Clinical and molecular manifestations of lower limb peripheral artery disease
Jalkanen, Juho (2017-11-10)
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Lower limb peripheral artery disease (PAD) is poorly known by the general public and even health care professionals. The manifestations of PAD are diverse depending on the prevailing cardiovascular risk factors leading to the disease. Also the outcome of patients is very different depending on the different manifestations of the disease. The end-stage of PAD, known as critical limb ischemia (CLI), is associated with very poor survival. In order to understand the heterogenic nature of PAD in depth, different molecular mechanisms of the disease in association with major cardiovascular risk factors and disease severity were investigated. The findings indicate that different cardiovascular risk factors are associated with diverse molecular pathology. This thesis work also shows that the presence of crural atherosclerosis and CLI are tightly associated with poor patient survival, and that especially CLI is associated with elevated levels of multiple circulating cytokines, which resembles a systemic inflammatory condition. The major future implications of the current findings are that CLI can no longer be referred to as a plain condition of the lower limb and effort should be put into the attenuation of the systemic inflammatory condition. Most importantly, the current findings imply that future effort should be put into studying the risk factor specific molecular mechanism leading to the disease in order to develop new specific medical therapies according to the prevailing inflammatory pathology.
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