Yuan Shuai, Damrauer Scott M, Larsson Susanna C
Department of Surgery, University of Pennsylvania Perelman School of Medicine, Philadelphia. (S.Y., S.M.D.).
Corporal Michael J. Crescenz VA Medical Center, Philadelphia, PA (S.Y., S.M.D.).
Arterioscler Thromb Vasc Biol. 2025 Jun 12. doi: 10.1161/ATVBAHA.125.322136.
Peripheral arterial disease (PAD) is a major vascular complication associated with significant morbidity and mortality. While traditional cardiovascular risk factors such as smoking, hypertension, and diabetes are well established, emerging evidence suggests that alcohol consumption, alcoholic liver disease, and metabolic-associated steatotic liver disease may also contribute to PAD risk. This review synthesizes current epidemiological evidence linking alcohol intake, alcoholic liver disease, and metabolic-associated steatotic liver disease to PAD and explores potential mechanisms, including atherosclerosis, endothelial dysfunction, chronic inflammation, dyslipidemia, and coagulation abnormalities. Observational studies suggest a possible protective effect of light-to-moderate alcohol consumption though genetic studies challenge this notion. In addition, alcoholic liver disease and metabolic-associated steatotic liver disease are increasingly recognized as contributors to systemic vascular dysfunction and PAD progression. In conclusion, given the rising burden of liver disease, it is crucial to determine whether PAD screening is warranted in patients with high-risk alcoholic liver disease and metabolic-associated steatotic liver disease. Addressing modifiable risk factors and optimizing pharmacological interventions may help mitigate PAD risk. Future research should focus on longitudinal studies, sex- and ethnicity-specific differences, and omics-based approaches to refine risk prediction, early detection, and targeted interventions.
外周动脉疾病（PAD）是一种主要的血管并发症，伴有显著的发病率和死亡率。虽然吸烟、高血压和糖尿病等传统心血管危险因素已得到充分证实，但新出现的证据表明，饮酒、酒精性肝病和代谢相关脂肪性肝病也可能增加PAD风险。本综述综合了目前将酒精摄入、酒精性肝病和代谢相关脂肪性肝病与PAD联系起来的流行病学证据，并探讨了潜在机制，包括动脉粥样硬化、内皮功能障碍、慢性炎症、血脂异常和凝血异常。观察性研究表明，轻度至中度饮酒可能具有保护作用，尽管基因研究对这一观点提出了挑战。此外，酒精性肝病和代谢相关脂肪性肝病越来越被认为是全身血管功能障碍和PAD进展的促成因素。总之，鉴于肝病负担不断增加，确定高危酒精性肝病和代谢相关脂肪性肝病患者是否有必要进行PAD筛查至关重要。解决可改变的危险因素并优化药物干预可能有助于降低PAD风险。未来的研究应侧重于纵向研究、性别和种族特异性差异以及基于组学的方法，以完善风险预测、早期检测和靶向干预。
