Serum cFAS Content Correlates With Incidence of Peripheral Arterial Disease

Figures

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  Figure 1. Flowchart of Study Patients Patients were selected for the study from an initial pool of 1,081 patients in our vascular biobank. A total of 734 patients were excluded for reasons including lack of serum samples (n = 198), presence of other significant vascular disease (n = 140), prior inclusion in other studies (n = 100), unverified peripheral artery disease (PAD) status (n = 152), advanced chronic kidney disease (CKD) (stage 4/5; n = 54), history of alcohol abuse (n = 35), repeat patients (n = 28), anticoagulation use without PAD (n = 10), smoking history without PAD (n = 12), and cardiovascular disease without PAD (n = 5). The final cohort included 347 patients, categorized as 34 healthy control subjects without PAD, 164 with PAD, and 149 with chronic limb threatening ischemia (CLTI).

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  Figure 2. Violin Plot Displaying Serum cFAS levels Across 3 Patient Groups: No PAD, PAD, and CLTI The distribution and density of serum circulating fatty acid synthase (cFAS) levels are shown for each group, with individual data points overlaid. The median and IQRs are represented within the box plots embedded in each violin. Serum cFAS levels are markedly higher in the PAD and CLTI groups compared with the no PAD group, with the highest levels observed in patients with CLTI, indicating a potential association between cFAS levels and PAD severity. Abbreviations as in Figure 1.

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  Figure 3. Area Under the Receiver-Operating Characteristic Curve Illustrating the Diagnostic Performance of Serum cFAS Levels for Distinguishing Peripheral Artery Disease From No Peripheral Artery Disease The empirical area under the receiver-operating characteristic curve (solid line) shows sensitivity (true positive rate [TPR]) vs 1-specificity (false positive rate [FPR]) for various circulating fatty acid synthase (cFAS) thresholds. The optimal cutoff point, determined using the Youden Index, is marked at cFAS = 340 pg/mg, which maximizes sensitivity and specificity. The dashed line represents the chance line, indicating random classification performance. This optimal cutoff highlights the diagnostic potential of cFAS for peripheral artery disease detection.

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  Figure 4. Area Under the Receiver-Operating Characteristic Curve Showing the Diagnostic Performance of Serum CFAS Levels for Distinguishing Chronic Limb Threatening Ischemia From No Peripheral Artery Disease or Peripheral Artery Disease The empirical area under the receiver-operating characteristic curve (solid line) plots sensitivity (TPR) vs 1-specificity (FPR) across various cFAS thresholds. The optimal cutoff point, determined by the Youden Index, is indicated at cFAS = 490 pg/mg, maximizing sensitivity and specificity for chronic limb threatening ischemia detection. The dashed line represents the chance line, illustrating random classification. This cutoff underscores the potential of cFAS as a marker for advanced peripheral artery disease stages such as chronic limb threatening ischemia. Abbreviations as in Figure 3.