Subscribe to RSS
DOI: 10.1055/s-0038-1650215
Smoking, Haemostatic Factors and the Severity of Aorto-lliac and Femoro-Popliteal Disease
Publication History
Received 27 July 1995
Accepted after resubmission 10 October 1995
Publication Date:
10 July 2018 (online)
Summary
To determine relationships between haemostatic and rheological factors and severity of peripheral atherosclerosis and differences by site, an angiographic cross-sectional survey was carried out on 192 men and women with intermittent claudication or rest pain. 34 patients were classified as having aorto-iliac disease, 85 femoro-popliteal disease and 73 dual-site disease. Mean levels of haemostatic or rheological factors did not differ significantly between the three site groups. In all 192 patients, disease severity in the femoro-popliteal segments was correlated with plasma nephelometric fibrinogen (r = 0.20, p ≤0.01), von Willebrand factor (r = 0.14, p ≤0.05) and fibrin D-dimer (r = 0.22, p ≤0.001). On multiple regression analyses, fibrinogen was independently associated with disease severity in the femoro-popliteal segments (p ≤0.05), but not in the aorto-iliac segments. Adjustment for packyears or serum thiocyanate had little effect on the association of fibrinogen with severity of disease. An inverse relationship between plasminogen activator inhibitor and disease severity in the femoro-popliteal segments was found only in men (r = -0.24, p ≤0.01). We conclude that elevated fibrinogen and disturbed fibrinolytic activity may be related to the extent of disease within the femoro-popliteal arteries, more so than in the aorto-iliac arteries.
-
References
- 1 Dormandy JA, Hoare E, Colley J, Arrowsmith DE, Dormandy TL. Clinical, haemodynamic and biochemical findings in 126 patients with intermittent claudication. BMJ 1973; iv: 576-581
- 2 Lee AJ, Smith WCS, Lowe GDO, Tunstall-Pedoe H. Plasma fibrinogen and coronary risk factors: the Scottish Heart Health Study. J Clin Epidemiol 1993; 43 (09) 913-919
- 3 Smith FB, Lowe GDO, Fowkes FGR, Rumley A, Rumley AG, Donnan PT, Housley E. Smoking, haemostatic factors and lipid peroxides in a population case control study of peripheral arterial disease. Atherosclerosis 1993; 102: 155-162
- 4 Baxter K, Wiseman S, Powell J, Greenhalgh R. Pilot study of a screening test for peripheral arterial disease in middle-aged men: fibrinogen as a possible risk factor. Cardiovasc Res 1988; 22: 300-302
- 5 Blann AD, McCollum CN. Haemostatic risk factors in patients with vascular disease. Atherosclerosis 1992; 93: 255-256
- 6 Folsom AR, Wu K, Shahar E, Davis CE. Association of hemostatic variables with prevalent cardiovascular disease and asymptomatic carotid artery atherosclerosis. Arterioscler Thromb 1993; 13: 1829-1836
- 7 Cortellaro M, Boschetti C, Cofrancesco E, Zanussi C, Catalano M, de Gaetano G, Gabrielli L, Lombardi B, Specchia G, Tavazzi L, Tremoli E, Della Volpe A, Polli E. and the PLAT study group Increased fibrin turnover and high PAI-1 activity as predictors of ischemic events in atherosclerotic patients: a case control study. Arterioscler Thromb 1993; 13: 1412-1417
- 8 Al-Zahrani H, Lowe GDO, Douglas JT, Cushieri R, Pollock JG, Smith WCS. Increased fibrin turnover in peripheral arterial disease: comparison with a population study. Clin Haemorheol 1992; 12: 867-872
- 9 Lee AJ, Fowkes FGR, Lowe GDO, Rumley A. Fibrin D-dimer, haemostatic factors and peripheral arterial disease. Thromb Haemost 1995; 74 (03) 828-832
- 10 Smith FB, Lee AJ, Rumley A, Fowkes FGR, Lowe GDO. Tissue-plasmino-gen activator, plasminogen activator inhibitor and risk of peripheral arterial disease. Atherosclerosis 1995; 115: 35-43
- 11 Banerjee AK, Pearson J, Gilliland EL, Goss D, Lewis JD, Stirling Y, Meade TW. A six-year prospective study of fibrinogen and other risk factors associated with mortality in stable claudicants. Thromb Haemost 1992; 68: 261-263
- 12 Fowkes FGR, Lowe GDO, Housley E, Rattray A, Rumley A, Elton RA, MacGregor IR, Dawes J. Cross-linked fibrin degradation products, progression of peripheral arterial disease, and risk of coronary artery disease. Lancet 1993; 342: 84-86
- 13 Lassila R, Peltonen S, Lepantalo M, Saarinen O, Kauhanen P, Manninen V. Severity of peripheral atherosclerosis is associated with fibrinogen and degradation of cross-linked fibrin. Arterioscler Thromb 1993; 13: 1738-1742
- 14 Herren T, Strieker H, Haeberli A, Do D-D, Straub PW. Fibrin formation and degradation in patients with atherosclerotic disease. Circulation 1994; 90: 2679-2686
- 15 Leng GC, Fowkes FGR. The epidemiology of peripheral arterial disease. Vase Med Rev 1993; 4: 05-18
- 16 Kannel WB, D’Agostino RB, Belanger AJ. Update on fibrinogen as a cardiovascular risk factor. Ann Epidemiol 1992; 2: 457-466
- 17 Lowe GDO, Fowkes FGR, Dawes J, Donnan PT, Lennie SE, Housley E. Blood viscosity, fibrinogen, and activation of coagulation and leukocytes in peripheral arterial disease and the normal population in the Edinburgh Artery Study. Circulation 1993; 87: 1915-1920
- 18 Fowkes FGR, Housley E, Riemersma R, Macintyre CCA, Cawood EHH, Prescott RJ, Ruckley CV. Smoking, lipids, glucose intolerance, and blood pressure as risk factors for peripheral atherosclerosis compared with ischemic heart disease in the Edinburgh Artery Study. Am J Epidemiol 1992; 135: 331-340
- 19 Lawton G. Cigarette smoking and atherosclerosis. Their relationship in the aorta and femoral arterie. Brit J Surg 1973; 60: 873-876
- 20 Strong JP, Richards ML. Cigarette smoking and atherosclerosis in autop-sied men. Atherosclerosis 1976; 23: 1413-1420
- 21 Lowe GDO. Blood rheology in arterial disease. Clin Sci 1986; 71: 137-146
- 22 Lowe GDO. Blood viscosity in vitro and in vivo. Bailliere’s Clin Haematol 1987; 1: 597-636
- 23 Leng GC, Fowkes FGR. The Edinburgh Claudication Questionnaire: an improved version of the WHO/Rose questionnaire for use in epidemiological surveys. J Clin Epidemiol 1992; 45: 1101-1109
- 24 Rose GA. The diagnosis of ischaemic heart pain and intermittent claudication in field surveys. Bull WHO 1962; 27: 645-658
- 25 von Clauss A. Gerinnungsphysiologische Schnellmethode zur Bestimmung des Fibrinogens. Acta Haematol (Basel) 1957; 17: 237-246
- 26 Butts WC, Kuehneman M, Widdowson GM. Automated method for determining serum thiocyanate, to distinguish smokers from non-smokers. Clin Chem 1974; 20: 1344-1348
- 27 Feyerabend C, Russell MAH. Rapid gas-liquid chromatographic determination of cotinine in biological fluids. Analyst 1980; 105: 0998-1001
- 28 Smith FB, Lee AJ, Fowkes FGR, Lowe GDO, Rumley A. Variation in cardiovascular risk factors by angiographic site of lower limb atherosclerosis. Eur J Vase Surg 1995 (in press)
- 29 Bollinger A, Breddin K, Hess H, Heystraten FMJ, Kollath J, Konttila A, Pouliadis G, Marshall M, Mey T, Mietaschk A, Roth F-J, Schoop W. Semiquantitative assessment of lower limb atherosclerosis from routine angiographic images. Atherosclerosis 1981; 38: 339-346
- 30 Smith FB, Lee AJ, Fowkes FGR, Gillespie I, Whyman MR, Lowe GDO. Classification of site of peripheral atherosclerosis and observer variation using the Bollinger angiographic scoring system. J Vase Invest 1995; 1 (02) 79-85
- 31 Woodward M, Tunstall-Pedoe H. An iterative technique for identifying smoking deceivers with application to the Scottish Heart Health Study. Prev Med 1992; 21: 88-97
- 32 Stuart J, George AJ, Davies AJ, Auckland A, Hurlow RA. Haematological stress syndrome in atherosclerosis. J Clin Pathol 1981; 34: 464-467
- 33 Rumley A, Woodbum KR, Lowe GDO, Love J, Pollock JG. Correlation between plasma fibrinogen, fibrin degradation products, and the angiographic extent of peripheral arterial occlusive disease. Blood Coag Fibrinol 1994 5. (suppl 2): (abstrO-50)
- 34 Sweetnam PM, Thomas HF, Yamell JWG, Elwood PC. Fibrinogen is a good predictor of cardiovascular disease. The ten year follow-up of the Caerphilly and Speedwell studies. Blood Coag Fibrinol 1994 5. (suppl 2): (abstr 0-2)
- 35 Fuster V, Stein B, Ambrose JA, Badimon L, Badimon JJ, Chesebro JH. Atherosclerotic plaque rupture and thrombosis: evolving concepts. Circulation 1990 82. (suppl II): II-47-II-59
- 36 Humphries SE. Genetic regulation of fibrinogen. Eur Heart J 1995; 16 (suppl A) 16-20
- 37 Curran J, Hamsten A, Fatah K, Blomback M, Humphries SE, Green FR. A genetic polymorphism in the a-fibrinogen gene at amino acid 312 and its relevance to myocardial infarction. Blood Coag Fibrinol 1994 13. (suppl 2): (abstr 0-14)
- 38 Blann AD, McCollum CN. Adverse influence of cigarette smoking on the endothelium. Thromb Haemost 1993; 70 (04) 707-711
- 39 Conlan MG, Folsom AR, Finch A, Davis CE, Sorlie P, Marcucci G, Wu KK. Associations of factor VIII and von Willebrand factor with age, race, sex and risk factors for atherosclerosis. The Atherosclerosis Risk In Communities (ARIC) Study. Thromb Haemost 1993; 70 (03) 380-385
- 40 Cortellaro M, Cofrancesco E, Boschetti C, Mussoni L, Donati MB, Catalano M, Gabrielli L, Lombardi B, Specchia G, Tavazzi L, Tremoli E, Turn M. and the PLAT Group Association of increased fibrin turnover and defective fibrinolytic capacity with leg atherosclerosis. Thromb Haemost 1994; 72 (02) 292-296
- 41 Hamsten A, Wiman B, De Faire U, Blomback M. Increased plasma levels of a rapid inhibitor of tissue plasminogen activator in young survivors of myocardial infarction. N Engl J Med 1985; 313: 1557-1563
- 42 Gram J, Jespersen J. A selective depression of tissue plasminogen activator (t-PA) activity in euglobins characterizes a risk group among survivors of acute myocardial infarction. Thromb Haemost 1987; 57: 137-139
- 43 Olofsson BO, Dahlen G, Nilsson TK. Evidence for increased levels of plasminogen activator inhibitor and tissue plasminogen activator on plasma of patients with angiographically verified coronary artery disease. Eur Heart J 1989; 10: 77-82
- 44 Hamsten A, De Faire U, Walldius G, Dahlen G, Szamosi A, Landou C, Blomback M, Wiman B. Plasminogen activator inhibitor in plasma: risk factor for recurrent myocardial infarction. Lancet 1987; ii: 3-9
- 45 Wojta J, Gallicchio M, Zoellner H, Hufnagl P, Last K, Filonzi EL, Binder BR, Hamilton JA, McGrath K. Thrombin stimulates expression of tissue type plasminogen activator and plasminogen activator inhibitor type 1 in cultured human vascular smooth muscle cells. Thromb Haemost 1993; 70: 469-474
- 46 Van Hinsbergh VWM, Sprengers ED, Kooistra T. Effect of thrombin on the production of plasminogen activators and PA inhibitor-1 by human foreskin microvascular endothelial cells. Thromb Haemost 1987; 57: 148-153
- 47 Sprengers ED, Kluft C. Plasminogen activator inhibitors. Blood 1987; 69 (02) 381-387
- 48 Juhan-Vague I, Alessi M-C. Plasminogen activator inhibitor 1 and athero-thrombosis. Thromb Haemost 1993; 70 (01) 138-143