Variation in cardiovascular risk factors by angiographic site of lower limb atherosclerosis

Objective: To determine differences in the levels of the cardiovascular risk factors, cigarette smoking, serum lipids and blood pressure, between three groups of patients with different sites of lower limb atherosclerosis. Design: Cross-sectional survey of a consecutive series of patients with symptoms of either intermittent claudication or rest pain. Methods and materials: One hundred and ninety-two men and women who had undergone angiography were classified using the Bollinger scoring system into groups with predominantly aortoiliac, femoropopliteal or dual-site disease. History of cigarette smoking, serum cotinine, serum thiocyanate, total cholesterol and HDL cholesterol were estimated. Systolic and diastolic pressures were measured and the ankle brachial pressure index (ABPI) was calculated. Results: Eighty-five patients were classified as having femoropopliteal disease, 34 aortoiliac disease and 73 dual-site disease. After adjusting for age, sex and severity of disease, aortoiliac patients were significantly younger (p ≤ 0.001), more likely to be female and current smokers, and had the highest levels of diastolic blood pressure. Life time cigarette consumption (pack-years) and total cholesterol concentrations were highest in femoropopliteal disease. Patients with dualsite disease were more likely to have had a myocardial infarction and angina pectoris (p ≤ 0.05). Systolic blood pressure was also highest in this group. Conclusion: Different levels of cardiovascular risk factors may predispose individuals to atherosclerosis at different sites in the lower limb. Large population studies would be required to delineate the risks more precisely.