Peripheral arterial disease (PAD) is a common vascular disease, still underdiagnosed and undertreated. Dyslipidaemia represents one of the major risk factors. Increasing evidence supports that apolipoprotein B levels are a better outcome predictor than LDL cholesterol, but there is only limited data on their impact on PAD. Our analysis will also include lipoprotein(a), Lp(a). Study’s aim: analyse correlations between specific lipid parameters and PAD outcomes, including MACE (major adverse cardiac events) and MALE (major adverse limb events).

Retrospective study of PAD patients prospectively enrolled in a regional hospital-based real-life registry. We used descriptive statistics and regression analysis. Baseline characteristics and biomarker levels, including apoB and Lp(a) were analysed in relation to disease severity.

130 patients included between December 2022 – July 2024 were analysed. Mean age was 71.8, 51.5 % were females. Dyslipidaemia was present in 88.5 %. Forty-four % of patients had their LDL-c level on range and only 29 % their ApoB level. Mean LDL-c value was 2 mmol/l, mean apoB level 0.84 g/l and mean Lp(a) 102 nmol/l. Diabetes was present in 39 %, hypertension in 79 % and patients were smokers (current or former) in 82 %. Fifty-six % of patients were polyvascular, 95 % were on antithrombotic and 87 % on statins. Thirty-eight % of patients suffered from a composite endpoint of MACE or MALE. Among those, 65 % had high ApoB level (>0.65 g/l) and 73 % had high LDL-c (>1.4 mmol/l). There is a significant correlation between LDL-c value and ApoB level. Risk factors for MACE/MALE population are: male gender (OR: 2.11, p=0.04), diabetes (OR: 3.77, p<0.001). In a multivariate (apoB, LDL-c, Lp(a), diabetes, male, hypertension) logistic regression, we also found male and diabetes as independent risk factors. There was a trend towards significance between the ApoB – MACE/MALE association.

Our study aims to contribute to a better understanding of the role of apoB and Lp(a) in the outcomes of PAD. This could lead to new algorithms guiding the management of patients, particularly those in actual grey zone. Our preliminary results underline the potential importance of these biomarkers in the global risk assessment of PAD patients. More in-depth analysis is required to better understand their prognostic significance.