Esther Martinez-Aguilar1, Josune Orbe2, Alejandro Fernández-Montero3, Sebastián Fernández-Alonso1, Jose A Rodríguez2, Leopoldo Fernández-Alonso1, Jose A Páramo4, Carmen Roncal5. 1. Department of Vascular Surgery, Complejo Hospitalario de Navarra, Pamplona, Spain; IdiSNA-Health Research Institute of Navarra, Pamplona, Spain. 2. IdiSNA-Health Research Institute of Navarra, Pamplona, Spain; Laboratory of Atherothrombosis, Program of Cardiovascular Diseases, Center for Applied Medical Research (CIMA), University of Navarra, Pamplona, Spain; CIBERCV, Ministry of Economy and Competitiveness, ISCIII, Madrid, Spain. 3. IdiSNA-Health Research Institute of Navarra, Pamplona, Spain; Department of Occupational Medicine, University Clinic of Navarra, Pamplona, Spain. 4. IdiSNA-Health Research Institute of Navarra, Pamplona, Spain; CIBERCV, Ministry of Economy and Competitiveness, ISCIII, Madrid, Spain; Hematology Service, University Clinic of Navarra, Pamplona, Spain. 5. IdiSNA-Health Research Institute of Navarra, Pamplona, Spain; Laboratory of Atherothrombosis, Program of Cardiovascular Diseases, Center for Applied Medical Research (CIMA), University of Navarra, Pamplona, Spain; CIBERCV, Ministry of Economy and Competitiveness, ISCIII, Madrid, Spain. Electronic address: croncalm@unav.es.
Abstract
OBJECTIVE: The prognosis of patients with peripheral arterial disease (PAD) is characterized by an exceptionally high risk for myocardial infarction, ischemic stroke, and death; however, studies in search of new prognostic biomarkers in PAD are scarce. Even though low levels of high-density lipoprotein cholesterol (HDL-C) have been associated with higher risk of cardiovascular (CV) complications and death in different atherosclerotic diseases, recent epidemiologic studies have challenged its prognostic utility. The aim of this study was to test the predictive value of HDL-C as a risk factor for ischemic events or death in symptomatic PAD patients. METHODS: Clinical and demographic parameters of 254 symptomatic PAD patients were recorded. Amputation, ischemic coronary disease, cerebrovascular disease, and all-cause mortality were recorded during a mean follow-up of 2.7 years. RESULTS: Multivariate analyses showed that disease severity (critical limb ischemia) was significantly reduced in patients with normal HDL-C levels compared with the group with low HDL-C levels (multivariate analysis odds ratio, 0.09; 95% confidence interval [CI], 0.03-0.24). A decreased risk for mortality (hazard ratio, 0.46; 95% CI, 0.21-0.99) and major adverse CV events (hazard ratio, 0.38; 95% CI, 0.16-0.86) was also found in patients with normal vs reduced levels of HDL-C in both Cox proportional hazards models and Kaplan-Meier estimates, after adjustment for confounding factors. CONCLUSIONS: Reduced HDL-C levels were significantly associated with higher risk for development of CV complications as well as with mortality in PAD patients. These findings highlight the usefulness of this simple test for early identification of PAD patients at high risk for development of major CV events.
OBJECTIVE: The prognosis of patients with peripheral arterial disease (PAD) is characterized by an exceptionally high risk for myocardial infarction, ischemic stroke, and death; however, studies in search of new prognostic biomarkers in PAD are scarce. Even though low levels of high-density lipoprotein cholesterol (HDL-C) have been associated with higher risk of cardiovascular (CV) complications and death in different atherosclerotic diseases, recent epidemiologic studies have challenged its prognostic utility. The aim of this study was to test the predictive value of HDL-C as a risk factor for ischemic events or death in symptomatic PAD patients. METHODS: Clinical and demographic parameters of 254 symptomatic PAD patients were recorded. Amputation, ischemiccoronary disease, cerebrovascular disease, and all-cause mortality were recorded during a mean follow-up of 2.7 years. RESULTS: Multivariate analyses showed that disease severity (critical limb ischemia) was significantly reduced in patients with normal HDL-C levels compared with the group with low HDL-C levels (multivariate analysis odds ratio, 0.09; 95% confidence interval [CI], 0.03-0.24). A decreased risk for mortality (hazard ratio, 0.46; 95% CI, 0.21-0.99) and major adverse CV events (hazard ratio, 0.38; 95% CI, 0.16-0.86) was also found in patients with normal vs reduced levels of HDL-C in both Cox proportional hazards models and Kaplan-Meier estimates, after adjustment for confounding factors. CONCLUSIONS: Reduced HDL-C levels were significantly associated with higher risk for development of CV complications as well as with mortality in PAD patients. These findings highlight the usefulness of this simple test for early identification of PAD patients at high risk for development of major CV events.
Authors: Elena M Yubero-Serrano; Juan F Alcalá-Diaz; Diego Gómez-Coronado; Jose Lopez-Miranda; Francisco M Gutierrez-Mariscal; Antonio P Arenas-de Larriva; Patricia J Peña-Orihuela; Ruth Blanco-Rojo; Javier Martinez-Botas; Jose D Torres-Peña; Pablo Perez-Martinez; Jose M Ordovas; Javier Delgado-Lista Journal: Cardiovasc Diabetol Date: 2021-03-25 Impact factor: 9.951
Authors: Goren Saenz-Pipaon; Patxi San Martín; Núria Planell; Alberto Maillo; Susana Ravassa; Amaia Vilas-Zornoza; Esther Martinez-Aguilar; José Antonio Rodriguez; Daniel Alameda; David Lara-Astiaso; Felipe Prosper; José Antonio Paramo; Josune Orbe; David Gomez-Cabrero; Carmen Roncal Journal: J Extracell Vesicles Date: 2020-02-19