Coronary artery diseaseComparison of Usefulness of Inflammatory Markers in Patients With Versus Without Peripheral Arterial Disease in Predicting Adverse Cardiovascular Outcomes (Myocardial Infarction, Stroke, and Death)
Section snippets
Patient selection
All men and women who were ≥18 years of age and were referred to the Brigham and Women’s Noninvasive Vascular Laboratory (Boston, Massachusetts) for ABI and segmental Doppler pressure measurement were offered participation between March 1, 1999 and January 31, 2002. Subjects were excluded if they had nonskin cancer, hepatic disease, renal disease (creatinine >1.4 mg/dl), infectious disease, planned revascularization or critical limb ischemia, or myocardial infarction, stroke, or gangrene within
Results
We approached 126 subjects and enrolled 110 during the enrollment phase; 50 subjects had no evidence of significant lower extremity vascular disease and 60 met the criteria for PAD (Table 1). No enrolled subject was later excluded. The physician referral pattern to the vascular laboratory was as expected: 45% by vascular surgeons, 38% by primary care physicians, and 16% by cardiovascular physicians. Subjects who had PAD were older, more likely to have vascular disease risk factors, more likely
Discussion
In this prospective evaluation of patients who presented to a vascular laboratory, our data show a significant relation between severity of PAD and levels of systemic inflammation. Further, patients who have PAD are medically undertreated, despite recommendations that advocate aggressive decreases in risk factors. Most importantly, in addition to demonstrating independent relations between inflammation and outcomes and between extent of atherosclerosis and outcomes, we have shown a graded
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This study was supported by Grant K23 HL-04169 from the National Institutes of Health, Bethesda, Maryland.
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Dr. Ridker has been named as a co-inventor on patents filed by the Brigham and Women’s Hospital that relate to the use of inflammatory markers in cardiovascular disease.