Lipid profiles of patients with manifest coronary versus peripheral atherosclerosis - Is there a difference?

J Intern Med. 2021 Dec;290(6):1249-1263. doi: 10.1111/joim.13368. Epub 2021 Sep 10.


Aim: Peripheral arterial disease (PAD) and coronary artery disease (CAD) are both caused by atherosclerosis. Serum lipids and lipoproteins are predictive of the development of atherosclerosis but it is not clear if they differ in the two manifestations, PAD and CAD. We tested whether a more detailed characterization of the lipid and lipoprotein patterns of PAD and CAD allows a clear differentiation between the two atherosclerotic phenotypes.

Methods: A cohort of 274 statin-naïve patients with either newly diagnosed imaging proven PAD (n = 89) or stable CAD (n = 185) was characterized using nuclear magnetic resonance- and liquid chromatography-tandem mass spectrometry-based advanced lipid and lipoprotein analysis. An independent cohort of 1239 patients with PAD and CAD was used for validation.

Results: We found a significant difference in markers of inflammation as well as ceramide and phosphatidylcholine levels between patients with PAD and CAD. In contrast, basic lipid markers including total cholesterol, LDL cholesterol, HDL cholesterol, lipoprotein(a) or detailed lipoprotein profiles did not differ significantly between patients with PAD and CAD. Applying ratios and scores derived from ceramides and phosphatidylcholines further improved the discrimination between PAD and CAD. These significant differences were independent of body composition, from the status of smoking or type 2 diabetes mellitus, and also from apolipoprotein C-III and other inflammatory parameters which were different between CAD and PAD.

Conclusion: The present study clearly suggests that PAD and CAD differ in terms of their ceramide- and phosphatidylcholine-based lipid patterns but not in lipoprotein characteristics.

Keywords: cholesterol; coronary artery disease; lipid; lipoproteins; mass spectrometry; peripheral arterial disease.

Publication types

  • Research Support, Non-U.S. Gov't

MeSH terms

  • Atherosclerosis* / blood
  • Ceramides / blood
  • Coronary Artery Disease* / blood
  • Diabetes Mellitus, Type 2
  • Humans
  • Lipids / blood*
  • Lipoproteins / blood*
  • Peripheral Arterial Disease* / blood
  • Phosphatidylcholines / blood
  • Risk Factors


  • Ceramides
  • Lipids
  • Lipoproteins
  • Phosphatidylcholines