Tikkanen E, Jägerroos V, Holmes MV, et al. - In this study, the metabolic biomarker profile for future peripheral artery disease (PAD) risk was identified to be distinct from that of coronary artery disease (CAD), thus, indicating pathophysiological differences.

• Five prospective cohorts from Finnish population (FINRISK 1997, 2002, 2007, and 2012, and Health 2000; n=31,657; median follow‐up time of 14 years) were used to examine links between >200 metabolic biomarkers and incident PAD and CAD.

• Robust association of apolipoproteins and cholesterol measures with incident CAD (eg, hazard ratio [HR] per SD for higher apolipoprotein B/A‐1 ratio, 1.30), but not with incident PAD (HR per SD for higher apolipoprotein B/A‐1 ratio, 1.04), was revealed in age‐ and gender‐adjusted Cox models.

• Triglyceride concentrations in low‐density lipoprotein and high‐density lipoprotein were found to be linked with both endpoints.

• The following were strongly related to incident PAD: lower proportion of polyunsaturated fatty acids vs total fatty acids, and higher levels of monounsaturated fatty acids, glycolysis‐related metabolites, and inflammatory protein markers.

• In addition, many of these links were stronger for PAD vs for CAD.

• Most disparities in metabolic profiles for PAD and CAD continued when adjusting for conventional risk factors.