A Comparative Analysis of Modifiable Risk Factors for Chronic Limb-threatening Ischemia

Aim: The purpose of the present study is to identify modifiable risk factors causing chronic limb-threatening ischemia (CLTI). On the basis of the findings, we believe that early detection of the modifiable risk factors and its timely management will be of greater value to lead the patient toward better prognosis and prevention of major complications. Materials and Methods: In a prospective single-center study, 75 patients diagnosed with CLTI were comprehensively evaluated to identify the cause of CLTI and the presence of associated known risk factors. Analysis of Statistical Data: Data were analyzed using binary logistic regression to identify independent predictors and receiver operating characteristic (ROC) curve analysis to assess diagnostic accuracy. Smoking (78.7%), diabetes (74.7%), hypertension (HTN; 69.3%), and hyperlipidemia (80%) emerged as statistically significant ( P < 0.05) predictors of CLTI severity. All patients had severe ankle–brachial index (ABI; <0.4), while gangrene and ulceration were observed in 50.7% and 52%, respectively. Pulse deficit classification significantly correlated with disease severity. These findings, supported by SPSS-based multivariate modeling, highlight the strong predictive value of modifiable risk factors in advanced CLTI and underscore their importance in early detection and clinical risk stratification. Results: In this observational study of 75 patients with CLTI, key modifiable risk factors and clinical correlates were analyzed. The majority of participants were male (78.7%) with a mean age of 65.39 years. Overweight status was prevalent (58.7%), while smoking (78.7%), tobacco chewing (81.3%), and alcohol use (60%) were significantly associated with severe disease. Physical inactivity was reported in 84% of patients. All patients exhibited severe peripheral arterial disease, with ABI values <0.4 and widespread distal pulse deficits. Gangrene (50.7%) and ulceration (52%) were common clinical manifestations. Diabetes mellitus (74.7%), HTN (69.3%), and hyperlipidemia (80%) were the most frequent comorbidities, and logistic regression confirmed these as strong predictors of disease severity. ROC analysis further supported the predictive strength of combined risk factors. These findings highlight the critical role of modifiable lifestyle behaviors and comorbid conditions in CLTI pathogenesis, emphasizing the need for targeted preventive and multidisciplinary management strategies. Conclusions: This study highlights that CLTI is strongly associated with modifiable risk factors – particularly smoking, physical inactivity, and substance use – as well as prevalent comorbidities such as diabetes, HTN, and hyperlipidemia. The universal presence of severe ABI impairment and high rates of tissue loss underscores late presentation and inadequate preventive care. Statistical analyses confirmed these factors as independent predictors of disease severity. The findings align with global data, reinforcing the preventable nature of CLTI through early intervention. Emphasis on risk factor modification, patient education, and integrated care is crucial. Strengthening primary prevention can significantly reduce CLTI-related morbidity and amputation rates.