Biomedical subjects

F B Smith

Publications and source records attributed to F B Smith.

At least 19 recordsLinked to original sources

PubMed2005

Plasma fibrinogen level and the risk of major cardiovascular diseases and nonvascular mortality: an individual participant meta-analysis.

CONTEXT: Plasma fibrinogen levels may be associated with the risk of coronary heart disease (CHD) and stroke. OBJECTIVE: To assess the relationships of fibrinogen levels with risk of major vascular and with risk of nonvascular outcomes based on individual participant data. DATA SOURCES: Relevant studies were identified by computer-assisted searches, hand searches of reference lists, and personal communication with relevant investigators. STUDY SELECTION: All identified prospective studies were included with information available on baseline fibrinogen levels and details of subsequent major vascular morbidity and/or cause-specific mortality during at least 1 year of follow-up. Studies were excluded if they recruited participants on the basis of having had a previous history of cardiovascular disease; participants with known preexisting CHD or stroke were excluded. DATA EXTRACTION: Individual records were provided on each of 154,211 participants in 31 prospective studies. During 1.38 million person-years of follow-up, there were 6944 first nonfatal myocardial infarctions or stroke events and 13,210 deaths. Cause-specific mortality was generally available. Analyses involved proportional hazards modeling with adjustment for confounding by known cardiovascular risk factors and for regression dilution bias. DATA SYNTHESIS: Within each age group considered (40-59, 60-69, and > or =70 years), there was an approximately log-linear association with usual fibrinogen level for the risk of any CHD, any stroke, other vascular (eg, non-CHD, nonstroke) mortality, and nonvascular mortality. There was no evidence of a threshold within the range of usual fibrinogen level studied at any age. The age- and sex- adjusted hazard ratio per 1-g/L increase in usual fibrinogen level for CHD was 2.42 (95% confidence interval [CI], 2.24-2.60); stroke, 2.06 (95% CI, 1.83-2.33); other vascular mortality, 2.76 (95% CI, 2.28-3.35); and nonvascular mortality, 2.03 (95% CI, 1.90-2.18). The hazard ratios for CHD and stroke were reduced to about 1.8 after further adjustment for measured values of several established vascular risk factors. In a subset of 7011 participants with available C-reactive protein values, the findings for CHD were essentially unchanged following additional adjustment for C-reactive protein. The associations of fibrinogen level with CHD or stroke did not differ substantially according to sex, smoking, blood pressure, blood lipid levels, or several features of study design. CONCLUSIONS: In this large individual participant meta-analysis, moderately strong associations were found between usual plasma fibrinogen level and the risks of CHD, stroke, other vascular mortality, and nonvascular mortality in a wide range of circumstances in healthy middle-aged adults. Assessment of any causal relevance of elevated fibrinogen levels to disease requires additional research.

Adult↗

PubMed2005

Criteria for previously undiagnosed diabetes and risk of mortality: 15-year follow-up of the Edinburgh Artery Study cohort.

AIMS: To compare risk of all-cause and cardiovascular mortality associated with different criteria for undiagnosed diabetes and glucose tolerance. METHODS: A population-based cohort of 758 men and 738 women of 55-74 years of age who had an oral glucose tolerance test or known diabetes at baseline were followed up until death or for 15 years. Mortality outcomes were compared by baseline diabetes status using people with normal glucose tolerance (i.e. those without diabetes, impaired fasting glucose or impaired glucose tolerance) as the reference group. RESULTS: Prevalence of undiagnosed diabetes using World Health Organization (WHO) criteria (fasting glucose of > or = 7.0 mmol/l and/or a 2-h post-challenge glucose of > or = 11.1 mmol/l) was 6.6%, of which 81% was associated with fasting glucose > or = 7.0 mmol/l and 19% was associated with isolated post-challenge hyperglycaemia. Hazard ratios (95% CI) for all-cause mortality adjusted for age and sex were 1.51 (1.09-2.08) for new diabetes by the American Diabetes Association (ADA) criterion (fasting glucose of > or = 7.0 mmol/l regardless of post-challenge glucose), 1.60 (1.20-2.13) for new diabetes by WHO criteria and 1.98 (1.14-3.44) for isolated post-challenge hyperglycaemia. Hazard ratios (95% CI) for cardiovascular mortality adjusted for age and sex were 1.89 (1.17-3.00), 1.73 (1.12-2.66) and 1.08 (0.34-3.40) for new diabetes by ADA and WHO criteria and for isolated post-challenge hyperglycaemia, respectively. CONCLUSIONS: Undiagnosed diabetes was associated with increased risk of all-cause mortality by any criteria but significantly increased cardiovascular disease mortality was only associated with diabetes diagnosed using the fasting glucose criterion. Mortality risks were similar in this population using either ADA or WHO criteria for diagnosis of diabetes.

Aged↗

PubMed2004

Improved prediction of fatal myocardial infarction using the ankle brachial index in addition to conventional risk factors: the Edinburgh Artery Study.

BACKGROUND: Prediction of major cardiovascular and cerebrovascular events using conventional risk factor models is limited. Noninvasive measures of subclinical atherosclerosis such as the ankle brachial index (ABI) could improve risk prediction and provide more focused primary prevention strategies. We wished to determine the added value of a low ABI in the prediction of long-term risk of cardiovascular and cerebrovascular events and death. METHODS AND RESULTS: In 1988, 1592 men and women 55 to 74 years of age were randomly selected from the age-sex registers of 11 general practices in Edinburgh, Scotland, and followed up over a period of 12 years for incident events. After adjustment for age and sex, an ABI < or =0.9 was predictive of an increased risk of fatal myocardial infarction (MI), cardiovascular death, all-cause death, combined fatal and nonfatal MI, and total cardiovascular events. After further adjustment for prevalent cardiovascular disease, diabetes, and conventional risk factors, a low ABI was independently predictive of the risk of fatal MI. Addition of the ABI significantly (P< or =0.01) increased the predictive value of the model for fatal MI compared with a model containing risk factors alone. Comparison of areas under receiver operator characteristic curves confirmed that a model including the ABI discriminated marginally better than one without. CONCLUSIONS: Addition of the ABI significantly improved prediction of fatal MI over and above that of conventional risk factors. We recommend that the ABI be incorporated into routine cardiovascular screening and that the potential of its inclusion into cardiovascular scoring systems (with a view to improving their accuracy) now be examined.

Aged↗

PubMed2001

Relationship of estrogen and progesterone receptor protein levels in carcinomatous and adjacent non-neoplastic epithelium of the breast: a histopathologic and image cytometric study.

BACKGROUND: Results of a previous study demonstrating a correlation between steroid hormone receptor concentrations in benign and tumor tissue in patients with breast carcinoma suggest that receptor levels in breast epithelium undergoing malignant transformation may play a role in determining the receptor levels in the resulting carcinoma. Data used in that study were derived from ligand binding assays and may reflect shortcomings inherent in this methodology, particularly the dilution of receptor proteins from benign and malignant epithelial cells by stromal components. METHODS: We performed a correlation study of steroid hormone receptor expression in benign and malignant breast epithelial cells using computerized image cytometry and histologic sections stained for estrogen (ER) and progesterone receptor (PR), avoiding the problems of contribution of stromal cells to the measurements and uncertainty about the histologic composition of the sample. Sections which contained both tumor and non-neoplastic breast elements were obtained from surgical specimens from 50 patients with breast carcinoma. RESULTS: Positive area (PA) scores for ER in benign and malignant epithelium showed direct correlation that was significant (r = 0.46, p < 0.001), whereas those for PR, although trended in the same direction, did not (r = 0.17, p > 0.2). PA levels for both receptor proteins were higher in benign breast epithelium with proliferative features, compared to non-proliferative benign epithelium, and in tumors when the associated benign tissue had proliferative changes, but neither of these differences were statistically significant, suggesting that the correlation of ER levels in benign and malignant epithelium was not simply a function of proliferative change. CONCLUSION: Our results provide support for the concept that ER expression in breast carcinoma depends partially on epithelial cell receptor levels in the breast in which it arises, but not for the analogous hypothesis for PR. When costs and benefits of tamoxifen chemoprevention are weighed for a patient at risk for breast carcinoma, and when cyto- or histopathologic breast tissue specimens are available, it may be reasonable to include breast epithelial ER levels among the factors considered in making the treatment decision.

Antineoplastic Agents, Hormonal↗

PubMed2001

Developing a behavior rating scale for comparing teachers' ratings of children with and without craniofacial anomalies.

OBJECTIVE: Published psychometric tools are often insensitive to the experience of children with craniofacial anomalies (CFAs). The purposes of this study were to develop a valid and reliable assessment of behavior among children with and without CFAs and to compare teacher ratings of these two groups of children. METHODS: Teachers were asked prospectively to assess social competence and peer acceptance among 99 consecutively evaluated school-aged patients with CFAs and 99 "controls" (classmates without CFA matched by race, gender, intellectual status, general socioeconomic status, and grade). Sixth grade was the median grade of the subjects. OUTCOME MEASURE: Child Behavior Rating Scale (CBRS). RESULTS: Using oblique promax rotation, four factors emerged from the CBRS with the CFA patient group and controls. The factors explained 67% of the total variance and 69% of the variance of the two groups, respectively. The four factors were: (1) self-maintenance, (2) social adjustment, (3) independence, and (4) teasing. Cronbach alpha results averaged 0.77 for the CFA group and 0.83 for the controls; test-retest reliability estimates were .93. Results demonstrate the consistency of the factors and high level of interrelationship among the items across subject groups. Expected differences (p <.05) were found among subject groups on the total score and factor 4. CONCLUSIONS: The CBRS demonstrates psychometric worthiness. The findings indicated that patients with CFA had lower total scores on the CBRS, and they were rated as experiencing more teasing than their matched peers.

Adaptation, Psychological↗

PubMed2000

Intravenous naftidrofuryl for critical limb ischaemia.

BACKGROUND: Peripheral arterial disease affects 5% of men and women by late middle age. In approximately 25% of those affected the condition will progress to critical limb ischaemia (rest pain, ulceration and gangrene) within five years. The vasoactive drug naftidrofuryl is a serotononergic receptor antagonist which may be beneficial in the treatment of severe lower limb disease such as critical limb ischaemia. OBJECTIVES: To determine whether the vasoactive drug, naftidrofuryl, when administered intravenously is effective in alleviating symptoms and reducing progression of disease in patients with critical limb ischaemia. SEARCH STRATEGY: Randomised controlled trials were identified using the search strategy of the Peripheral Vascular Diseases Review group, including MEDLINE and EMBASE searches and reviewing reference lists in papers. In addition, publications were identified through pharmaceutical companies. SELECTION CRITERIA: All randomised controlled trials of critical limb ischaemia in which patients were randomly allocated to intravenous naftidrofuryl or control (either pharmacological, inert placebo or conservative therapy) were included. Patients with intermittent claudication were not eligible for inclusion. Trials were selected by one reviewer and checked independently. DATA COLLECTION AND ANALYSIS: Fifteen trials were identified, but eight were excluded because of poor methodology. The seven remaining trials involved a total of 229 participants from five different countries. The following outcomes were reported: pain reduction, rest pain/necrosis, progression of disease in terms of incidence of surgical reconstruction/amputation, mortality and side effects. On extraction of the data, odds ratios and weighted mean differences were estimated where appropriate. MAIN RESULTS: Treatment with naftidrofuryl tended to show reduction of pain evaluated by both analogue score and analgesic consumption, but the effect was statistically non-significant (weighted mean difference -0.42, 95% confidence interval -1.19 to 0.35). Similarly, improvement in rest pain or skin necrosis occurred, but these effects were also not significant. The effect on mean ankle systolic ankle pressure was inconclusive. REVIEWER'S CONCLUSIONS: Based on the results of these trials, it cannot be confirmed that intravenous naftidrofuryl is effective in the treatment of patients with critical limb ischaemia. However, these results were based on trials of generally low methodological quality which had only a small number of participants, the duration of treatment was extremely short and the methods varied between the trials. The wide range of endpoints effectively precluded any meaningful pooling of the results. Intravenous naftidrofuryl was withdrawn as a treatment for peripheral arterial disease in 1995 because of reported side effects.

Extremities↗

PubMed2000

Tissue plasminogen activator and leucocyte elastase as predictors of cardiovascular events in subjects with angina pectoris: Edinburgh Artery Study.

AIMS: To evaluate the relationship between haemostatic and rheological factors and cardiovascular outcome in subjects with angina pectoris in the general population. METHODS AND RESULTS: Two hundred and seven men and women aged 55-74 had evidence of angina at baseline. Sixty-seven (32.3%) had a fatal or non-fatal cardiovascular event during follow-up. Median levels of tissue plasminogen activator antigen and leucocyte elastase were higher in the event group compared with the no event group (10.0 ng. ml(-1)vs 7.2 ng. ml(-1);P</=0.001, and 40.3 ng. ml(-1)vs 31.0 ng. ml(-1);P</=0.01, respectively). Whole blood viscosity was also significantly higher in the event group than in the no event group (3.80 mPa.s vs 3.53 mPa.s;P</=0.05). After adjusting for age and sex, unit increases in both tissue plasminogen activator antigen and leucocyte elastase levels were significantly associated with an increased risk of a cardiovascular event. These associations remained after further adjusting for cardiovascular risk factors and baseline myocardial infarction. The relative risks were 2.07 (95% CI, 1.30-3.45;P</=0.01) for tissue plasminogen activator antigen and 1. 95 (95% CI, 1.12-3.50;P</=0.05) for leucocyte elastase. CONCLUSION: Disturbed fibrinolysis and activation of leucocytes may be implicated in the development of thrombotic cardiovascular events in subjects with angina pectoris in the general population.

Aged↗

PubMed2000

Plasma fibrinogen, haemostatic factors and prediction of peripheral arterial disease in the Edinburgh Artery Study.

The role of fibrinogen and other haemostatic factors in prediction of peripheral arterial disease (PAD) has not been established. We examined the associations of plasma fibrinogen, von Willebrand Factor (vWF), tissue plasminogen activator (t-PA) antigen, fibrin D-dimer, and factor VII with the development and clinical progression of PAD. In the Edinburgh Artery Study, 1592 men and women, aged between 55 and 74 years, were followed prospectively over 5 years to detect the onset of PAD, and the deterioration of established PAD. At baseline, 418 individuals had evidence of PAD and 60 (14.4%) subsequently deteriorated. 1080 subjects had no baseline disease, but 59 (5.5%) developed PAD during follow-up. Median levels of fibrinogen and vWF were higher in the group developing disease compared with the group which did not (2.78 g/l versus 2.57 g/l, P< or =0.01; 116 IU/dl versus 104 IU/dl, P< or =0.05; respectively). After adjusting for age and sex, fibrinogen (P< or =0.01) and vWF (P< or =0.05) were significantly associated with the risk of developing PAD. The association between fibrinogen and development of disease remained after adjusting for cardiovascular risk factors and baseline ischaemic heart disease (relative risk, 1.35, 95% confidence interval, 1.05, 1.73; P< or =0.05). None of the haemostatic factors were significantly associated with progression of PAD. In conclusion, plasma fibrinogen levels are related to the future onset of PAD, providing further evidence of a possible role of elevated fibrinogen in the development of atherosclerotic disease.

Aged↗

PubMed1999

Factors associated with victimization of personnel in emergency departments.

OBJECTIVE: The purpose of this study was to identify the incidence of ED personnel victimization in Central Florida and examine its relationship to victims' reports of 3 factors: characteristics of the patient/perpetrator, characteristics of the personnel victimized, and characteristics of the ED environment. METHODS: Data were collected anonymously in a mail survey using 37 items from Mahoney's Emergency Department Victimization Questionnaire (EDVQ) and a demographic questionnaire. Chi square, Spearman's rank correlation coefficient, and Pearson's product moment correlation were used to describe frequencies, incidence, and their relationships to the variables studied. A sample of 226 of the 600 direct care personnel (37%) from 18 of the 19 hospital emergency departments in a tri-county area (95%) participated. RESULTS: The incidence of physical assault was reported to be 42% during the past year and 72% during the respondents' careers. Alcohol use was associated with incidence (1-tailed Pearson; P =.001). Verbal abuse was significantly higher on day shift (P =.043). The most desired environmental variable was 24-hour security attendants, available to 51.8% of the respondents. More than a fourth of the subjects reported that they had completed no coursework or had no continuing education in violence prevention. DISCUSSION: Respondents reported avoiding identification on duty, underreporting, postvictimization staff turnover, dissatisfaction with security, and the desire for every security provision listed. The goals of reducing the fears and victimization of ED personnel should become a priority within the health care system.

Adult↗

PubMed1998

Smoking, hemorheologic factors, and progression of peripheral arterial disease in patients with claudication.

PURPOSE: The purpose of the current study was to determine whether hemostatic and rheologic factors are associated with the deterioration of peripheral arterial disease in patients with intermittent claudication and the influence of smoking and severity of underlying disease on these relationships. METHODS: We conducted a prospective cohort study with a 6-year follow-up period of a consecutive series of 607 patients with uncomplicated intermittent claudication. The study setting was the Peripheral Vascular Clinic, Royal Infirmary of Edinburgh. The main outcome measures were peripheral vascular intervention or onset of severe chronic leg ischemia (rest pain, ulceration, gangrene). RESULTS: A total of 210 patients died during follow-up. Two hundred three patients did not have a vascular event or deterioration of limb ischemia, 45 patients underwent a peripheral vascular intervention, and 64 progressed to severe chronic leg ischemia. Median levels (interquartile ranges) of whole blood viscosity were significantly higher in the vascular intervention group (3.75 mPa/sec; range, 3.38 to 4.13 mPa/sec) than in those who did not deteriorate 3.48 mPa/sec; range, 3.06 to 3.83 mPa/sec) (p < or = 0.05), and plasma von Willebrand factor was higher in those with severe chronic leg ischemia (154.0 IU/dl; range, 122.0 to 187.0 IU/dl) than in those who did not deteriorate (131.0 IU/dl; range, 106.0 to 165.0 IU/dl) (p < or = 0.01). After adjustment for age, sex, cigarette smoking, and ankle brachial pressure index, the levels of plasma fibrinogen and blood and plasma viscosities were each associated with an increased risk of vascular intervention (all p < or = 0.05). There were no significant associations between any of the hemorheologic factors and the risk of severe chronic leg ischemia on multivariate analyses. CONCLUSION: Elevations in rheologic factors may have important effects on further reduction of blood flow in the legs of patients with claudication and promote worsening ischemia and clinical progression of symptoms.

Blood Viscosity↗

PubMed1998

Haemostatic factors and prediction of ischaemic heart disease and stroke in claudicants.

Thrombotic risk factors may be important in determining cardiovascular outcome in patients with symptomatic peripheral arterial disease. A cohort study with a 6-year follow-up period was established to determine the relationships between haemostatic and rheological factors and incident ischaemic heart disease (IHD) and stroke events in patients with peripheral arterial disease. A consecutive series of 607 patients with intermittent claudication was examined between 1989 and 1990 at the Peripheral Vascular Clinic, Royal Infirmary of Edinburgh. Main outcome measures were combined fatal and non-fatal stroke, non-fatal myocardial infarction (MI), coronary death and total coronary events. A total of 210 patients died during follow-up. 203 patients did not experience a vascular event or deterioration of limb ischaemia. Median levels of fibrinogen, von Willebrand factor (VWF), tissue plasminogen activator (t-PA) antigen, fibrin D-dimer and whole blood viscosity were significantly higher in those who experienced an event compared with those who did not. After adjusting for age and sex, fibrin D-dimer was significantly associated with risk of non-fatal myocardial infarction (RR 1.50, 95% CI 1.09-2.06, P < or = 0.01). Both fibrinogen and fibrin D-dimer were associated with risk of total coronary events (P < or = 0.05). The risk of stroke was related to baseline levels of t-PA antigen (RR 1.87, 95% CI 1.04-3.34, P < or = 0.05) and whole blood viscosity (RR 1.33, 95% CI 1.07-1.65, P < or = 0.01). All the relationships became weaker and statistically non-significant after further adjustment for cigarette smoking, systolic blood pressure, glucose and baseline IHD. The associations of these factors to IHD and stroke may therefore be partly related to cardiovascular risk factors, but are likely to be important in the pathogenesis of future atherothrombotic events in subjects with peripheral arterial disease.

Aged↗

PubMed1998

Microvascular cytomegalovirus endothelialitis of the lung: a possible cause of secondary pulmonary hypertension in a patient with AIDS.

Postmortem examination of the lungs of a patient with advanced AIDS who had developed pulmonary arterial hypertension late in the course of the illness demonstrated extensive cytomegalovirus (CMV) infection in endothelial cells of the lung microvasculature. Enlarged CMV-infected endothelial cells were present in virtually all histologic sections of the lungs, protruded into and compromised the lumens of the small vessels they lined, and were estimated by image cytometry of immunohistochemically stained sections to comprise 0.8% of the total lung tissue volume. Comparison with experimental microvascular embolization studies suggests that this amount of compromise of the microvascular luminal area of the lung is sufficient to elevate pulmonary arterial pressure significantly. Pathologic features in this case differed from both the plexogenic arteriopathy seen in previously reported cases of AIDS-associated primary pulmonary hypertension and the usual form of CMV pneumonitis in AIDS in which alveolar epithelial cells are the predominant site of infection.

AIDS-Related Opportunistic Infections↗

PubMed1997

Haemostatic and rheological factors as predictors of restenosis following percutaneous transluminal angioplasty.

OBJECTIVES: To determine whether pre-angioplasty levels of haemostatic and rheological factors predicted restenosis of the dilated arterial segment following percutaneous transluminal angioplasty. DESIGN AND SETTING: Prospective study, Two regional hospital centres for angioplasty in Edinburgh and Glasgow, Scotland, UK. METHOD: Haemostatic and rheological factors were measured in 102 subjects with atherosclerotic disease of the lower limbs, immediately prior to percutaneous transluminal angioplasty. Subjects were followed up after 2-3 years for restenosis of the original angioplasty site using duplex scanning. RESULTS: Baseline clinical characteristics were similar between subjects who restenosed (n = 27) and those with no restenosis (n = 39), except that occluded lesions were more likely to restenose than stenoses (p < or = 0.05). There was no significant difference in age- and sex-adjusted mean levels of whole blood viscosity, plasma viscosity, haematocrit, von Willebrand factor, fibrin D-dimer or plasminogen activator inhibitor-1 activity between the stenosed and no restenosis groups (p > 0.1), but mean plasma fibrinogen was lower in the restenosed group (3.31 g/l vs. 3.75 g/l; p < or = 0.05). These results persisted after multivariate adjustment for smoking habit and type of lesion dilated. CONCLUSIONS: This study provides no evidence that raised, pre-angioplasty levels of haemostatic and rheological factors predict restenosis following percutaneous transluminal angioplasty of the arteries of the lower limbs.

Angioplasty, Balloon↗

PubMed1997

Hemostatic factors as predictors of ischemic heart disease and stroke in the Edinburgh Artery Study.

Plasma fibrinogen is a consistent predictor of ischemic heart disease (IHD) in prospective studies, but there are fewer data relating other hemostatic variables to IHD and also to stroke. We therefore studied the relationships of plasma fibrinogen, von Willebrand factor antigen, tissue plasminogen activator (TPA) antigen, factor VII, and fibrin D-dimer to incidence of IHD and stroke and determined whether any associations could be explained by conventional risk factors and baseline heart disease. In the Edinburgh Artery study, 1592 men and women aged 55 to 74 years, randomly sampled from the general population, were followed prospectively over 5 years to detect fatal and nonfatal IHD and stroke events. During the 5 years, 268 new vascular events were identified. Baseline plasma fibrinogen was independently related to risk of stroke in multivariate analysis that adjusted for cigarette smoking, LDL-cholesterol, systolic blood pressure, and preexisting IHD (relative risk [RR] 1.52, 95% confidence interval [CI] 1.17, 1.98). TPA antigen, and fibrin D-dimer were also independently associated with risk of stroke (RR 1.69,95% CI 1.22,2.35 and RR 1.96, 95% CI 1.12,3.41, respectively). Significant relationships were found between TPA antigen and myocardial infarction (P < or = .05). In older men and women, increased coagulation activity and disturbed fibrinolysis are predictors of future vascular events (both IHD and stroke).

Aged↗

PubMed1996

Variation in cardiovascular risk factors by angiographic site of lower limb atherosclerosis.

OBJECTIVE: To determine differences in the levels of the cardiovascular risk factors, cigarette smoking, serum lipids and blood pressure, between three groups of patients with different sites of lower limb atherosclerosis. DESIGN: Cross-sectional survey of a consecutive series of patients with symptoms of either intermittent claudication or rest pain. METHODS AND MATERIALS: One hundred and ninety-two men and women who had undergone angiography were classified using the Bollinger scoring system into groups with predominantly aortoiliac, femoropopliteal or dual-site disease. History of cigarette smoking, serum cotinine, serum thiocyanate, total cholesterol and HDL cholesterol were estimated. Systolic and diastolic pressures were measured and the ankle brachial pressure index (ABPI) was calculated. RESULTS: Eighty-five patients were classified as having femoropopliteal disease, 34 aortoiliac disease and 73 dual-site disease. After adjusting for age, sex and severity of disease, aortoiliac patients were significantly younger (p </- 0.001), more likely to be female and current smokers, and had the highest levels of diastolic blood pressure. Life time cigarette consumption (pack-years) and total cholesterol concentrations were highest in femoropopliteal disease. Patients with dual-site disease were more likely to have had a myocardial infarction and angina pectoris (p </- 0.05). Systolic blood pressure was also highest in this group. CONCLUSION: different levels of cardiovascular risk factors may predispose individuals to atherosclerosis at different sites in the lower limb. Large population studies would be required to delineate the risks more precisely.

Adult↗

PubMed1996

Smoking, haemostatic factors and the severity of aorto-iliac and femoro-popliteal disease.

To determine relationships between haemostatic and rheological factors and severity of peripheral atherosclerosis and differences by site, an angiographic cross-sectional survey was carried out on 192 men and women with intermittent claudication or rest pain. 34 patients were classified as having aorto-iliac disease, 85 femoro-popliteal disease and 73 dual-site disease. Mean levels of haemostatic or rheological factors did not differ significantly between the three site groups. In all 192 patients, disease severity in the femoro-popliteal segments was correlated with plasma nephelometric fibrinogen (r = 0.20, p < or = 0.01), von Willebrand factor (r = 0.14, p < or = 0.05) and fibrin D-dimer (r = 0.22, p < or = 0.001). On multiple regression analyses, fibrinogen was independently associated with disease severity in the femoro-popliteal segments (p < or = 0.05), but not in the aorto-iliac segments. Adjustment for packyears or serum thiocyanate had little effect on the association of fibrinogen with severity of disease. An inverse relationship between plasminogen activator inhibitor and disease severity in the femoro-popliteal segments was found only in men (r = 0.24, p < or = 0.01). We conclude that elevated fibrinogen and disturbed fibrinolytic activity may be related to the extent of disease within the femoro-popliteal arteries, more so than in the aorto-iliac arteries.

Adult↗

PubMed1995

Tissue-plasminogen activator, plasminogen activator inhibitor and risk of peripheral arterial disease.

In this population-based case-control study, we examined the relationship between the fibrinolytic variables tissue-plasminogen activator (t-PA) antigen and plasminogen activator inhibitor (PAI) activity, cardiovascular risk factors and peripheral arterial disease. Cases and controls were selected from the Edinburgh Artery Study, a random sample survey of men and women, aged 55-74 years. Mean levels of t-PA antigen and PAI activity were significantly elevated in 121 cases compared to 126 controls. The increased risks of peripheral arterial disease with increasing PAI activity and t-PA antigen levels were partly mediated by interactions with serum triglycerides, high density lipoprotein (HDL) cholesterol and cigarette smoking. For example, adjustment for triglycerides significantly reduced the odds of disease for PAI activity from 1.41 (95% confidence intervals 1.08, 1.86) to 1.24 (0.93, 1.65) and from 1.47 (1.09, 1.98) to 1.34 (0.99, 1.82) for t-PA antigen. We conclude that impaired fibrinolytic potential (raised PAI activity and t-PA antigen) is associated with peripheral atherosclerosis and that this relationship is partly influenced by lipids and cigarette smoking.

Age Factors↗

PubMed1995

The Russian influenza in the United Kingdom, 1889-1894.

The pandemic of severe influenza known in western Europe as the Russian flu, with its associated infections, caused extensive morbidity and high general mortality. In the United Kingdom, as elsewhere, sufferers and their doctors were hard put to explain the visitatiion and resorted to analogies with physical or bacteriological phenomena, or recalled older beliefs in extra-terrestrial forces. The outcomes were more disturbing than was appreciated at the time, or since. The Russian influenza and its sequelae might well have had a crucial part in creating the 'spirit of the 1890s'.

Anomie↗