Tetsuji Fujita, MD
Potential Financial Conflicts of Interest: None disclosed.
Fujita T. Association between Protein Levels and Mortality in Patients with Peripheral Arterial Disease. Ann Intern Med. 2008;149:64. doi: 10.7326/0003-4819-149-1-200807010-00018
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Published: Ann Intern Med. 2008;149(1):64.
TO THE EDITOR:
I read with great interest the excellent article by Vidula and colleagues (1). The authors found that higher levels of d-dimer, C-reactive protein (CRP), and serum amyloid A were associated with higher all-cause and cardiovascular near-term mortality rates among 377 patients with peripheral arterial disease (PAD), 76 of whom died during 4 years of follow-up. Of particular interest is that elevation of CRP and serum amyloid A levels was a surrogate marker of death within 2 years after determination of these protein levels. The relative risk for death within 1 year after measurement of CRP and serum amyloid A in patients with higher levels was 1.13 and 1.12, respectively, and the relative risk for death between 1 and 2 years was 1.15 and 1.13, respectively. Higher levels of these proteins were also associated with higher near-term cardiovascular mortality, comprising 41% of all deaths in the study group. These results suggest that CRP and serum amyloid A levels are mediators of atherosclerosis as well as markers for cardiovascular disease (2).
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