SMOKING, HEMORHEOLOGIC FACTORS, AND PROGRESSION OF PERIPHERAL ARTERIAL-DISEASE IN PATIENTS WITH CLAUDICATION

Purpose: The purpose of the current study was to determine whether hem ostatic and rheologic factors are associated with the deterioration of peripheral arterial disease in patients with intermittent claudicatio n and the influence of smoking and severity of underlying disease on t hese relationships. Methods: We conducted a prospective cohort study w ith a 6-year follow-up period of a consecutive series of 607 patients with uncomplicated intermittent claudication. The study setting was th e Peripheral Vascular Clinic, Royal Infirmary of Edinburgh. The main o utcome measures were peripheral vascular intervention or onset of seve re chronic leg ischemia (rest pain, ulceration, gangrene). Results: A total of 210 patients died during follow-up. Two hundred three patient s did not have a vascular event or deterioration of Limb ischemia, 45 patients underwent a peripheral vascular intervention, and 64 progress ed to severe chronic leg ischemia. Median levels (interquartile ranges ) of whole blood viscosity were significantly higher in the vascular i ntervention group (3.75 mPa/sec; range, 3.38 to 4.13 mPa/sec) than in those who did not deteriorate 3.48 mPa/sec; range, 3.06 to 3.83 mPa/se c) (p less than or equal to 0.05), and plasma von Willebrand factor wa s higher in those with severe chronic leg ischemia (154.0 IU/dl; range , 122.0 to 187.0 IU/dl) than in those who did not deteriorate (131.0 I U/dl; range, 106.0 to 165.0 lU/dl) (p less than or equal to 0.01). Aft er adjustment for age, sex, cigarette smoking, and ankle brachial pres sure index, the levels of plasma fibrinogen and blood and plasma visco sities were each associated with an increased risk of vascular interve ntion tall p less than or equal to 0.05). There were no significant as sociations between any of the hemorheologic factors and the risk of se vere chronic leg ischemia on multivariate analyses. Conclusion: Elevat ions in theologic factors may have important effects on further reduct ion of blood flow in the legs of patients with claudication and promot e worsening ischemia and clinical progression of symptoms.