Impact of Preoperative LDL Level on Lower Extremity Revascularization Outcomes

Abstract

Background: Recent guidelines recommend achieving low-density lipoprotein (LDL) < 70 mg/dL in patients with peripheral arterial disease (PAD). This study assesses the trends in LDL testing and its impact on lower extremity revascularization (LER) outcomes in a tertiary center.

Methods: A retrospective chart review of patients who underwent open, endovascular, or hybrid LER between 2013 and2020 was performed, with follow-up extending into 2024. Patients were divided into 2 groups based on baseline LDL < 70 mg/dL or higher prior to LER. Characteristics and outcomes of the 2 groups were compared.

Results: Of 2,039 patients that underwent LER, 33.1% did not have LDL testing prior to intervention. The proportion of patients with preoperative LDL testing significantly increased over the study period (39.3-66.2%) concomitantly with increased statin use (74.4-81%), while the proportion of patients with baseline LDL < 70 mg/dL remained low (∼36%). Patients with low LDL were more likely to be older White males with significantly higher burden of comorbidities treated for chronic limb-threatening ischemia. Survival and Cox regression analysis did not demonstrate significant association of baseline LDL < 70 mg/dL with major adverse cardiovascular events, limb events, or mortality.

Conclusion: Lipid testing and statin use prior to LER have increased, but most patients had baseline LDL higher than the suggested target by most recent guidelines. A preoperative LDL < 70 mg/dL did not demonstrate an association with outcomes. This study highlights a significant gap in the care of patients with PAD undergoing LER and an opportunity for improvement by application of contemporary guidelines.