TY - JOUR
T1 - Coronary and peripheral artery plaques
T2 - Do differences in plaque characteristics translate to differences in lipid management?
AU - Tsai, Shirling
AU - Vega, Gloria Lena
N1 - Publisher Copyright:
© American Federation for Medical Research 2020. No commercial re-use. See rights and permissions. Published by BMJ.
PY - 2020/8/1
Y1 - 2020/8/1
N2 - Optimal medical management of patients with peripheral arterial disease (PAD) includes statin therapy, which has been shown to decrease the risk of major cardiovascular events. However, the relationship between low-density lipoprotein (LDL) lowering, PAD progression and limb outcomes remains controversial. Although prevention of coronary and cerebrovascular events is a priority, limb outcomes are still important determinants of quality of life and healthcare spending. This review will highlight differences between coronary artery disease (CAD) and PAD, and in particular, the more prevalent role of lipids and LDL cholesterol in CAD versus calcification in PAD. This difference may contribute to the differential impact of LDL cholesterol levels on coronary events and outcomes versus limb outcomes. Beyond LDL lowering, immune modulators have emerged as another agent to treat atherosclerosis in CAD, however similar data in PAD are lacking. Small studies have suggested that other lipids besides LDL cholesterol, such as triglycerides or small dense LDL, may have a greater impact on limb outcomes in patients with PAD. Although statin therapy is central in the management of patients with PAD, current understanding of the distinctions between PAD and CAD suggest that there may be other non-LDL targets for risk reduction that require further study.
AB - Optimal medical management of patients with peripheral arterial disease (PAD) includes statin therapy, which has been shown to decrease the risk of major cardiovascular events. However, the relationship between low-density lipoprotein (LDL) lowering, PAD progression and limb outcomes remains controversial. Although prevention of coronary and cerebrovascular events is a priority, limb outcomes are still important determinants of quality of life and healthcare spending. This review will highlight differences between coronary artery disease (CAD) and PAD, and in particular, the more prevalent role of lipids and LDL cholesterol in CAD versus calcification in PAD. This difference may contribute to the differential impact of LDL cholesterol levels on coronary events and outcomes versus limb outcomes. Beyond LDL lowering, immune modulators have emerged as another agent to treat atherosclerosis in CAD, however similar data in PAD are lacking. Small studies have suggested that other lipids besides LDL cholesterol, such as triglycerides or small dense LDL, may have a greater impact on limb outcomes in patients with PAD. Although statin therapy is central in the management of patients with PAD, current understanding of the distinctions between PAD and CAD suggest that there may be other non-LDL targets for risk reduction that require further study.
KW - LDL
KW - atherosclerotic and lipoproteins
KW - peripheral arterial disease
KW - plaque
KW - triglycerides
UR - http://www.scopus.com/inward/record.url?scp=85088881052&partnerID=8YFLogxK
UR - http://www.scopus.com/inward/citedby.url?scp=85088881052&partnerID=8YFLogxK
U2 - 10.1136/jim-2019-001252
DO - 10.1136/jim-2019-001252
M3 - Review article
C2 - 32474407
AN - SCOPUS:85088881052
SN - 1081-5589
VL - 68
SP - 1141
EP - 1151
JO - Journal of Investigative Medicine
JF - Journal of Investigative Medicine
IS - 6
ER -