Malondialdehyde-Modified Low-Density Lipoprotein as a Predictor of Major Adverse Limb Events after Endovascular Therapy in Patients with Lower Extremity Arterial Disease

• Published in: Journal of Atherosclerosis and Thrombosis Vol. 30; no. 11; pp. 1612 - 1621
• Main Authors: Yokoi, Masashi, Ito, Tsuyoshi, Kawada, Yu, Mizoguchi, Tatsuya, Yamamoto, Junki, Mori, Kento, Nakasuka, Kosuke, Kikuchi, Shohei, Fujita, Hiroshi, Kitada, Shuichi, Goto, Toshihiko, Seo, Yoshihiro
• Format: Journal Article
• Language: English
• Published: Japan Japan Atherosclerosis Society 01.11.2023
• Subjects: EVT; MDA-LDL; Original; Outcome; Oxidative stress; Oxidized LDL; Oxidative stress; EVT; MDA-LDL; Outcome; Oxidized LDL
• ISSN: 1340-3478; 1880-3873
• DOI: 10.5551/jat.64091

Aim: Adverse limb events after endovascular therapy (EVT) are a major concern. This study aimed to investigate the relationship between serum malondialdehyde-modified low-density lipoprotein (MDA-LDL) level, a potentially potent indicator of atherosclerosis, and clinical outcomes after EVT in patients with lower extremity arterial disease (LEAD). Methods: A total of 208 LEAD patients who underwent EVT and MDA-LDL measurements were retrospectively analyzed. Those with chronic limb-threatening ischemia (CLTI) were included in the CLTI subgroup (n=106). Patients were further categorized into the High or Low MDA-LDL groups according to the cut-off value calculated by receiver operating characteristic analysis. Major adverse limb events (MALE), a composite of cardiovascular death, limb-related death, major amputation, and target-limb revascularization, were evaluated. Results: MALE occurred in 73 (35%) patients. The median follow-up interval was 17.4 months. The MDA-LDL cut-off values were 100.5 U/L (area under the curve [AUC] 0.651) in the overall population and 98.0 U/L (AUC 0.724) in the CLTI subgroup. Overall, the High MDA-LDL group showed significantly higher total cholesterol (189.7±37.5 mg/dL vs. 159.3±32.0 mg/dL, p＜0.01), low-density lipoprotein cholesterol (114.3±29.7 mg/dL vs. 87.3±25.3 mg/dL, p＜0.01), and triglyceride (166.9±91.1 mg/dL vs. 115.8±52.3 mg/dL, p＜0.01) than the Low MDA-LDL group. Multivariate Cox regression analyses revealed that MDA-LDL and C-reactive protein were independent predictors of MALE. In the CLTI subgroup, MDA-LDL was an independent predictor of MALE. The High MDA-LDL group showed worse MALE-free survival rates than the Low MDA-LDL group in overall (p＜0.01) and in the CLTI subgroup (p=0.01). Conclusions: Serum MDA-LDL level was associated with MALE after EVT.