Key result
Female sex is linked to ~67% lower odds of proximal atherosclerosis in symptomatic PAD.
Why the study?
The pathomechanisms underlying distinct atherosclerosis phenotypes within the lower extremity peripheral vascular tree remain poorly understood.
Are specific cardiovascular risk factors and sex associated with proximal versus distal atherosclerosis distribution in symptomatic PAD?
Cross-Sectional (n=637)
No
Are specific cardiovascular risk factors and sex associated with proximal versus distal atherosclerosis distribution in symptomatic PAD?
Answers are grounded in this paper and cite their sources.
In symptomatic PAD, female sex and smoking are associated with proximal atherosclerosis, whereas diabetes, CKD, and older age are associated with distal disease, suggesting distinct atherosclerotic phenotypes.
Objective Atherosclerosis expression varies across not only coronary, cerebrovascular, and peripheral arteries but also within the peripheral vascular tree. The underlying pathomechanisms of distinct atherosclerosis phenotypes in lower extremity peripheral artery disease (PAD) is poorly understood. We investigated the association of cardiovascular risk factors (CVRFs) and atherosclerosis distribution in a targeted approach analyzing symptomatic patients with isolated anatomic phenotypes of PAD. Methods In a cross-sectional analysis of consecutive patients undergoing first-time endovascular recanalization for symptomatic PAD, data of patients with isolated anatomic phenotypes of either proximal (iliac) or distal (infrageniculate) atherosclerosis segregation were extracted. We performed a multivariable logistic regression model with backward elimination to investigate the association of proximal and distal PAD with CVRFs. Results Of the 637 patients (29% females) with endovascular recanalization, 351 (55%) had proximal and 286 (45%) had distal atherosclerosis. Female sex [odds ratio (OR) 0.33, 95% confidence interval (CI) 0.20–0.54, p = 0.01], active smoking (OR 0.16, 95% CI 0.09–0.28, p < 0.001), and former smoking (OR 0.33, 95% CI 0.20–0.57, p < 0.001) were associated with proximal disease. Diabetes mellitus (DM) (OR 3.25, 95% CI 1.93–5.46, p < 0.001), chronic kidney disease (CKD) (OR 1.18, 95% CI 1.08–1.28, p < 0.001), and older age (OR 1.31, 95% CI 1.06–1.61, p = 0.01) were associated with distal disease. Conclusion Female sex, particularly in the context of smoking, is associated with clinically relevant, proximal atherosclerosis expression. Our additional findings that distal atherosclerosis expression is associated with DM, CKD, and older age suggest that PAD has at least two distinct atherosclerotic phenotypes with sex-specific and individual susceptibility to atherogenic risk factors.
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Baretella et al. (2023) conducted a cross-sectional in Symptomatic lower extremity peripheral artery disease (PAD) (n=637). Female sex vs. Male sex was evaluated on Proximal atherosclerosis distribution (OR 0.33, 95% CI 0.20-0.54, p=0.01). Female sex is significantly associated with a proximal atherosclerosis distribution pattern in patients with symptomatic lower extremity peripheral artery disease (OR 0.33).
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