Symptomatic peripheral arterial disease in women - Nontraditional biomarkers of elevated risk

Article

关键词: INTERCELLULAR-ADHESION MOLECULE-1;    C-REACTIVE PROTEIN;    CORONARY-HEART-DISEASE;    INTERMITTENT CLAUDICATION;    CARDIOVASCULAR-DISEASE;    EDINBURGH ARTERY;    ESTROGEN/PROGESTIN REPLACEMENT;    ATHEROSCLEROSIS RISK;    PRIMARY PREVENTION;    RANDOMIZED-TRIAL;   

DOI  :  10.1161/CIRCULATIONAHA.107.719369

来源: SCIE

【 摘 要 】

Background-Most investigations of novel biomarkers for prediction of cardiovascular disease pertain to coronary artery disease. Few large-scale prospective studies have critically assessed plasma-based factors as predictors of peripheral arterial disease (PAD), and comparative data between individual biomarkers and lipid levels are sparse, especially among women. Methods and Results-We evaluated the relationship between baseline levels of several novel biomarkers and confirmed incident symptomatic PAD (n = 100) in a prospective cohort study (median follow-up, 12.3 years) involving 27 935 US female health professionals >= 45 years of age without diagnosed vascular disease at baseline. Biomarkers assessed were high-sensitivity C-reactive protein, fibrinogen, soluble intercellular adhesion molecule-1 (sICAM-1), homocysteine, lipoprotein(a), hemoglobin A(1c), creatinine, and conventional lipid levels. In univariate analyses, levels of high-sensitivity C-reactive protein, fibrinogen, sICAM-1, homocysteine, lipoprotein(a), creatinine clearance, high-density lipoprotein cholesterol (HDL-C), non-HDL-C, and the ratio of total cholesterol to HDL-C (TC: HDL-C) were significantly related to PAD (all P < 0.05). However, after multivariable adjustment, risk associations were significant only for high-sensitivity C-reactive protein (adjusted hazard ratio [HR] extreme tertiles, 2.1; 95% confidence interval, 1.2 to 3.7), sICAM-1 (adjusted HR, 4.0; 95% confidence interval, 1.9 to 8.6), HDL-C (adjusted HR, 0.4; 95% confidence interval, 0.3 to 0.8), and TC: HDL-C (adjusted HR, 2.2; 95% confidence interval, 1.2 to 3.9). In a model simultaneously controlling for traditional risk factors plus these significant biomarkers, sICAM-1 remained independently predictive of PAD (adjusted HR in each tertile, 1.0 [reference], 2.3, and 3.5). Conclusions-Among a broad range of biomarkers of cardiovascular risk, only 4 factors, sICAM-1, high-sensitivity C-reactive protein, HDL-C, and TC: HDL-C, were significantly associated with incident symptomatic PAD in women. Findings pertaining to novel biomarkers provide clinical confirmation of a prominent role of endothelial activation and leukocyte recruitment in lower-extremity arterial disease.

【 授权许可】

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