Current smoking, total-to-HDL cholesterol ratio, lipoprotein(a), and hs-CRP predicted large-vessel PAD progression, whereas diabetes was the only predictor of small-vessel PAD progression.
Cohort (n=403)
Do traditional and novel risk factors differentially predict the progression of large-vessel versus small-vessel peripheral arterial disease?
Risk factors for PAD progression differ by vessel size, with smoking, lipids, and inflammation driving large-vessel disease, while diabetes uniquely drives small-vessel disease progression.
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 -0.30 ankle brachial index decrease for LV-PAD and a -0.27 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 4.6+/-2.5 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 factors contribute differentially to the progression of LV-PAD and SV-PAD. Cigarette smoking, lipids, and inflammation contribute to LV-PAD progression, whereas diabetes was the only significant predictor of SV-PAD progression.
Aboyans et al. (Wed,) conducted a cohort in Peripheral arterial disease (n=403). Traditional and novel risk factors was evaluated on Major progression of large-vessel and small-vessel PAD (defined as -0.30 ABI decrease and -0.27 TBI decrease, respectively). Current smoking, total-to-HDL cholesterol ratio, lipoprotein(a), and hs-CRP predicted large-vessel PAD progression, whereas diabetes was the only predictor of small-vessel PAD progression.
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