Association of sex and cardiovascular risk factors with atherosclerosis distribution pattern in lower extremity peripheral artery disease
ObjectiveAtherosclerosis 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. W...
| Main Authors: | , , , , , , , |
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| Format: | Article |
| Language: | English |
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Frontiers Media S.A.
2023-06-01
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| Series: | Frontiers in Cardiovascular Medicine |
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| Online Access: | https://www.frontiersin.org/articles/10.3389/fcvm.2023.1004003/full |
| _version_ | 1797794568708554752 |
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| author | Oliver Baretella Laura Buser Claudine Andres Dario Häberli Armando Lenz Yvonne Döring Yvonne Döring Yvonne Döring Yvonne Döring Iris Baumgartner Marc Schindewolf |
| author_facet | Oliver Baretella Laura Buser Claudine Andres Dario Häberli Armando Lenz Yvonne Döring Yvonne Döring Yvonne Döring Yvonne Döring Iris Baumgartner Marc Schindewolf |
| author_sort | Oliver Baretella |
| collection | DOAJ |
| description | ObjectiveAtherosclerosis 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.MethodsIn 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.ResultsOf 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, p = 0.01], active smoking (OR 0.16, 95% CI 0.09–0.28, p < 0.001), and former smoking (OR 0.33, 95% CI 0.20–0.57, p < 0.001) were associated with proximal disease. Diabetes mellitus (DM) (OR 3.25, 95% CI 1.93–5.46, p < 0.001), chronic kidney disease (CKD) (OR 1.18, 95% CI 1.08–1.28, p < 0.001), and older age (OR 1.31, 95% CI 1.06–1.61, p = 0.01) were associated with distal disease.ConclusionFemale 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. |
| first_indexed | 2024-03-13T03:04:54Z |
| format | Article |
| id | doaj.art-8497ea213f5749bebc38d1817b132c9f |
| institution | Directory Open Access Journal |
| issn | 2297-055X |
| language | English |
| last_indexed | 2024-03-13T03:04:54Z |
| publishDate | 2023-06-01 |
| publisher | Frontiers Media S.A. |
| record_format | Article |
| series | Frontiers in Cardiovascular Medicine |
| spelling | doaj.art-8497ea213f5749bebc38d1817b132c9f2023-06-27T07:15:52ZengFrontiers Media S.A.Frontiers in Cardiovascular Medicine2297-055X2023-06-011010.3389/fcvm.2023.10040031004003Association of sex and cardiovascular risk factors with atherosclerosis distribution pattern in lower extremity peripheral artery diseaseOliver Baretella0Laura Buser1Claudine Andres2Dario Häberli3Armando Lenz4Yvonne Döring5Yvonne Döring6Yvonne Döring7Yvonne Döring8Iris Baumgartner9Marc Schindewolf10Division of Angiology, Swiss Cardiovascular Center, Inselspital, Bern University Hospital, University of Bern, Bern, SwitzerlandDivision of Angiology, Swiss Cardiovascular Center, Inselspital, Bern University Hospital, University of Bern, Bern, SwitzerlandDivision of Angiology, Swiss Cardiovascular Center, Inselspital, Bern University Hospital, University of Bern, Bern, SwitzerlandDivision of Angiology, Swiss Cardiovascular Center, Inselspital, Bern University Hospital, University of Bern, Bern, SwitzerlandClinical Trials Unit Bern, University of Bern, Bern, SwitzerlandDivision of Angiology, Swiss Cardiovascular Center, Inselspital, Bern University Hospital, University of Bern, Bern, SwitzerlandInstitute for Cardiovascular Prevention (IPEK), Ludwig-Maximilians-Universität (LMU) München, Munich, GermanyGerman Centre for Cardiovascular Research (DZHK), Partner site Munich Heart Alliance, Munich, GermanyDepartment for BioMedical Research (DBMR), Bern University Hospital, University of Bern, Bern, SwitzerlandDivision of Angiology, Swiss Cardiovascular Center, Inselspital, Bern University Hospital, University of Bern, Bern, SwitzerlandDivision of Angiology, Swiss Cardiovascular Center, Inselspital, Bern University Hospital, University of Bern, Bern, SwitzerlandObjectiveAtherosclerosis 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.MethodsIn 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.ResultsOf 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, p = 0.01], active smoking (OR 0.16, 95% CI 0.09–0.28, p < 0.001), and former smoking (OR 0.33, 95% CI 0.20–0.57, p < 0.001) were associated with proximal disease. Diabetes mellitus (DM) (OR 3.25, 95% CI 1.93–5.46, p < 0.001), chronic kidney disease (CKD) (OR 1.18, 95% CI 1.08–1.28, p < 0.001), and older age (OR 1.31, 95% CI 1.06–1.61, p = 0.01) were associated with distal disease.ConclusionFemale 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.https://www.frontiersin.org/articles/10.3389/fcvm.2023.1004003/fulllower extremity peripheral artery diseaseiliac arteriesinfragenicular arteriesdiabetes mellituschronic kidney diseasesmoking |
| spellingShingle | Oliver Baretella Laura Buser Claudine Andres Dario Häberli Armando Lenz Yvonne Döring Yvonne Döring Yvonne Döring Yvonne Döring Iris Baumgartner Marc Schindewolf Association of sex and cardiovascular risk factors with atherosclerosis distribution pattern in lower extremity peripheral artery disease Frontiers in Cardiovascular Medicine lower extremity peripheral artery disease iliac arteries infragenicular arteries diabetes mellitus chronic kidney disease smoking |
| title | Association of sex and cardiovascular risk factors with atherosclerosis distribution pattern in lower extremity peripheral artery disease |
| title_full | Association of sex and cardiovascular risk factors with atherosclerosis distribution pattern in lower extremity peripheral artery disease |
| title_fullStr | Association of sex and cardiovascular risk factors with atherosclerosis distribution pattern in lower extremity peripheral artery disease |
| title_full_unstemmed | Association of sex and cardiovascular risk factors with atherosclerosis distribution pattern in lower extremity peripheral artery disease |
| title_short | Association of sex and cardiovascular risk factors with atherosclerosis distribution pattern in lower extremity peripheral artery disease |
| title_sort | association of sex and cardiovascular risk factors with atherosclerosis distribution pattern in lower extremity peripheral artery disease |
| topic | lower extremity peripheral artery disease iliac arteries infragenicular arteries diabetes mellitus chronic kidney disease smoking |
| url | https://www.frontiersin.org/articles/10.3389/fcvm.2023.1004003/full |
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