Abstract
Background
Lower extremity peripheral arterial disease (PAD) is an atherosclerotic disease of
the lower extremities. Atherosclerosis, inflammation and sarcopenia are independently
associated and potentiate each other. Inflammation is deeply involved in the formation
and progression of atherosclerosis and is also involved in the pathophysiology of
sarcopenia. Sarcopenia is defined as low muscle mass, with low muscle strength. This
study aims to determine the differences in skeletal muscle characteristics and in
inflammatory parameters between patients with claudication and with chronic limb threatening
ischemia (CLTI).
Methods
An observational, prospective study in patients with PAD was conducted from January
2018 to December 2020. The clinical characteristics and the cardiovascular risk factors
were prospectively registered. The inflammatory parameters determined were: positive
acute phase proteins (C-reactive Protein- CRP- and fibrinogen) and negative acute
phase proteins (albumin, total cholesterol and high-density lipoprotein- HDL. The
skeletal muscle area and density were quantified with a CT scan. The strength was
determined with a Jamar® hydraulic hand dynamometer.
Results
116 patients (mean age: 67.65±9.53 years-old) 64% with claudication and 46% with CLTI
were enrolled in the study. No differences were registered between patients with claudication
and CLTI on age, cardiovascular risk factors (hypertension, dyslipidemia, diabetes
mellitus, smoking habits) and medication. There was a higher prevalence of men in
the claudication group (88.89% versus 71.70%, p=0.019). Analysing the inflammatory parameters, we noted that patients with
CLTI had an increased serum levels of positive acute phase proteins: CRP (37.53±46.61mg/L
versus 9.18±26.12mg/L, p=0.000), and fibrinogen (466.18±208.07mg/dL versus 317.37±79.42mg/dL, p=0.000). CLTI patients had decreased negative acute phase proteins:
albumin (3.53±0.85g/dL versus 3.91±0.72g/dL, p=0.001), total cholesterol (145.41±38.59mg/dL versus 161.84±34.94mg/dL, p=0.013) and HDL (38.70±12.19mg/dL versus 51.31±15.85mg/dL, p=0.000). We noted that patients with CLTI had lower skeletal muscle
area and mass (14349.77±3036.60 mm2 versus 15690.56±3183.97 mm2 p=0.013; 10.11±17.03HU versus 18.02±13.63HU p=0.013). After adjusting for the variable sex, the association between
skeletal muscle density and CLTI persisted (r(97)=-0.232, p=0.021). The groups did
not differ in strength (patients with claudication: 25.39±8.23 Kgf versus CLTI: 25.17±11.95 Kgf p=0.910).
Conclusions
CLTI patients have decreased skeletal muscle mass and a systemic inflammation status.
Recognizing the deleterious triad of atherosclerosis, inflammation and loss of skeletal
mass patients with CLTI is an opportunity to improve medical therapy and to perform
a timely intervention to stop this vicious cycle.
Keywords
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Article Info
Publication History
Accepted:
July 6,
2022
Received in revised form:
July 3,
2022
Received:
June 10,
2022
Publication stage
In Press Journal Pre-ProofIdentification
Copyright
© 2022 Elsevier Inc. All rights reserved.
