Violi F, Criqui M, Longoni A, Castiglioni C
Universita degli Studi La Sapienzo, Istituto I Clinica Medica, Policlinico Umberto I, Roma, Italy.
Atherosclerosis. 1996 Feb;120(1-2):25-35. doi: 10.1016/0021-9150(95)05657-2.
The relationship between risk factors and the onset of cardiovascular events was analyzed in patients suffering from peripheral obstructive arterial disease. One thousand and eleven patients were recruited in 120 Italian centers and participated in a clinical trial on picotamide (A.D.E.P. study), whose results have been previously reported. Patients were followed-up for 18 months and cardiovascular events were recorded. Hypertension (35%), smoking (34%), and diabetes (19%) were the most common risk factors at baseline. During the follow-up period, 246 patients (11.7%) had a cardiovascular event, mainly affecting cerebral, cardiac or peripheral circulation. Thirty-five of these events (14.2%) were fatal. A logistic regression analysis showed in general that hypertension (odds ratio 1.48), an ankle arm pressure ratio lower than 0.8 (odds ratio 1.42), smoking (odds ratio 1.43), previous vascular surgery (odds ratio 1.35), high white blood cell (WBC) count (odds ratio 1.15 for a difference of 2.0 x 10(9) WBC/1) and plasma fibrinogen (odds ratio 1.16 for a difference of 1.05 g/l) were significantly associated with a higher incidence of cardiovascular events. In particular, deaths of any origin were more frequent in patients with an ankle/arm pressure ratio below 0.8. High plasma fibrinogen increased the risk of cerebrovascular events, hypertension or coronary heart events and, to a less evident extent, peripheral vascular complications and cerebrovascular events. A history of vascular surgery increased the risk of peripheral vascular complications. Both smoking and a high WBC count showed to be borderline significant risk factors for coronary heart events and the former also for peripheral vascular complications. In male patients (84%), ankle/arm pressure ratio lower than 0.8, high fibrinogen and hypertension were the most important factors for cardiovascular events. This study helps to identify some categories at higher risk of cardiovascular events among patients with peripheral obstructive arterial disease; this finding is useful to plan future trials to decrease the frequency of such complications.
在患有外周动脉阻塞性疾病的患者中，分析了风险因素与心血管事件发作之间的关系。1110名患者在意大利的120个中心招募，并参与了一项关于匹可他胺的临床试验（A.D.E.P.研究），其结果此前已报道。对患者进行了18个月的随访，并记录心血管事件。高血压（35%）、吸烟（34%）和糖尿病（19%）是基线时最常见的风险因素。在随访期间，246名患者（11.7%）发生了心血管事件，主要影响脑、心脏或外周循环。其中35例事件（14.2%）是致命的。逻辑回归分析总体显示，高血压（比值比1.48）、踝臂压力比低于0.8（比值比1.42）、吸烟（比值比1.43）、既往血管手术（比值比1.35）、高白细胞（WBC）计数（白细胞计数每相差2.0×10⁹/L，比值比1.15）和血浆纤维蛋白原（纤维蛋白原每相差1.05g/L，比值比1.16）与心血管事件的较高发生率显著相关。特别是，踝/臂压力比低于0.8的患者任何原因导致的死亡更为频繁。高血浆纤维蛋白原增加了脑血管事件、高血压或冠心病事件的风险，对外周血管并发症和脑血管事件的影响程度较小。血管手术史增加了外周血管并发症的风险。吸烟和高白细胞计数均显示为冠心病事件的临界显著风险因素，前者对外周血管并发症也是如此。在男性患者（84%）中，踝/臂压力比低于0.8、高纤维蛋白原和高血压是心血管事件的最重要因素。本研究有助于识别外周动脉阻塞性疾病患者中发生心血管事件风险较高的一些类别；这一发现有助于规划未来试验以降低此类并发症的发生率。
