Document Detail

Relationship between intermittent claudication, inflammation, thrombosis, and recurrent cardiac events among survivors of myocardial infarction.
MedLine Citation:
PMID:  14980996     Owner:  NLM     Status:  MEDLINE    
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 beta-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 beta-blockers had a significant 3-fold mortality excess relative to those receiving beta-blockers. CONCLUSIONS: Following myocardial infarction, the added presence of intermittent claudication is associated with heightened procoagulant and proinflammatory states and an underuse of beta-blocker therapy and is a strong independent predictor of recurrent cardiovascular events.
Craig R Narins; Wojciech Zareba; Arthur J Moss; Victor J Marder; Paul M Ridker; Ronald J Krone; Edgar Lichstein
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Publication Detail:
Type:  Journal Article; Research Support, U.S. Gov't, P.H.S.    
Journal Detail:
Title:  Archives of internal medicine     Volume:  164     ISSN:  0003-9926     ISO Abbreviation:  Arch. Intern. Med.     Publication Date:  2004 Feb 
Date Detail:
Created Date:  2004-02-24     Completed Date:  2004-03-18     Revised Date:  2007-11-14    
Medline Journal Info:
Nlm Unique ID:  0372440     Medline TA:  Arch Intern Med     Country:  United States    
Other Details:
Languages:  eng     Pagination:  440-6     Citation Subset:  AIM; IM    
Department of Medicine, University of Rochester Medical Center, Rochester, NY, USA. Thrombogenic Factors and Recurrent Coronary Events (THROMBO) Investigators.
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MeSH Terms
Intermittent Claudication / blood,  epidemiology*
Middle Aged
Myocardial Infarction / blood,  epidemiology*
Proportional Hazards Models
Risk Factors
Thrombosis / blood,  epidemiology
Grant Support

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