**4. Lower extremity arterial disease**

Lower extremity arterial disease (LEAD) (Fig. 5) is a common atherogenic disease of the cardiovascular system. Patients with LEAD exhibit normal to high atherogenic dyslipopro‐ teinemia [8, 31, 50 -52, 62].

<sup>\*</sup>Reference ranges derived from 125 serum samples that met the NCEP ATPIII guidelines for desirable lipid status \*\*LDL-C comprised of the sum of cholesterol in Md bands C through A as well as all the subfractions

**Figure 5.** Lower extremity arterial disease with combined atherogenic hyperlipoproteinemia with high concentration of atherogenic small dense LDL (LDL3,4 subfractions) SAAR score: 1.5

Almost all lower extremity arterial disease is due to atherosclerotic changes in artery vessels, and the pathology of LEAD is also similar to coronary heart disease. The most important risk factor for the development and progression of atherosclerotic LEAD are tobacco smoking, arterial hypertension, and hyperlipidemia. Other risk factors include diabetes mellitus, low physical activity, and a diet rich in lipids and carbohydrates. However, dyslipidemia plays an important role. Increased lipid levels of cholesterol and triglycerides are generally accepted as important risk factors for the development of atherosclerosis [14,25, 47].

In the last few decades, there has been much discussion about which atherogenic lipoproteins participate in the formation of the atherogenic lipoprotein profile, phenotype B. Atherogenic lipoproteins in relevant concentration in the blood serum are responsible for the acceleration of the development of atherogenic cardiovascular diseases, including the development of LEAD. The LDL subpopulations of small dense LDL are considered to be strongly atherogenic lipoprotein entities in the plasma/serum lipoprotein spectrum [38,59] with consequent acceleration of endothelial dysfunction and formation of the atheromatous subendothelial plaques in the arteries [21]. In the present study, we have focused on determining the incidence of an atherogenic lipoprotein phenotype, along with determining the role of atherogenic serum lipoproteins, in patients with lower extremity arterial disease.
