Association of the von Willebrand Factor-ADAMTS13 Ratio With Incident Cardiovascular Events in Patients With Peripheral Arterial Disease.
BACKGROUND
Platelet adhesion is mediated by von Willebrand factor (vWF), and disintegrin-like and metalloprotease domain with thrombospondin type-1 motif, number 13 (ADAMTS13) is a protease that cleaves vWF. A change in the balance between vWF and ADAMTS13 in favor of thrombosis might occur shortly before ischemic cardiovascular (CV) events.


OBJECTIVE
To determine whether vWF, ADAMTS13, and the ratio of vWF and ADAMTS13 change during the months preceding an acute CV event.


METHODS
Prospective longitudinal observational study.


METHODS
Outpatient.


METHODS
A total of 595 participants with peripheral artery disease (PAD).


METHODS
Blood samples were obtained every 2 months for up to 3 years and hemostatic factors examined at intervals preceding events.


RESULTS
Sixty-one participants (cases) experienced events and were matched to 122 PAD controls. During the 2-month interval prior to an event, cases (n = 48) had higher levels of the vWF and ADAMTS13 than controls (n = 95; P = .05), but significance was lost after adjusting for the baseline differences in myocardial infarction, unstable angina, and stroke. During the 10 months prior to an event, median values for vWF and the ratio of vWF and ADAMTS13 were higher in cases than in controls, but the differences were not statistically significant. However, in a subset of 20 patients with complete bimonthly data, there was a trend toward an increase in the ratio in the 10 months prior to a CV event ( P = .04).


CONCLUSIONS
In patients with PAD experiencing an ischemic CV event, a significant increase in the ratio of vWF to ADAMTS13 prior to the event could not be confirmed, although there was a weak trend in this direction.
1 Department of Medicine, Northwestern University Feinberg School of Medicine, Chicago, IL, USA.
David
D
Green
2 Department of Health Research and Policy, Stanford University, Stanford, CA, USA.
Lu
L
Tian
3 Department of Preventive Medicine, Northwestern University Feinberg School of Medicine, Chicago, IL, USA.
Philip
P
Greenland
3 Department of Preventive Medicine, Northwestern University Feinberg School of Medicine, Chicago, IL, USA.
Kiang
K
Liu
4 Department of Surgery, Northwestern University Feinberg School of Medicine, Chicago, IL, USA.|5 Jesse Brown Veterans Affairs Medical Center, Chicago, IL, USA.
Melina
M
Kibbe
6 Department of Pathology-Colchester Research Facility, University of Vermont College of Medicine, Colchester, VT, USA.
Russell
R
Tracy
1 Department of Medicine, Northwestern University Feinberg School of Medicine, Chicago, IL, USA.
Sanjiv
S
Shah
1 Department of Medicine, Northwestern University Feinberg School of Medicine, Chicago, IL, USA.|3 Department of Preventive Medicine, Northwestern University Feinberg School of Medicine, Chicago, IL, USA.
John T
JT
Wilkins
1 Department of Medicine, Northwestern University Feinberg School of Medicine, Chicago, IL, USA.|3 Department of Preventive Medicine, Northwestern University Feinberg School of Medicine, Chicago, IL, USA.
Mark D
MD
Huffman
3 Department of Preventive Medicine, Northwestern University Feinberg School of Medicine, Chicago, IL, USA.
Yihua
Y
Liao
1 Department of Medicine, Northwestern University Feinberg School of Medicine, Chicago, IL, USA.|3 Department of Preventive Medicine, Northwestern University Feinberg School of Medicine, Chicago, IL, USA.
Donald
D
Lloyd Jones
1 Department of Medicine, Northwestern University Feinberg School of Medicine, Chicago, IL, USA.|3 Department of Preventive Medicine, Northwestern University Feinberg School of Medicine, Chicago, IL, USA.
Mary M
MM
McDermott
D000071120:ADAMTS13 Protein / Q000097:blood*; D000368:Aged; D002318:Cardiovascular Diseases / Q000097:blood*; D016022:Case-Control Studies; D005260:Female; D006801:Humans; D008137:Longitudinal Studies; D008297:Male; D008875:Middle Aged; D058729:Peripheral Arterial Disease / Q000150:complications*; D011446:Prospective Studies; D014841:von Willebrand Factor / Q000032:analysis*
D014841:von Willebrand Factor; D000071120:ADAMTS13 Protein; C099604:ADAMTS13 protein, human
ADAMTS13 protein; biomarkers; human; ischemic stroke; myocardial infarction; peripheral vascular disease; von Willebrand factor