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Ankle—brachial index and hemostatic markers in the Atherosclerosis Risk in Communities (ARIC) study cohort

Division of Epidemiology & Community Health, School of Public Health, University of Minnesota, Minneapolis, MN, USA

Gerardo Heiss

Department of Epidemiology, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA

Lori L. Boland

Division of Epidemiology & Community Health, School of Public Health, University of Minnesota, Minneapolis, MN, USA

Alan T. Hirsch

Division of Epidemiology & Community Health, School of Public Health, University of Minnesota, Minneapolis, MN, USA, Minneapolis Heart Institute, Minneapolis, MN, USA

Kenneth Wu

Division of Hematology, University of Texas Medical School, Houston, TX, USA

Aaron R. Folsom

Division of Epidemiology & Community Health, School of Public Health, University of Minnesota, Minneapolis, MN, USA, folsom{at}epi.umn.edu

To determine whether elevated levels of hemostatic and inflammatory markers [von Willebrand factor (vWF), fibrinogen, D-dimer, factor VII, factor VIII, PAI-1, tPA, beta-thromboglobulin (β-TG), CRP, and WBC count] are associated with increased peripheral arterial disease (PAD) prevalence, measured by low ABI, we studied 13,778 participants from the ARIC study in a cross-sectional analysis after adjustment for major cardiovascular risk factors. PAD was positively associated with fibrinogen, vWF, factor VIII, WBC count, D-dimer, β-TG, and CRP (p for trend <0.05) but not with the other markers. Adjusted odds ratios for the highest versus the lowest quartile of fibrinogen in men and women, respectively, were 3.49 (95% CI 1.68—7.26) and 2.44 (95% CI 1.58—3.77); for vWF 2.36 (95% CI 1.36—4.07) and 1.45 (95% CI 1.00—2.10); for factor VIII 2.31 (95% CI 1.36—3.94) and 1.68 (95% CI 1.14—2.48). In a smaller subset, the sex and risk factor adjusted odds ratio for the highest versus the lowest quartile of D-dimer was 2.70 (95% CI 1.56—4.65), for β-TG was 1.80 (95% CI 1.12—2.88), and for CRP was 1.57 (95% CI 0.84—2.95). Plasma levels of hemostatic and inflammatory markers are elevated in PAD, suggesting these processes are involved in the pathophysiology of PAD.

Key Words: atherosclerosis • blood coagulation factors • hemostasis • peripheral vascular disease

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