Role of Lipoprotein(a) and Blood Cells Ratios in Peripheral Artery Disease

Peripheral artery disease (PAD) is a major global health issue. This study investigated the relationship between lipoprotein(a) [Lp(a)], high-density lipoprotein cholesterol (HDL-C) to blood cells ratios, and PAD development. The study included 361 patients categorized into groups based on the presence of stenotic atherosclerosis in lower limb arteries (LLAs) diagnosed via duplex ultrasound. Group 1 (n = 238) had atherosclerosis at the first visit. A second visit involved 281 patients: 158 from Group 1, 32 new diagnoses (Group 2), and 91 with no atherosclerosis at either visit (Group 3). Laboratory analysis included lipid profiles, Lp(a), and complete blood counts, calculating ratios like Lp(a)/HDL-C and monocyte-to-HDL-C ratio (MHR). Showed patients with stenotic atherosclerosis had significantly higher Lp(a) (20.2 vs. 12.1 mg/dL, <i>p</i> < 0.01), MHR (0.54 vs. 0.39, <i>p</i> = 0.002), and Lp(a)/HDL-C ratios (20.9 vs. 8.8, <i>p</i> = 0.003). The combination of monocytes ≥ 0.55 × 10⁹/L and Lp(a) ≥ 30 mg/dL was present in 27% of PAD patients vs. 10% without (<i>p</i> < 0.01). Kaplan-Meier analysis indicated that high Lp(a) levels led to chronic limb ischemia 9.5 years earlier. Combined assessment of Lp(a) and monocyte-related ratios provides superior predictive value for PAD, suggesting clinical utility for risk stratification and early intervention.