest decile of decline was considered major progression, which was a Ϫ0.30 ankle brachial index decrease for LV-PAD and a Ϫ0.27 toe brachial index decrease for SV-PAD progression. In addition to traditional risk factors, the roles of high-sensitivity C-reactive protein, serum amyloid-A, lipoprotein(a), and homocysteine were assessed. Over the average follow-up interval of 4.6Ϯ2.5 years, the 403 patients showed a significant ankle brachial index and toe brachial index deterioration. In multivariable analysis, current smoking, ratio of total to HDL cholesterol, lipoprotein(a), and high-sensitivity C-reactive protein were related to LV-PAD progression, whereas only diabetes was associated with SV-PAD progression. Conclusions-Risk

Long‐Term Prognostic Risk in Lower Extremity Peripheral Arterial Disease as a Function of the Number of Peripheral Arterial Lesions

“…This raises the question whether it is possible that the manifestation of atherosclerosis may present differentially among individual patients’ arteries. More aggressive expression of atherosclerosis has been found in patients with distal versus aortoiliac disease and in patients in whom higher inflammation markers can be found 17, 18, 19. These studies suggested which concomitant factors could be associated with a more aggressive underlying atherosclerotic process but were unable to document whether this could be linked to the number of lower extremity lesions and patient outcomes 17, 18.…”

“…More aggressive expression of atherosclerosis has been found in patients with distal versus aortoiliac disease and in patients in whom higher inflammation markers can be found 17, 18, 19. These studies suggested which concomitant factors could be associated with a more aggressive underlying atherosclerotic process but were unable to document whether this could be linked to the number of lower extremity lesions and patient outcomes 17, 18. Consequently, future work needs to verify whether having more lower extremity lesions is associated with a more aggressive underlying atherosclerotic process expressed by higher inflammation markers or undergoing multiple lower extremity revascularizations to better characterize PAD subpopulations that are at increased risk of an adverse prognosis.…”

Peripheral Arterial Disease—What Do We Need to Know?

“…14 Smoking not only contributes to the incidence, but also is a significant predictor of progression of symptomatic PAD. 15 Smoking cessation may not reduce claudication symptoms but has been shown to reduce overall mortality and cardiovascular events. 16 …”

Atherosclerotic Risk Factors Among Ankle-Brachial Index and Toe-Brachial Index in Peritoneal Dialysis Patients

“…In this study, a positive correlation existed between ABI value and systolic blood pressure, diastolic blood pressure, and pulse pressure. In a longitudinal study of the general population, [16] among traditional risk factors, blood pressure was not an independent factor or significant predictor for ABI values. Vinuesa et al [17] described that in chronic kidney disease patients, low ABI value was correlated with low systolic blood pressure, low diastolic blood pressure, and high pulse pressure.…”

“…Aboyans et al [16] recently identified risk factors contributing differentially to the progression of large-vessel peripheral vascular disease (LV-PAD) and small-vessel peripheral vascular disease (SV-PAD). Their study of the general population demonstrated that cigarette smoking, elevated lipid levels, and inflammation contribute to LV-PAD, and that diabetes was the only significant predictor of SV-PAD progression.…”