This Article  • Full text  • PDF  • Send to a friend  • Save in My Folder  • Save to citation manager  • Permissions  Citing Articles  • Citation map  • Citing articles on HighWire  • Citing articles on ISI (16)  • Contact me when this article is cited  Related Content  • Similar articles in this journal  Topic Collections  • Cardiovascular System  • Prognosis/ Outcomes  • Cardiovascular Disease/ Myocardial Infarction  • Alert me on articles by topic  Social Bookmarking   What's this?

Craig R. Narins, MD; Wojciech Zareba, MD, PhD; Arthur J. Moss, MD; Victor J. Marder, MD; Paul M. Ridker, MD; Ronald J. Krone, MD; Edgar Lichstein, MD; for the Thrombogenic Factors and Recurrent Coronary Events (THROMBO) Investigators

Arch Intern Med. 2004;164:440-446.

Background  Among coronary disease patients, concomitant peripheral arterial disease is a potent risk factor for future cardiac events and mortality. We sought to determine clinical and biochemical markers that might better elucidate the relationship between coronary and peripheral arterial disease.

Methods  Two months after an index myocardial infarction, 1045 patients provided detailed medical histories and underwent blood testing for selected hemostatic, lipid, and inflammatory markers. Patients were then followed up prospectively for a mean of 26 months.

Results  Compared with individuals without intermittent claudication (n = 966), those with claudication (n = 78) (information was unavailable for 1 individual) were significantly older and demonstrated an increased frequency of diabetes mellitus, tobacco use, prior cardiac and cerebrovascular events, and depressed left ventricular function. Individuals with claudication were less likely to receive -blocker therapy after the index infarction. Individuals with claudication had evidence of enhanced procoagulant and proinflammatory states manifested by relative elevations in plasma fibrinogen, D-dimer, C-reactive protein, and serum amyloid A concentrations. During follow-up, the presence of claudication was associated with an independent 2-fold increase in the combined end point of death or nonfatal cardiac event (38.5% vs 17.8%, P = .001) and a 5-fold increase in cardiac mortality (19.2% vs 3.6%, P = .001). Patients with intermittent claudication who were not treated with -blockers had a significant 3-fold mortality excess relative to those receiving -blockers.

Conclusions  Following myocardial infarction, the added presence of intermittent claudication is associated with heightened procoagulant and proinflammatory states and an underuse of -blocker therapy and is a strong independent predictor of recurrent cardiovascular events.

From the Heart Research Follow-up Program, Cardiology Unit, Department of Medicine, University of Rochester Medical Center, Rochester, NY (Drs Narins, Zareba, and Moss); Vascular Medicine Center, Orthopedic Hospital, The David Geffen School of Medicine at UCLA, University of California, Los Angeles (Dr Marder); Center for Cardiovascular Disease Prevention, Division of Cardiology, Brigham and Women's Hospital, Boston, Mass (Dr Ridker); Division of Cardiology, Department of Medicine, Washington University School of Medicine, St Louis, Mo (Dr Krone); and Department of Medicine, Maimonides Medical Center, Brooklyn, NY (Dr Lichstein). The authors have no relevent financial interest in this article.

CiteULike    Connotea    Del.icio.us    Digg    Reddit    Technorati     What's this?

THIS ARTICLE HAS BEEN CITED BY OTHER ARTICLES

C-Reactive Protein Predicts Future Arterial and Cardiovascular Events in Patients With Symptomatic Peripheral Arterial Disease
Hogh et al.
VASC ENDOVASCULAR SURG 2008;42:341-347.
ABSTRACT  

A Prognostic Risk Index for Long-term Mortality in Patients With Peripheral Arterial Disease
Feringa et al.
Arch Intern Med 2007;167:2482-2489.
ABSTRACT | FULL TEXT  

A Cause for Concern
Camenzind et al.
Circulation 2007;115:1440-1455.
FULL TEXT  

The Influence of Peripheral Arterial Disease on Outcomes: A Pooled Analysis of Mortality in Eight Large Randomized Percutaneous Coronary Intervention Trials
Saw et al.
J Am Coll Cardiol 2006;48:1567-1572.
ABSTRACT | FULL TEXT  

Peripheral Arterial Disease: Morbidity and Mortality Implications
Golomb et al.
Circulation 2006;114:688-699.
FULL TEXT  

Cardioprotective Medication Is Associated With Improved Survival in Patients With Peripheral Arterial Disease
Feringa et al.
J Am Coll Cardiol 2006;47:1182-1187.
ABSTRACT | FULL TEXT  

Antiatherogenic Effects of Dietary Plant Sterols Are Associated with Inhibition of Proinflammatory Cytokine Production in Apo E-KO Mice
Nashed et al.
J. Nutr. 2005;135:2438-2444.
ABSTRACT | FULL TEXT