Jornal Vascular Brasileiro
https://www.jvascbras.org/article/doi/10.1590/1677-5449.202300141
Jornal Vascular Brasileiro
Original Article

Influência dos fatores de risco para aterosclerose na distribuição anatômica da doença arterial periférica em pacientes com isquemia crônica crítica de membros: um estudo transversal

Influence of atherosclerosis risk factors on the anatomical distribution of peripheral arterial  disease in patients with chronic limb-threatening ischemia: a cross-sectional study

Vanessa Prado dos Santos; Camila Izabel Cerutti; Marcelo José Carlos Alencar; André Brito Queiroz; Lucas de Mello Ferreira; Cícero Fidelis; José Siqueira de Araújo Filho; Carlos Alberto Silveira Alves

Downloads: 4
Views: 329

Resumo

   Contexto: Os fatores de risco para aterosclerose podem ter influência distinta nas doenças cardiovasculares, impactando também no território da doença arterial periférica (DAP).

Objetivos: Estudar a influência dos diferentes fatores de risco para a aterosclerose na distribuição anatômica da DAP em pacientes com isquemia crítica crônica de membros (ICCM).

Métodos: Foi realizado um estudo observacional, transversal e analítico, incluindo 476 doentes internados devido à ICCM por DAP. Foram estudados, comparativamente, os pacientes com DAP dos três distintos territórios anatômicos (aortoilíaco, femoropoplíteo e infragenicular) em relação à presença dos fatores de risco para a aterosclerose (idade, gênero, diabetes mellitus, tabagismo e hipertensão arterial). A análise multivariada foi realizada para testar a associação entre os fatores de risco e a distribuição anatômica da DAP.

Resultados: A média de idade dos pacientes foi de 69 anos, 249 (52%) eram homens, e 273 (57%), diabéticos. Predominaram os pacientes na Categoria 5 da Classificação de Rutherford (353/74%). Na análise multivariada, as mulheres tiveram chance 2,7 (IC: 1,75-4,26) vezes maior de doença do território femoropoplíteo. Os doentes tabagistas tiveram 3,6 (IC: 1,54-8,30) vezes maior risco de doença do território aortoilíaco. Diabéticos apresentaram 1,8 (IC: 1,04-3,19) vezes maior chance de obstrução apenas do território infragenicular.

Conclusões: O estudo mostrou que gênero, diabetes mellitus e tabagismo influenciam no padrão de distribuição da DAP em pacientes com ICCM. Os doentes diabéticos apresentaram maior chance de doença isolada do território infragenicular, as mulheres tiveram maior risco de DAP do território femoropoplíteo e os tabagistas possuem maior chance comprometimento aortoilíaco.

Palavras-chave

aterosclerose, isquemia crônica crítica de membros, doença arterial periférica, diabetes mellitus, fatores de risco

Abstract

Background: Atherosclerosis risk factors can have different impacts on cardiovascular diseases and on the anatomical distribution of Peripheral Arterial Disease (PAD). Objectives: To study the influence of atherosclerosis risk factors on the anatomical distribution of PAD in patients with chronic limb-threatening ischemia (CLTI).

Methods: We performed an observational, cross-sectional, and analytical study that included 476 hospitalized patients with CLTI due to PAD. We compared the presence of atherosclerosis risk factors (age, gender, diabetes mellitus, smoking, and hypertension) in patients with PAD involving three different anatomic areas (aortoiliac, femoropopliteal, and infrapopliteal). Multivariate analysis was performed to identify associations between atherosclerosis risk factors and PAD distribution.

Results: The mean age of the 476 patients was 69 years, 249 (52%) were men, and 273 (57%) had diabetes. Seventy-four percent (353) had minor tissue loss. Multivariate analysis identified three risk factors associated with PAD anatomical distribution (gender, smoking, and DM). Women had a 2.7 (CI: 1.75-4.26) times greater chance of having femoropopliteal disease. Smokers had a 3.6-fold (CI: 1.54-8.30) greater risk of aortoiliac disease. Diabetic patients were 1.8 (CI: 1.04-3.19) times more likely to have isolated infrapopliteal occlusive disease.

Conclusions: The study showed that gender, DM, and smoking impact on the anatomical distribution of PAD in patients with CLTI. Diabetic patients were more likely to have only infrapopliteal disease, women had a greater risk of femoropopliteal PAD, and smokers had a greater risk of aortoiliac occlusive disease.

Keywords

atherosclerosis; chronic limb-threatening ischemia; peripheral arterial disease; diabetes mellitus; risk factors

References

1 GBD 2017 Causes of Death Collaborators. Global, regional, and national age-sex-specific mortality for 282 causes of death in 195 countries and territories, 1980-2017: a systematic analysis for the Global Burden of Disease Study 2017. Lancet. 2018;392(10159):1736-88. http://dx.doi.org/10.1016/S0140-6736(18)32203-7. PMid:30496103.

2 Pouncey AL, Woodward M. Sex-specific differences in cardiovascular risk, risk factors and risk management in the peripheral arterial disease population. Diagnostics. 2022;12(4):808. http://dx.doi.org/10.3390/diagnostics12040808. PMid:35453859.

3 Lin J, Chen Y, Jiang N, Li Z, Xu S. Burden of peripheral artery disease and its attributable risk factors in 204 countries and territories from 1990 to 2019. Front Cardiovasc Med. 2022;9:868370. http://dx.doi.org/10.3389/fcvm.2022.868370. PMid:35498034.

4 Cea-Soriano L, Fowkes FGR, Johansson S, Allum AM, García Rodriguez LA. Time trends in peripheral artery disease incidence, prevalence and secondary preventive therapy: a cohort study in The Health Improvement Network in the UK. BMJ Open. 2018;8(1):e018184. http://dx.doi.org/10.1136/bmjopen-2017-018184. PMid:29358428.

5 Massa KHC, Duarte YAO, Chiavegatto ADP Fo. Analysis of the prevalence of cardiovascular diseases and associated factors among the elderly, 2000-2010. Cien Saude Colet. 2019;24(1):105-14. http://dx.doi.org/10.1590/1413-81232018241.02072017. PMid:30698245.

6 GBD 2019 Risk Factors Collaborators. Global burden of 87 risk factors in 204 countries and territories, 1990-2019: a systematic analysis for the Global Burden of Disease Study 2019. Lancet. 2020;396(10258):1223-49. http://dx.doi.org/10.1016/S0140-6736(20)30752-2. PMid:33069327.

7 Malta DC, Gonçalves RPF, Machado ÍE, Freitas MIF, Azeredo C, Szwarcwald CL. Prevalência da hipertensão arterial segundo diferentes critérios diagnósticos, Pesquisa Nacional de Saúde. Rev Bras Epidemiol. 2018;21(Supl 1):e180021. http://dx.doi.org/10.1590/1980-549720180021.supl.1.

8 Lin X, Xu Y, Pan X, et al. Global, regional, and national burden and trend of diabetes in 195 countries and territories: an analysis from 1990 to 2025. Sci Rep. 2020;10(1):14790. http://dx.doi.org/10.1038/s41598-020-71908-9. PMid:32901098.

9 U.S. Department of Health and Human Services. National diabetes statistics report 2020. Estimates of diabetes and its burden in the United States. Washington: U.S. Department of Health and Human Services; 2020. [citado 2022 jul 29]. https://www.cdc.gov/diabetes/pdfs/data/statistics/national-diabetes-statistics-report.pdf

10 Muzy J, Campos MR, Emmerick I, Silva RSD, Schramm JMA. Prevalência de diabetes mellitus e suas complicações e caracterização das lacunas na atenção à saúde a partir da triangulação de pesquisas. Cad Saude Publica. 2021;37(5):e00076120. http://dx.doi.org/10.1590/0102-311x00076120. PMid:34076095.

11 Zhang Y, Lazzarini PA, McPhail SM, van Netten JJ, Armstrong DG, Pacella RE. Global disability burdens of diabetes-related lower-extremity complications in 1990 and 2016. Diabetes Care. 2020;43(5):964-74. http://dx.doi.org/10.2337/dc19-1614. PMid:32139380.

12 Norgren L, Hiatt WR, Dormandy JA, Nehler MR, Harris KA, Fowkes FG. Inter-society consensus for the management of peripheral arterial disease (TASC II). J Vasc Surg. 2007;45(1, Supl):S5-67. http://dx.doi.org/10.1016/j.jvs.2006.12.037. PMid:17223489.

13 Conte MS, Bradbury AW, Kolh P, et al. Global vascular guidelines on the management of chronic limb-threatening ischemia. Eur J Vasc Endovasc Surg. 2019;58(1S):S1-109.E33. http://dx.doi.org/10.1016/j.ejvs.2019.05.006. PMid:31182334.

14 Nehler MR, Duval S, Diao L, et al. Epidemiology of peripheral arterial disease and critical limb ischemia in an insured national population. J Vasc Surg. 2014;60(3):686-95.e2. http://dx.doi.org/10.1016/j.jvs.2014.03.290. PMid:24820900.

15 Strengthening the Reporting of Observational Studies in Epidemiology [site na Internet]. Berna: STROBE; c2023. [citado 2023 Abr 4]. https://www.strobe-statement.org/checklists/

16 Lowry D, Saeed M, Narendran P, Tiwari A. A review of distribution of atherosclerosis in the lower limb arteries of patients with diabetes mellitus and peripheral vascular disease. Vasc Endovascular Surg. 2018;52(7):535-42. http://dx.doi.org/10.1177/1538574418791622. PMid:30068238.

17 Rutherford RB, Baker JD, Ernst C, et al. Recommended standards for reports dealing with lower extremity ischemia: revised version. J Vasc Surg. 1997;26(3):517-38. http://dx.doi.org/10.1016/S0741-5214(97)70045-4. PMid:9308598.

18 Diehm N, Shang A, Silvestro A, et al. Association of cardiovascular risk factors with pattern of lower limb atherosclerosis in 2659 patients undergoing angioplasty. Eur J Vasc Endovasc Surg. 2006;31(1):59-63. http://dx.doi.org/10.1016/j.ejvs.2005.09.006. PMid:16269257.

19 Shatnawi NJ, Al-Zoubi NA, Hawamdeh HM, et al. The relation of anatomical distribution of symptomatic peripheral arterial disease (PAD) with HbA1c level in patients with type 2 diabetes mellitus. Ther Adv Endocrinol Metab. 2021;12:20420188211000504. http://dx.doi.org/10.1177/20420188211000504. PMid:33767809.

20 Comşa HI, Zdrenghea D, Man SC, et al. The role of novel atherosclerosis markers in peripheral artery disease: is there a gender difference? Cardiovasc J Afr. 2018;29(5):322-30. http://dx.doi.org/10.5830/CVJA-2018-023. PMid:29750230.

21 Garofolo L, Ferreira SRG, Miranda F Jr. Biomarkers of inflammation may be of use for identification of more severe peripheral arterial occlusive disease. J Vasc Bras. 2014;13(3):182-91. http://dx.doi.org/10.1590/jvb.2014.045.

22 Malta DC, Duncan BB, Schmidt MI, et al. Prevalência de diabetes mellitus determinada pela hemoglobina glicada na população adulta brasileira, Pesquisa Nacional de Saúde. Rev Bras Epidemiol. 2019;22(Supl 2):E190006.SUPL.2. http://dx.doi.org/10.1590/1980-549720190006.supl.2.

23 Trainotti GO, Mariúba JV, Bertanha M, et al. Comparação das alterações angiográficas entre pacientes diabéticos e não diabéticos com doença arterial periférica. J Vasc Bras. 2023;22:e20200053. PMid:36794171.

24 Santos VP, Caffaro RA, Pozzan G, Saieg MA, Castelli V Jr. Comparative histological study of atherosclerotic lesions and microvascular changes in amputated lower limbs of diabetic and non-diabetic patients. Arq Bras Endocrinol Metabol. 2008;52(7):1115-23. http://dx.doi.org/10.1590/S0004-27302008000700007. PMid:19082299.

25 Clark D III, Cain LR, Blaha MJ, et al. Cigarette smoking and subclinical peripheral arterial disease in blacks of the Jackson Heart Study. J Am Heart Assoc. 2019;8(3):e010674. http://dx.doi.org/10.1161/JAHA.118.010674. PMid:30672360.

26 Jayalath RW, Mangan SH, Golledge J. Aortic calcification. Eur J Vasc Endovasc Surg. 2005;30(5):476-88. http://dx.doi.org/10.1016/j.ejvs.2005.04.030. PMid:15963738.

27 Ding N, Sang Y, Chen J, et al. Cigarette smoking, smoking cessation, and long-term risk of 3 major atherosclerotic diseases. J Am Coll Cardiol. 2019;74(4):498-507. http://dx.doi.org/10.1016/j.jacc.2019.05.049. PMid:31345423.

28 Libby P, Ridker PM, Hansson GK. Inflammation in atherosclerosis: from pathophysiology to practice. J Am Coll Cardiol. 2009;54(23):2129-38. http://dx.doi.org/10.1016/j.jacc.2009.09.009. PMid:19942084.
 


Submitted date:
01/20/2023

Accepted date:
04/18/2023

Sociedade Brasileira de Angiologia e Cirurgia Vascular (SBACV)"> Sociedade Brasileira de Angiologia e Cirurgia Vascular (SBACV)">
64b6d71aa9539552b0284eb2 jvb Articles
Links & Downloads

J Vasc Bras

Share this page
Page Sections