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American Journal of Epidemiology Advance Access published online on December 15, 2005
American Journal of Epidemiology, doi:10.1093/aje/kwj051
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American Journal of Epidemiology Copyright © 2005 by the Johns Hopkins Bloomberg School of Public Health All rights reserved; printed in U.S.A.
Received June 20, 2005
Accepted October 6, 2005

ORIGINAL CONTRIBUTIONS

Hemostatic Factors, Inflammatory Markers, and Progressive Peripheral Atherosclerosis

Ioanna Tzoulaki 1 *, Gordon D. Murray 1, Jacqueline F. Price 1, Felicity B. Smith 1, Amanda J. Lee 2, Ann Rumley 3, Gordon D. O. Lowe 3, and F. Gerald R. Fowkes 1

1 Wolfson Unit for Prevention of Peripheral Vascular Diseases, School of Medicine and Veterinary Medicine, University of Edinburgh, Edinburgh, United Kingdom
2 Department of General Practice and Primary Care, College of Life Sciences and Medicine, University of Aberdeen, Aberdeen, United Kingdom
3 Division of Cardiovascular and Medical Sciences, University of Glasgow and Royal Infirmary, Glasgow, United Kingdom

* To whom correspondence should be addressed.
Ioanna Tzoulaki, E-mail: I.Tzoulaki{at}sms.ed.ac.uk


  Abstract

The interplay between inflammatory and hemostatic mechanisms may play a crucial role in the development and progression of atherosclerosis. The authors evaluated the separate and joint associations of hemostatic and inflammatory variables on peripheral atherosclerotic progression in the Edinburgh Artery Study, a population cohort study of 1,592 men and women aged 55-74 years that started in 1987. Levels of fibrinogen, fibrin D-dimer, von Willebrand factor, tissue plasminogen activator antigen, factor VII, prothrombin fragment 1 + 2, urinary fibrinopeptide A, C-reactive protein, and interleukin-6 were measured at baseline. Arm and ankle blood pressures were measured, and atherosclerotic progression was assessed by computing ankle brachial index (ABI) at baseline (1,582 participants) and after 12 years of follow-up (813 participants). Fibrinogen (p = 0.05) and D-dimer (p ≤ 0.05) were significantly associated with ABI change independently of baseline ABI and cardiovascular disease risk factors. However, these associations were no longer significant when analyses were adjusted for either C-reactive protein or interleukin-6. Moreover, subjects with higher levels of both D-dimer and interleukin-6 at baseline had the greatest ABI decline. In conclusion, fibrinogen and D-dimer, but not other hemostatic factors, were associated with progressive peripheral atherosclerosis. Since D-dimer and fibrinogen are acute phase reactants, these data support the hypothesis that inflammation is more related to atherosclerosis than is hypercoagulation.

Keywords: arteriosclerosis; cohort studies; hemostasis; inflammation; peripheral vascular diseases.
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