PLASMA-LIPOPROTEIN ABNORMALITIES AND APOLIPOPROTEIN-E PHENOTYPES IN INTERMITTENT CLAUDICATION - A MULTIVARIATE-ANALYSIS OF RANDOMLY SELECTED SUBJECTS

Background and Aim: The prevalence and significance of lipoprotein abn ormalities in intermittent claudication (IC) were investigated. From a n epidemiological screening of 15,253 middle-aged men in Linkoping Cou nty, Sweden, 339 males were randomly selected within three strata: 115 subjects with IC, 115 healthy controls matched for sex, age and smoki ng habits, and 109 sex- and age-matched never-smokers. Methods and Res ults: All subjects underwent a treadmill exercise test to confirm or e xclude hemodynamically significant peripheral atherosclerosis. The sig nificance of the individual plasma lipoproteins was tested by multivar iate logistic-regression analysis. Major risk factors for IC-smoke his tory, hypertension, diabetes-were included and adjustment made for fac tors that affect the lipoprotein concentrations. The most frequent lip oprotein abnormalities found in IC were abnormally high levels of low density lipoprotein (LDL) triglycerides (TG) and abnormally low concen trations of high density lipoprotein (HDL) cholesterol (Chol). Almost half of all claudicants had either one or both lipoprotein abnormaliti es. The lipid composition of LDL and HDL was changed with a significan t increase of TG relative to Chol. The highest increase in risk of IC (by change of 1 standard deviation in lipoprotein concentration) was a ssociated with elevation of LDL-Chol, 2.22 (1.44-3.43) [odds-ratio, 95 % confidence interval] and lowering of HDL(2)-Chol 1.94 (1.19-3.19), w hile the lowest significant risk was associated with elevation of plas ma TG 1.61 (1.01-3.09) and IDL-TG 1.55 (1.04-2.31). Multivariate logis tic regression analysis in contrast to univariate disclosed that very low density lipoproteins (VLDL) were not significantly associated to I C. Neither were intermediate density lipoproteins (IDL) Chol or HDL's major protein (HDL-apoAI), multi-variately associated to IC. Apolipopr otein E phenotypes and epsilon-allele frequencies did not differ signi ficantly between claudicants and healthy controls. Conclusions: The st udy shows that several lipoprotein abnormalities are present in claudi cants. Multivariate analysis demonstrates that the risk of IC is mainl y associated to the LDL and HDL particles, while VLDL, IDL-Chol, HDL-T G and HDL-apoAI lipoproteins are not associated to IC. The results of the study suggests that more attention should be paid to plasma lipopr otein concentrations in IC and that efforts should be made in lowering even slightly elevated LDL levels and increasing HDL-Chol. (C) 1996, Medikal Press.