Baretella Oliver, Buser Laura, Andres Claudine, Häberli Dario, Lenz Armando, Döring Yvonne, Baumgartner Iris, Schindewolf Marc
Division of Angiology, Swiss Cardiovascular Center, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland.
Clinical Trials Unit Bern, University of Bern, Bern, Switzerland.
Front Cardiovasc Med. 2023 Jun 27;10:1004003. doi: 10.3389/fcvm.2023.1004003. eCollection 2023.
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.
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.
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, = 0.01], active smoking (OR 0.16, 95% CI 0.09-0.28, < 0.001), and former smoking (OR 0.33, 95% CI 0.20-0.57, < 0.001) were associated with proximal disease. Diabetes mellitus (DM) (OR 3.25, 95% CI 1.93-5.46, < 0.001), chronic kidney disease (CKD) (OR 1.18, 95% CI 1.08-1.28, < 0.001), and older age (OR 1.31, 95% CI 1.06-1.61, = 0.01) were associated with distal disease.
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.
动脉粥样硬化的表现不仅在冠状动脉、脑血管和外周动脉中有所不同，而且在外周血管系统内也存在差异。下肢外周动脉疾病（PAD）中不同动脉粥样硬化表型的潜在病理机制尚不清楚。我们采用靶向方法，分析有症状的孤立解剖表型PAD患者，研究心血管危险因素（CVRFs）与动脉粥样硬化分布之间的关联。
在对首次因有症状的PAD接受血管内再通治疗的连续患者进行的横断面分析中，提取了近端（髂动脉）或远端（膝下）动脉粥样硬化分离的孤立解剖表型患者的数据。我们进行了多变量逻辑回归模型并采用向后排除法，以研究近端和远端PAD与CVRFs之间的关联。
在637例接受血管内再通治疗的患者（29%为女性）中，351例（55%）患有近端动脉粥样硬化，286例（45%）患有远端动脉粥样硬化。女性（优势比[OR]0.33，95%置信区间[CI]0.20 - 0.54，P = 0.01）、当前吸烟者（OR 0.16，95% CI 0.09 - 0.28，P < 0.001）和既往吸烟者（OR 0.33，95% CI 0.20 - 0.57，P < 0.001）与近端疾病相关。糖尿病（DM）（OR 3.25，95% CI 1.93 - 5.46，P < 0.001）、慢性肾脏病（CKD）（OR 1.18，95% CI 1.08 - 1.28，P < 0.001）和高龄（OR 1.31，95% CI 1.06 - 1.61，P = 0.01）与远端疾病相关。
女性，尤其是在吸烟的情况下，与临床相关的近端动脉粥样硬化表现有关。我们的其他发现表明，远端动脉粥样硬化表现与DM、CKD和高龄有关，这提示PAD至少有两种不同的动脉粥样硬化表型，对致动脉粥样硬化危险因素具有性别特异性和个体易感性。
