Markers of fibrinolysis may predict development of lower extremity arterial disease in patients with diabetes: A longitudinal prospective cohort study with 10 years of follow-up.

Rautio, Aslak; Boman, Kurt; Eriksson, Jan W.; Svensson, Maria K.

Background: A previous cross-sectional study suggested that tissue plasminogen activator–activity might be an early marker of asymptomatic lower extremity arterial disease, but the long-term relationship is unknown. Subjects and methods: This study included 96 diabetic (48 type 1/48 type 2) and 62 non-diabetic subjects aged 30–70 years without previously known lower extremity arterial disease (age: 50.3 ± 9.3 years, gender: M/W 47.5/52.5% and body mass index: 26.6 ± 4.5 kg/m2). The relationships between asymptomatic lower extremity arterial disease and fibrinolytic markers (tissue plasminogen activator–activity, tissue plasminogen activator–mass, plasminogen activator inhibitor-1 activity) at baseline and after 10 years were assessed by logistic regression analysis adjusting for age, hypertension, statin treatment, HbA1c, triglycerides and low-density lipoprotein cholesterol as fixed covariates. Results: The tissue plasminogen activator–activity at baseline and at the 10-year follow-up significantly predicted the presence of sign(s) of lower extremity arterial disease (odds ratio = 1.78, 95% confidence interval: 1.02–3.10, p = 0.043 and odds ratio = 1.78, 95% confidence interval: 1.12–2.23, p = 0.014, respectively). In addition, tissue plasminogen activator–mass at the 10-year follow-up was associated with signs of lower extremity arterial disease (odds ratio = 1.07, 95% confidence interval: 1.00–1.15, p = 0.046). Baseline age, hypertension and HbA1c were independently associated with sign(s) of lower extremity arterial disease at 10 years (odds ratio = 1.09, 95% confidence interval: 1.04–1.14, p = < 0.001; odds ratio = 3.68, 95% confidence interval: 1.67–8.12, p = 0.001 and odds ratio = 1.54, 95% confidence interval: 1.21–1.95, p = < 0.001, respectively). Conclusion: This long-term study supports previous findings of a significant association between asymptomatic lower extremity arterial disease and tissue plasminogen activator–activity. Thus, tissue plasminogen activator–activity may be an early marker of lower extremity arterial disease although the mechanism of this relationship remains unclear.

Diabetes & Vascular Disease Research, 2016, Vol 13, Issue 3, p183

1479-1641

Academic Journal

10.1177/1479164115618516