Mary M McDermott1, Christopher M Kramer2, Lu Tian3, James Carr4, Jack M Guralnik5, Tamar Polonsky6, Timothy Carroll7, Melina Kibbe8, Michael H Criqui9, Luigi Ferrucci10, Lihui Zhao11, Daniel S Hippe12, John Wilkins13, Dongxiang Xu12, Yihua Liao11, Walter McCarthy14, Chun Yuan12. 1. Department of Medicine Northwestern University Feinberg School of Medicine, Chicago, Illinois; Department of Preventive Medicine, Northwestern University Feinberg School of Medicine, Chicago, Illinois. Electronic address: mdm608@northwestern.edu. 2. Departments of Medicine, Radiology, and Medical Imaging, University of Virginia Health System, Charlottesville, Virginia. 3. Department of Health Research and Policy, Stanford University School of Medicine, Stanford, California. 4. Department of Radiology, Northwestern University Feinberg School of Medicine, Chicago, Illinois. 5. Department of Epidemiology and Public Health, University of Maryland School of Medicine, Baltimore, Maryland. 6. Department of Medicine, University of Chicago, Chicago, Illinois. 7. Department of Radiology, University of Chicago, Chicago, Illinois. 8. Jesse Brown Veterans Affairs Medical Center, Chicago, Illinois; Division of Vascular Surgery, Department of Surgery, Northwestern University Feinberg School of Medicine, Chicago, Illinois. 9. National Institute on Aging, Bethesda, Maryland. 10. Department of Family and Preventive Medicine, University of California, San Diego, San Diego, California. 11. Department of Preventive Medicine, Northwestern University Feinberg School of Medicine, Chicago, Illinois. 12. Department of Radiology and Bioengineering, University of Washington, Seattle, Washington. 13. Department of Medicine Northwestern University Feinberg School of Medicine, Chicago, Illinois; Department of Preventive Medicine, Northwestern University Feinberg School of Medicine, Chicago, Illinois. 14. University Cardiovascular Surgeons, Rush University Medical Center, Chicago, Illinois.
Abstract
OBJECTIVES: The aim of this study was to describe associations of the presence of lipid-rich necrotic core (LRNC) in the proximal superficial femoral artery (SFA) with lower extremity peripheral artery disease (PAD) event rates and systemic cardiovascular event rates. BACKGROUND: LRNC in the coronary and carotid arteries is associated with adverse outcomes but has not been studied previously in lower extremity arteries. METHODS: Participants with ankle-brachial index (ABI) values <1.00 were identified from Chicago medical centers and followed annually. Magnetic resonance imaging was used to characterize SFA atherosclerotic plaque at baseline. Medical records for hospitalizations and procedures after baseline were adjudicated for lower extremity revascularization, amputation, and critical limb ischemia and also for new coronary events, ischemic stroke, and mortality. RESULTS: Of 254 participants with PAD, 62 (24%) had LRNC and 149 (59%) had calcium in the SFA at baseline. Cox regression analyses were adjusted for age, sex, race, comorbidities, baseline ABI, and other confounders. SFA LRNC was associated with an increased incidence of the combined outcome of lower extremity amputation, critical limb ischemia, ABI decline >0.15, and revascularization at 47-month follow-up (hazard ratio: 2.18; 95% confidence interval: 1.27 to 3.75; p = 0.005). The association of SFA LRNC with PAD events was maintained even when this combined outcome excluded lower extremity revascularization (hazard ratio: 2.58; 95% confidence interval: 1.25 to 5.33; p = 0.01). LRNC in the SFA was not associated with all-cause mortality, acute coronary events, or stroke. CONCLUSIONS: Among patients with PAD, LRNC in the SFA was associated with higher rates of clinical PAD events, and this association was independent of ABI. Further study is needed to determine whether interventions that reduce SFA LRNC prevent PAD events.
OBJECTIVES: The aim of this study was to describe associations of the presence of lipid-rich necrotic core (LRNC) in the proximal superficial femoral artery (SFA) with lower extremity peripheral artery disease (PAD) event rates and systemic cardiovascular event rates. BACKGROUND:LRNC in the coronary and carotid arteries is associated with adverse outcomes but has not been studied previously in lower extremity arteries. METHODS:Participants with ankle-brachial index (ABI) values <1.00 were identified from Chicago medical centers and followed annually. Magnetic resonance imaging was used to characterize SFAatherosclerotic plaque at baseline. Medical records for hospitalizations and procedures after baseline were adjudicated for lower extremity revascularization, amputation, and critical limb ischemia and also for new coronary events, ischemic stroke, and mortality. RESULTS: Of 254 participants with PAD, 62 (24%) had LRNC and 149 (59%) had calcium in the SFA at baseline. Cox regression analyses were adjusted for age, sex, race, comorbidities, baseline ABI, and other confounders. SFALRNC was associated with an increased incidence of the combined outcome of lower extremity amputation, critical limb ischemia, ABI decline >0.15, and revascularization at 47-month follow-up (hazard ratio: 2.18; 95% confidence interval: 1.27 to 3.75; p = 0.005). The association of SFALRNC with PAD events was maintained even when this combined outcome excluded lower extremity revascularization (hazard ratio: 2.58; 95% confidence interval: 1.25 to 5.33; p = 0.01). LRNC in the SFA was not associated with all-cause mortality, acute coronary events, or stroke. CONCLUSIONS: Among patients with PAD, LRNC in the SFA was associated with higher rates of clinical PAD events, and this association was independent of ABI. Further study is needed to determine whether interventions that reduce SFALRNC prevent PAD events.
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