Background Previous studies have suggested site‐specific differences in lesion distribution and risk factor profiles in peripheral artery disease (PAD). However, these associations have not been systematically evaluated within a broader framework incorporating disease extent, clinical severity, and systemic vascular involvement. Methods We conducted a retrospective cohort study of 3548 patients with lower extremity PAD. Lesion distribution was classified as aortoiliac (AI), femoropopliteal (FP), or infrapopliteal (IP) in patients with single‐site disease, while disease extent was defined as single‐site versus multisite involvement (≥ 2 segments). Ordinal logistic regression was used to assess associations with lesion distribution and multivariable logistic regression to evaluate disease extent, clinical severity, and vascular comorbidities. Stratified and sensitivity analyses were performed. Results Distinct patterns of association were observed across multiple dimensions of PAD, including lesion distribution, disease extent, and clinical severity. Age and diabetes were strongly associated with distal lesions, whereas smoking was associated with proximal disease. Lipid‐related variables showed heterogeneous associations that varied across individual lipid measures and were modified by diabetes status and age. In contrast, disease extent was more strongly associated with smoking and hypertension, but not diabetes. Disease extent, as reflected by multisite involvement, was independently associated with increased disease severity and a higher prevalence of cerebrovascular disease (CeVD), indicating a greater systemic atherosclerotic burden. Conclusions Cardiovascular risk factors exhibit differential associations across multiple dimensions of PAD, including lesion distribution, disease extent, and clinical severity. These findings highlight the multidimensional and heterogeneous nature of PAD and support more individualized, site‐specific approaches to risk assessment and management. In particular, these findings suggest the potential value of tailoring risk factor control according to lesion characteristics, such as emphasizing smoking cessation in proximal disease and optimizing glycemic control in distal disease.
Meng et al. (Thu,) studied this question.