CIRCULATING ICAM-1 AND VCAM-1 IN PERIPHERAL ARTERY DISEASE AND HYPERCHOLESTEROLEMIA - RELATIONSHIP TO THE LOCATION OF ATHEROSCLEROTIC DISEASE, SMOKING, AND IN THE PREDICTION OF ADVERSE EVENTS

We examined the relationship of soluble intercellular adhesion molecul e-1 (sICAM-1) and vascular cell adhesion molecule-1 (sVCAM-1) with smo king and hypercholesterolaemia in peripheral artery disease (PAD). Ser um samples were obtained from 119 patients with objectively-proven PAD , 39 patients with hypercholesterolaemia but asymptomatic for PAD, and 132 age and sex matched asymptomatic controls. Using ELISAs, we found increased sICAM-1 and sVCAM-1 (both p<0.01) in the patients with PAD relative to the controls. but no significant change in patients with h ypercholesterolaemia. However, the effect for sVCAM-1 was lost when sm oking was entered as a covariate. Only sICAM-1 was higher in patients with PAD in the femoral/iliac arteries compared to the carotid arterie s (p<0.05). In a 39-month follow-up of 112 patients with PAD, increase d ICAM-1 weakly (univariate p<0.05) predicted those 57 whose disease p rogressed (i.e., to end points such as myocardial infarction and arter ial surgery). However, high fibrinogen was a much better (univariate p =0.001, multivariate p<0.05) predictor of disease progression. We sugg est (i) that increased levels of sVCAM-1 in atherosclerosis are due to smoking, (ii) that increased sICAM-1 is independent of this risk fact or. (iii) that both these changes are independent of hypercholesterola emia, and (iv) that increased sICAM-1 is a weak predictor of disease p rogression in peripheral atherosclerosis.