McDermott
MM, Greenland P, Green D, et al.
Circulation 2003; 107:3191-8 BACKGROUND:
We determined whether higher levels of D-dimer, C-reactive protein (CRP), fibrinogen,
and serum amyloid A are associated independently with functional impairment in
patients with and without peripheral arterial disease (PAD).
METHODS AND RESULTS:
Participants were 370 men and women with PAD (ankle brachial index <0.90) and
231 without PAD. Functional outcomes were 6-minute walk distance and 4-meter walking
velocity. A summary performance score combined performance in walking speed, standing
balance, and time for 5 repeated chair rises into an ordinal score ranging from
0 to 12 (12=best). Adjusting for age, sex, ankle brachial index, comorbidities,
and other potential mediators and confounders, D-dimer levels were associated
independently and inversely with performance on all 3 functional measures in the
entire cohort and among patients with and without PAD, respectively. Adjusting
for known and potential confounders, CRP levels were associated independently
with 6-minute walk distance and the summary performance score among participants
with PAD. No significant associations were observed between CRP and the functional
measures among participants without PAD. Fibrinogen and SAA levels were not associated
independently with the functional measures.
CONCLUSIONS: Higher D-dimer levels
are associated with poorer functioning among individuals with and without PAD.
Higher CRP levels were associated with poorer 6-minute walk performance and a
lower summary performance score among participants with PAD but not among those
without PAD. Additional study is needed to determine whether D-dimer and CRP are
involved in the pathophysiology of functional impairment or whether they are simply
sensitive markers of the extent of systemic atherosclerosis. |
