Little is known about the association between limb prognosis in peripheral artery disease and apolipoprotein E (apoE). We evaluated the long-term impact of apoE on adverse limb events in patients with intermittent claudication receiving statin treatment.

A total of 218 consecutive patients (mean age, 73 ± 8 years; 81% men) with intermittent claudication who underwent their first intervention between 2009 and 2020 were included in this study. All patients had achieved LDL-C < 100 mg/dL on statin treatment and were divided into two groups based on the apoE value (≥ 4.7 or < 4.7 mg/dL). We evaluated the incidence of major adverse limb events (MALEs), including vessel revascularization and limb ischemia development.

A total of 39 and 179 patients were allocated to the higher and lower apoE groups, respectively. Compared to the lower apoE group, the higher apoE group had a significantly higher total cholesterol level, triglyceride level, and non-high-density lipoprotein cholesterol level. During the median follow-up period of 3.6 years, 30 patients (13.8%) developed MALEs. Kaplan-Meier analysis revealed that the cumulative incidence of MALEs in the higher apoE group was significantly higher than that in the lower apoE group (44.0% versus 21.6%, log-rank test, P = 0.002). During multivariable Cox hazard analysis, higher apoE level (≥ 4.7 mg/dL) (hazard ratio, 2.61; 95% confidence interval, 1.18-5.70, P = 0.019) was the only strong independent predictor of MALEs.

ApoE levels could be a strong predictor and residual risk for long-term limb prognosis in patients with intermittent claudication and achieving LDL-C < 100 mg/dL with statin treatment.

关于外周动脉疾病的肢体预后与载脂蛋白 E (apoE) 之间的关联知之甚少。我们评估了 apoE 对接受他汀类药物治疗的间歇性跛行患者不良肢体事件的长期影响。

本研究共纳入 218 名在 2009 年至 2020 年期间接受首次干预的间歇性跛行患者（平均年龄，73 ± 8 岁；81% 为男性）。所有患者在他汀类药物治疗中均达到 LDL-C < 100 mg/dL，并根据 apoE 值（≥ 4.7 或 < 4.7 mg/dL）分为两组。我们评估了主要不良肢体事件 (MALE) 的发生率，包括血管血运重建和肢体缺血的发展。

总共 39 名和 179 名患者分别被分配到较高和较低的 apoE 组。与低apoE组相比，高apoE组的总胆固醇水平、甘油三酯水平和非高密度脂蛋白胆固醇水平显着升高。在 3.6 年的中位随访期间，30 名患者 (13.8%) 发生了男性。Kaplan-Meier 分析显示，高 apoE 组的 MALE 累积发生率显着高于低 apoE 组（44.0% 对 21.6%，对数秩检验，P = 0.002）。在多变量 Cox 风险分析期间，较高的 apoE 水平（≥ 4.7 mg/dL）（风险比，2.61；95% 置信区间，1.18-5.70，P = 0.019）是 MALE 的唯一强独立预测因子。

对于间歇性跛行和使用他汀类药物治疗达到 LDL-C < 100 mg/dL 的患者，ApoE 水平可能是长期肢体预后的强预测因子和残余风险。