PREVALENCE OF OBLITERATING ATHEROSCLEROSIS OF THE LOWER EXTREMITIES AND FACTORS AFFECTING IT
DOI:
https://doi.org/10.32782/health-2024.3.4Keywords:
obliterating atherosclerosis of the lower extremities, dyslipidemia, obesity, diabetes, hypertension, chronic kidney disease, ABIAbstract
The incidence of obliterating atherosclerosis of the lower extremities is estimated at 3–10 %. This frequency increases with age and is 15–20 % in people over 70. Approximately 40 % of patients in the early stages of obliterating atherosclerosis of the lower extremities are asymptomatic, with an ABI (ankle-brachial index) < 0.90 or cessation of a pulse. Asymptomatic patients are critical because this clinical stage is associated with the best prognosis if the diagnosis is made correctly. If therapy is started in asymptomatic patients with obliterating atherosclerosis of the lower extremities, it can prevent the development of later stages of the disease. Modifiable risk factors that contribute to the development of obliterating atherosclerosis of the lower extremities include smoking, diabetes, hypertension, dyslipidemia, elevated plasma homocysteine, and hypothyroidism. Obesity is positively correlated with high ABI, and the prevalence of obliterating atherosclerosis of the lower extremities in patients with type 2 diabetes is 23.5 %. Decreased glomerular filtration rate and microalbuminuria are also associated with obliterating atherosclerosis of the lower extremities. Obliterating atherosclerosis of the lower extremities is interconnected with several diseases; this interaction is often manifested in women. Among them are hypothyroidism, osteoporosis, and the use of oral contraceptives, which lead to an increase in the frequency of pathology. Postmenopausal women with osteoporosis have a higher risk of obliterating atherosclerosis of the lower extremities than postmenopausal women with normal bone mineral density. Patients with chronic kidney disease are more likely to develop obliterating atherosclerosis of the lower extremities because they have additional risk factors such as hypoalbuminemia, albuminuria, and arterial calcification. The risk of obliterating atherosclerosis of the lower extremities increases with a decrease in glomerular filtration rate. Albuminuria is associated with endothelial dysfunction, which is a risk factor for systemic atherosclerosis, including obliterating atherosclerosis of the lower extremities, and with medial arterial calcification, which increases the stiffness of the arterial walls and leads to an increase in the ABI value, that is, the "false normal" value. Hyperparathyroidism and vitamin D deficiency are other factors that increase arterial stiffness, leading to "false normal" ABI values in individuals with chronic kidney disease. Uremic patients on dialysis have chronic inflammation, hypoalbuminemia, and an increased risk of obliterating atherosclerosis of the lower extremities. In general, obliterating atherosclerosis of the lower extremities is a common disease, the percentage of which increases among the elderly and men. In women, this pathology is manifested by more pronounced functional disorders.
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