Inflammatory markers, D-dimer, pro-thrombotic factors, and physical activity levels in patients with peripheral arterial disease

Abstract

Men and women with lower extremity peripheral arterial disease (PAD) have reduced physical activity levels compared with persons without PAD. We describe associations between physical activity levels with D-dimer, pro-coagulant factors, and inflammatory markers in patients with PAD. Participants were188 patients with PAD identified from non-invasive vascular laboratories. Physical activity was measured over 7 days with a vertical accelerometer. We measured the ankleÀbrachial index (ABI) and levels of D-dimer, C-reactive protein (CRP), fibrinogen, serum amyloid A (SAA), prothrombin 1.2, t-PA antigen, PAI-1, and the t-PA antigen=PAI-1 ratio. Adjusting for age, sex, race, body mass index, ABI, comorbidities, smoking, total cholesterol=HDL ratio and statin use (for CRP only), we found significant inverse linear associations between physical activity levels and log D-dimer (p ¼ 0.002), log CRP (p < 0.001), fibrinogen (p ¼ 0.014), and log SAA (p ¼ 0.012). There were no significant associations between physical activity levels and other blood factors. In an analysis adjusting for all blood factors simultaneously along with known and potential confounders, log D-dimer was the only blood factor associated significantly with physical activity levels (p ¼ 0.036). Based on these findings, future studies should assess whether interventions to increase physical activity in patients with PAD reduce levels of D-dimer and inflammatory markers.

Potential Vascular Mechanisms of Ramipril Induced Increases in Walking Ability in Patients With Intermittent Claudication

“…10 Thus, it has been suggested that ACE inhibitors may favorably modify inflammation and thrombosis, both of which are critical in the complications of atherosclerosis [11][12][13] and functional decline in patients with PAD. 14 In the current study, we conducted exploratory analyses of the potential mechanisms underlying the improvement in functional capacity observed after ramipril therapy, through the assessment of circulating biomarkers related to angiogenesis/arteriogenesis, inflammation, leukocyte adhesion, and thrombosis.…”

Physical Activity During Daily Life and Functional Decline in Peripheral Arterial Disease

“…Fourth, increased levels of physical activity could favorably alter gait, resulting in more efficient walking techniques 46,47. Finally, higher physical activity levels are inversely associated with inflammatory markers in PAD persons 48. These physiologic and metabolic changes associated with physical activity may explain the association of higher physical activity with slower functional decline among persons with PAD.…”

Novel markers of peripheral arterial disease

“…However, participants with the highest D-dimer and IL-6 levels had the greatest decline in ABI over a 12-year period 88. McDermott et al have demonstrated an elevated D-dimer to be associated with walking impairment,41 functional capacity,39 physical activity levels,40 and functional decline over time 42. Whether D-dimer is involved in the pathophysiology of functional impairment in PAD patients or is simply a marker of the same is not established 38.…”