CROSS-LINKED FIBRIN DEGRADATION PRODUCTS, PROGRESSION OF PERIPHERAL ARTERIAL-DISEASE, AND RISK OF CORONARY HEART-DISEASE

Haemostatic and rheological factors may predict cardiovascular disease . We studied patients with intermittent claudication to see if the pro gression of peripheral arterial disease and the risks of coronary even ts could be predicted by baseline packed cell volume, plasma fibrinoge n, blood and plasma viscosites, von Willebrand factor antigen, cross-l inked fibrin degradation products (XLFDP), urinary fibrinopeptide A, a nd plasma leucocyte elastase. In 617 patients with claudication follow ed up for one year, baseline XLFDP was related most strongly to corona ry events, relative risk 4.4 (95% CI 1.3-19.0) between top and bottom quintiles. Plasma fibrinogen was the strongest independent predictor o f death from coronary disease. XLFDP was the only factor, in addition to age and cigarette smoking, that was independently associated (p = 0 .008) with deterioration in peripheral arterial disease. We conclude t hat, in patients with peripheral arterial disease, plasma concentratio n of XLFDP, a measure of ongoing fibrin formation and degradation, is a strong predictor of both disease progression and future coronary ris k. These results accord with the hypothesis that fibrin formation cont ributes to progression of coronary and peripheral atherosclerosis.