Circulation, Vol 87, 1915-1920, Copyright © 1993 by American Heart Association
GD Lowe, FG Fowkes, J Dawes, PT Donnan, SE Lennie and E Housley
BACKGROUND. Increased blood and plasma viscosity, hematocrit, fibrinogen,
and activation of coagulation and leukocytes have been reported in patients
with claudication; however, their associations with symptomatic and
asymptomatic peripheral arterial disease have not been reported in an
epidemiological study. METHODS AND RESULTS. Blood and plasma viscosity,
hematocrit, fibrinogen, urinary fibrinopeptide A, plasma leukocyte
elastase, and uric acid were measured in a random sample of 1,581 men and
women aged 55-74 years in Edinburgh, Scotland, and related to peripheral
arterial stenosis (ankle-brachial systolic pressure index, ABPI) and to
lower limb ischemia (intermittent claudication and reactive hyperemia
test). Each variable (except fibrinopeptide A) was significantly related to
prevalent symptomatic and asymptomatic peripheral arterial disease. On
multivariate analysis, blood viscosity (p < 0.05) and fibrinogen (p <
0.01) were independently associated with peripheral arterial narrowing
(ABPI); a positive interaction was found between fibrinogen and smoking in
the association with ABPI. Plasma viscosity was associated with
claudication in the presence of a given degree of arterial narrowing (odds
ratio of claudication in top quintile compared with bottom quintile of
plasma viscosity, 3.35; 95% CI, 1.32, 8.51). Leukocyte elastase and uric
acid were each associated with reactive hyperemia independently of arterial
narrowing (p < 0.01). CONCLUSIONS. Blood rheological factors and
leukocyte activation as well as arterial narrowing are associated with
lower limb ischemia in the general population and may be implicated in its
pathogenesis.
ARTICLES
Blood viscosity, fibrinogen, and activation of coagulation and leukocytes in peripheral arterial disease and the normal population in the Edinburgh Artery Study
University Department of Medicine, Glasgow (Scotland) Royal Infirmary.
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