Impact of Preoperative LDL Level on Lower Extremity Revascularization Outcomes.

Abstract

Background: Recent guidelines recommend achieving low-density lipoprotein (LDL) <70 mg/dL in patients with peripheral arterial disease (PAD). This study assesses the trends in LDL testing and its impact on lower extremity revascularization (LER) outcomes in a tertiary center.

Methods: A retrospective chart review of patients who underwent open, endovascular or hybrid LER between 2013-2020 was performed, with follow up extending into 2024. Patients were divided into two groups based on baseline LDL<70mg/dL or higher prior to LER. Characteristics and outcomes of the two groups were compared.

Results: Of 2,039 patients that underwent LER, 33.1% did not have LDL testing prior to intervention. The proportion of patients with preoperative LDL testing significantly increased over the study period (39.3% to 66.2%) concomitantly with increased statin use (74.4% to 81%) while the proportion of patients with baseline LDL<70mg/dL remained low (∼36%). Patients with low LDL were more likely to be older white males with significantly higher burden of comorbidities treated for chronic limb-threatening ischemia. Survival and cox regression analysis did not demonstrate significant association of baseline LDL<70mg/dL with major adverse cardiovascular events, limb events or mortality.

Conclusions: Lipid testing and statin use prior to LER have increased but most patients had baseline LDL higher than the suggested target by most recent guidelines. A preoperative LDL<70mg/dL did not demonstrate an association with outcomes. This study highlights a significant gap in the care of patients with PAD undergoing LER and an opportunity for improvement by application of contemporary guidelines.