FEMORAL AND CORONARY ATHEROSCLEROSIS IN PATIENTS WITH HYPERLIPEMIA - ARTERIOGRAPHIC FINDINGS CORRELATED TO CLINICAL AND BIOCHEMICAL PARAMETERS

Quantitative assessment of atherosclerosis from arteriograms was appli ed in clinical followup trials for the evaluation of lipid-modulating treatment or risk factors. Computer-estimated lumen volume and arteria l edge roughness in the femoral artery and in the aorta, visual scorin g of aorto-femoral arteriograms and manual measuring of coronary arter y stenosis were used. In each of 276 hypercholesterolaemic patients tw o femoral arteriograms were made, with a 10-minute interval. The repro ducibility of the computer analysis method was found to be constant ov er the years, with slightly better reproducibility for lumen volume th an for edge roughness. A small but significant drift in the radiologic al equipment was confirmed by the use of phantoms. In 290 patients, at herosclerosis assessments from the femoral artery (lumen volume and ro ughness) and visual scoring of the aorto-femoral arteriogram were corr elated with clinical symptoms of coronary artery disease or previous m yocardial infarction to test whether femoral atherosclerosis estimates can replace coronary studies in clinical trials. Both men and women w ith 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 tho se without. Thus, femoral atherosclerosis is an expression of a more g eneralized 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 w omen, high serum triglyceride values were associated with more extensi ve atherosclerosis. High fasting glucose values were associated with m ore 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 m ass index on the development of peripheral atherosclerosis in hypercho lesterolaemia were also investigated. The results indicated that the h ypercholesterolaemic patients most likely to develop peripheral athero sclerosis are male and female smokers who do not take any physical exe rcise, 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 compu ter-estimated in a 7.35-cm segment of the distal aorta. A correlation between atherosclerosis in the aorta and in the femoral arteries indic ated that aortic atherosclerosis is a manifestation of a more general disease. Abdominal aortic aneurysm, defined as a visual bulging of the infrarenal aorta, was diagnosed in 28 of 234 patients (mean age 54.5 years), which is more frequent than expected, and might be due to the high cholesterol levels in this selected population. The 28 patients w ith aortic aneurysm had more extensive visual atherosclerosis in the l ower arterial tree and in men, a greater edge roughness.