Criqui M H, Browner D, Fronek A, Klauber M R, Coughlin S S, Barrett-Connor E, Gabriel S
Department of Community and Family Medicine, University of California, San Diego, School of Medicine, La Jolla 92093.
Am J Epidemiol. 1989 Jun;129(6):1110-9. doi: 10.1093/oxfordjournals.aje.a115233.
The authors used noninvasive techniques, including flow velocity by Doppler ultrasound, to accurately assess and distinguish between large and small vessel peripheral arterial disease in a population study in southern California, 1978-1981. In 565 men and women aged 38-82 years, there were 69 cases of large vessel peripheral arterial disease, 19 of which were severe, and 90 cases of isolated small vessel peripheral arterial disease. In cross-sectional multivariate analysis in men, large vessel peripheral arterial disease was significantly associated with age, pack-years of cigarettes smoked, systolic blood pressure, fasting plasma glucose, and marginally with obesity. Similar analysis in women revealed significant associations only for age and systolic blood pressure, although the associations for pack-years of cigarettes, obesity, and low density lipoprotein cholesterol were suggestive. By contrast, isolated small vessel peripheral arterial disease was not significantly associated with any of the major cardiovascular disease risk factors, including two measures of carbohydrate metabolism, fasting plasma glucose and glycosylated hemoglobin. These findings, coupled with our earlier report that large vessel peripheral arterial disease but not isolated small vessel peripheral arterial disease was independently predictive of subsequent mortality, suggest that large vessel peripheral arterial disease and isolated small vessel peripheral arterial disease are epidemiologically, as well as pathophysiologically, distinct entities.
1978年至1981年，在南加州的一项人群研究中，作者使用了包括多普勒超声测量流速在内的非侵入性技术，以准确评估和区分大血管和小血管周围动脉疾病。在565名年龄在38至82岁的男性和女性中，有69例大血管周围动脉疾病，其中19例病情严重，还有90例孤立性小血管周围动脉疾病。在男性的横断面多变量分析中，大血管周围动脉疾病与年龄、吸烟包年数、收缩压、空腹血糖显著相关，与肥胖的相关性较弱。对女性进行的类似分析显示，仅年龄和收缩压存在显著关联，尽管吸烟包年数、肥胖和低密度脂蛋白胆固醇的关联具有一定提示性。相比之下，孤立性小血管周围动脉疾病与任何主要心血管疾病危险因素均无显著关联，包括两种碳水化合物代谢指标，即空腹血糖和糖化血红蛋白。这些发现，再加上我们之前的报告，即大血管周围动脉疾病而非孤立性小血管周围动脉疾病可独立预测随后的死亡率，表明大血管周围动脉疾病和孤立性小血管周围动脉疾病在流行病学以及病理生理学上都是不同的实体。
