CIRCULATING VASCULAR CELL-ADHESION MOLECULE-1 CORRELATES WITH THE EXTENT OF HUMAN ATHEROSCLEROSIS IN CONTRAST TO CIRCULATING INTERCELLULAR-ADHESION MOLECULE-1, E-SELECTIN, P-SELECTIN, AND THROMBOMODULIN

Secondary prevention of atherosclerosis, especially before the onset o f symptoms, appears desirable and could be possible with a serum marke r detecting atherosclerosis. Circulating, shedded forms of adhesion mo lecules may serve as such because their expression is upregulated in a therosclerotic plaques. In 52 patients with peripheral arterial vascul ar disease (Fontaine class Ila, 7 patients; class IIb, 29 patients; an d class III, 16 patients), the extent of atherosclerosis was evaluated on the basis of angiograms of a large portion of the arterial system. The area diseased by atherosclerosis was determined by the percentage of vessel wall irregularities of the following calculated segments: a orta (distal from the kidney arteries), common iliac artery, external iliac artery, common femoral artery, lateral circumflex femoral artery , and popliteal artery. The maximal surface area that could exhibit at herosclerotic changes was 250 cm(2). The serum concentration of circul ating vascular cell adhesion molecule-1 (VCAM-1) correlated with the e xtent of atherosclerosis (r=.8, P<.001). In contrast, circulating inte rcellular adhesion molecule-1, E-selectin, P-selectin, and thrombomodu lin (as markers for endothelial cell damage) did not correlate with th e extent of atherosclerosis. Furthermore, circulating VCAM-1 could be used to indicate stages of atherosclerosis with a high degree of stati stical significance. The potential bias of factors such as age, diabet es mellitus, hypercholesterolemia, arterial hypertension, renal failur e, and history of myocardial infarction on the correlation of circulat ing VCAM-1 with the extent of atherosclerosis could be excluded by mul tivariate analysis. These findings suggest an important role of VCAM-1 in atherosclerosis and may serve as the basis for further evaluation of circulating VCAM-1 as a potential serum marker for atherosclerosis.