Femoral and coronary atherosclerosis in patients with hyperlipidaemia. Arteriographic findings correlated to clinical and biochemical parameters.

Abstract

Quantitative assessment of atherosclerosis from arteriograms was applied in clinical follow-up trials for the evaluation of lipid-modulating treatment or risk factors. Computer-estimated lumen volume and arterial edge roughness in the femoral artery and in the aorta, visual scoring of aorto-femoral arteriograms and manual measuring of coronary artery stenosis were used. In each of 276 hypercholesterolaemic patients two femoral arteriograms were made, with a 10-minute interval. The reproducibility of the computer analysis method was found to be constant over the years, with slightly better reproducibility for lumen volume than for edge roughness. A small but significant drift in the radiological equipment was confirmed by the use of phantoms. In 290 patients, atherosclerosis assessments from the femoral artery (lumen volume and roughness) and visual scoring of the aorto-femoral arteriogram were correlated with clinical symptoms of coronary artery disease or previous myocardial infarction to test whether femoral atherosclerosis estimates can replace coronary studies in clinical trials. Both men and women with coronary artery disease had lower values for femoral lumen volume and more edge roughness than patients without these symptoms. Men with previous myocardial infarction had higher mean visual scores than those without. Thus, femoral atherosclerosis is an expression of a more generalized disease associated with clinical symptoms of coronary heart disease. The 290 patients were tested for correlation between degree of peripheral atherosclerosis and various metabolic risk factors. In women, high serum triglyceride values were associated with more extensive atherosclerosis. High fasting glucose values were associated with more extensive atherosclerosis in men. In men and women, high uric acid values were associated with greater roughness in the femoral artery. The effects of smoking, hypertension, poor physical fitness and body mass index on the development of peripheral atherosclerosis in hypercholesterolaemia were also investigated. The results indicated that the hypercholesterolaemic patients most likely to develop peripheral atherosclerosis are male and female smokers who do not take any physical exercise, and who have increased values of systolic blood pressure, uric acid and fasting glucose concentrations. Aortograms from 293 subjects were digitized and circular lumen volume and edge roughness were computer-estimated in a 7.35-cm segment of the distal aorta. A correlation between atherosclerosis in the aorta and in the femoral arteries indicated that aortic atherosclerosis is a manifestation of a more general disease.(ABSTRACT TRUNCATED AT 400 WORDS)