Atherosclerosis dyslipidemia and peripheral arterial disease

Factors associated with increased risk for intermittent claudication include smoking, hypertension, hyperlipidemia, and diabetes mellitus (5). Of these factors, hyperlipidemia has recently become the focus of intense study. A significant association between PAD, hyperlipidemia, and increased mortality secondary to coronary artery disease (CAD) and cerebrovascular events has been noted. Fifty percent of patients who suffer from symptomatic PAD are dysplipidemic with total cholesterol >220 mg/dL and/or LDL >140 mg/dL (6). Conversely, in a study of patients with familial hypercholestrolemia (FH), 31 % had hemodynami-cally significant PAD localized predominantly to the femoral-popliteal vessels and 30% had associated CAD. The incidence of PAD was highest (50%) in patients with FH and CAD, underscoring the diffuse nature of the atherosclerotic vascular disease (7). An increased incidence of femoral atherosclerosis has also been noted in asymptomatic patients with FH (8).

Compared to patients with CAD, patients with peripheral, carotid, and aortic atherosclerosis receive less attention to lipid risk factors (9,10). In one study of 299 patients with symptomatic PAD documented by angiography, only 27% had any lipid profiles done, and of these only 9% were receiving treatment for hypercholesterolemia (9). Physician recognition and management of hypercholesterolemia in patients with peripheral and carotid atherosclerosis undergoing vascular surgery was evaluated in 80 patients retrospectively (10). Of the 66% screened patients found to be hypercholesterolemic, only 24% received in-hospi-tal management and only 13% received intervention at discharge. This underscores the need for education and greater awareness of surgeons and physicians involved in the management of patients with PAD.

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