Open AccessPatients with a failed infrainguinal bypass graft have abnormal lipid metabolism
Author(s) -
Lewis D. R.,
Taberner P. V.,
Lemon M. J. C.,
Day A.,
Shih M. F.,
Brooks S. T.,
Bird R. N.,
Lamont P. M.,
Smith F. C. T.
Publication year - 1999
Publication title -
british journal of surgery
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 2.202
H-Index - 201
eISSN - 1365-2168
pISSN - 0007-1323
DOI - 10.1046/j.1365-2168.1999.0708a.x
Subject(s) - medicine , triglyceride , cholesterol , lipid metabolism , prospective cohort study , gastroenterology , mann–whitney u test , lipid profile , lipoprotein lipase , surgery , lipoprotein , endocrinology , adipose tissue
Background: Dyslipidaemias adversely affect vascular tone, endothelial function and platelet activation. Abnormal lipid metabolism has not been established as a risk factor for infrainguinal bypass graft failure. Lipid metabolism was evaluated prospectively in patients with patent and occluded grafts. Methods: Twenty‐eight patients with failed infrainguinal grafts (group 1) were identified from a prospective computerized database. Twenty matched controls with functioning grafts (group 2) were recruited from a graft surveillance programme. Fasting blood samples were analysed for triglyceride (TG), high‐density lipoprotein (HDL) and cholesterol. A newly devised rapid TG tolerance test was conducted with analysis of TG at 1, 2 and 2·5 h. Endothelial lipoprotein lipase (LPL) was measured 30 min after intravenous administration of heparin 50 units kg –1 . Results: The cholesterol: HDL ratio was significantly higher in group 1 than group 2 (median 6·0 (range 3·1–10·0) versus 4·7 (2·3–9·4); P = 0·0008, Mann–Whitney test) as was fasting TG (2·6 (1·0–6·3) versus 1·7 (0·6–4·7) mmol l –1 ; P = 0·03). The area under the curve of the TG tolerance test was not significantly different ( P = 0·08); however, the 2·5‐h levels of TG were significantly different between the groups (group 1, 2·0 (0·5–6·6) mmol l –1 ; group 2, 1·2 (0·3–6·8) mmol l –1 ; P = 0·01). LPL was significantly lower in group 1 (52·4 (2·2–235·9) versus 86·8 (28·6–281·5) mmol/l; P = 0·04). Conclusion: These data suggest that abnormal lipid metabolism is a significant risk factor for infrainguinal graft occlusion. This study provides a rationale for randomized trials of lipid‐modifying therapies in patients undergoing arterial reconstruction for peripheral vascular disease. © 1999 British Journal of Surgery Society Ltd