HEMOSTATIC FACTORS AND PREDICTION OF ISCHEMIC-HEART-DISEASE AND STROKE IN CLAUDICANTS

Thrombotic risk factors may be important in determining cardiovascular outcome in patients with symptomatic peripheral arterial disease. A c ohort study with a 6-year follow-up period was established to determin e the relationships between haemostatic and rheological factors and in cident ischaemic heart disease (MD) and stroke events in patients with peripheral arterial disease, A consecutive series of 607 patients wit h intermittent claudication was examined between 1989 and 1990 at the Peripheral Vascular Clinic, Royal Infirmary of Edinburgh. Main outcome measures were combined fatal and non-fatal stroke, nonfatal myocardia l infarction (MI), coronary death and total coronary events. A total o f 210 patients died during follow-up. 203 patients did not experience a vascular event or deterioration of limb ischaemia. Median levels of fibrinogen, von Willebrand factor (VWF), tissue plasminogen activator (t-PA) antigen, fibrin D-dimer and whole blood viscosity were signific antly higher in those who experienced an event compared with those who did not. After adjusting for age and sex, fibrin D-dimer was signific antly associated with risk of non-fatal myocardial infarction (RR 1 50 , 95% CI 1.09-2.06, P less than or equal to 0.01). Both fibrinogen and fibrin D-dimer were associated with risk of total coronary events (P less than or equal to 0.05). The risk of stroke was related to baselin e levels of t-PA antigen (RR 1.87, 95% CI 1.04-3.34, P less than or eq ual to 0.05) and whole blood viscosity (RR 1.33, 95% CI 1.07-1.65, P l ess than or equal to 0.01). All the relationships became weaker and st atistically non-significant after further adjustment for cigarette smo king, systolic blood pressure, glucose and baseline IHD. The associati ons of these factors to IHD and stroke may therefore be partly related to cardiovascular risk factors, but are likely to be important in the pathogenesis of future atherothrombotic events in subjects with perip heral arterial disease.