Cross-linked fibrin degradation products, progression of peripheral arterial disease, and risk of coronary heart disease

Haemostatic and rheological factors may predict cardiovascu- lar disease. We studied patients with intermittent claudication to see if the progression of peripheral arterial disease and the risks of coronary events could be predicted by baseline packed cell volume, plasma fibrinogen, blood and plasma viscosites, von Willebrand factor antigen, croo-linked fibrin degradation products (XLFDP), urinary fibrinopeptide A, and plasma leuco- cyte elastase. In 617 patients with claudication followed up for one year, baseline XLFDP was related most strongly to coronary events, relative risk 4·4 (95% CI 1·3–19·0) between top and bottom quintiles. Plasma fibrinogen was the strongest in- dependent predictor of death from coronary disease. XLFDP was the only factor, in addition to age and cigarette smoking, that was independently associated (p=0·008) with deteriora- tion in peripheral arterial disease. We conclude that, in patients with peripheral arterial disease, plasma concen- tration of XLFDP, a measure of ongoing fibrin formation and degradation, is a strong predictor of both disease progression and future coronary risk. Thes results accord with the hypothesis tha fibrin formation contributes to progression of coronary and peripheral atherosclerosis. Lancet 1993; 342: 84–86