Risk Factors for Progression of Peripheral Arterial Disease in Large and Small Vessels

TLDR

Peripheral arterial disease (PAD) natural history is poorly understood, with most data limited to clinical symptoms. The study aimed to determine whether risk factors for progression differ between large‑vessel PAD (LV‑PAD) and small‑vessel PAD (SV‑PAD). Using noninvasive tests, the authors evaluated traditional and novel risk factors—including smoking, lipid ratios, lipoprotein(a), hs‑CRP, SAA, and homocysteine—by comparing baseline and follow‑up measurements and defining major progression as a −0.30 ankle‑brachial index or −0.27 toe‑brachial index decline. Over an average 4.6‑year follow‑up of 403 patients, significant ABI and TBI deterioration was observed, with multivariable analysis showing smoking, total/HDL ratio, lipoprotein(a), and hs‑CRP associated with LV‑PAD progression, while only diabetes predicted SV‑PAD progression.

Abstract

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).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.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.