HEMOSTATIC AND RHEOLOGICAL FACTORS IN INTERMITTENT CLAUDICATION - THEINFLUENCE OF SMOKING AND EXTENT OF ARTERIAL-DISEASE

Patients with intermittent claudication have been reported to have dis turbances in blood rheology and haemostasis. Whether these disturbance s are a result of, or largely independent of, smoking history and arte rial narrowing has not yet been established, The levels of whole blood and plasma viscosity, haematocrit, von Willebrand factor antigen, fib rin D-dimer antigen and urinary fibrinopeptide A antigen were compared in 617 claudicants and 722 controls from two epidemiological studies in Edinburgh. After adjustment for age and sex, all factors, except wh ole blood viscosity and haematocrit, were significantly higher in the claudicants compared to controls (P less than or equal to 0.001). The risk of intermittent claudication was significantly raised for unit ch ange in each factor, except for whole blood viscosity and haematocrit. Adjustment for lifetime smoking had little effect on the odds ratios. After further adjustment for the ankle brachial pressure index (as a measure of the extent of peripheral arterial disease), haematocrit, vo n Willebrand factor and urinary fibrinopeptide A showed a significant independent relationship with the risk of intermittent claudication. W e conclude that the association between selected rheological and haemo static factors and leg ischaemia is largely independent of both smokin g history and the extent of arterial narrowing, and may be directly re lated to microvascular ischaemia.