Effect of growth differentiation factor-15 (GDF-15) level on extent and severity of atherosclerosis in peripheral arterial disease patients free of obstructive coronary artery disease: A cross-sectional observational study

Members of the transforming growth factor-β superfamily, such as growth differentiation factor 15 (GDF-15), are potent regulators of vascular remodeling and play key roles in atherosclerosis. In this study, we investigated the effect of GDF-15 level on the extent and severity of atherosclerosis in patients with peripheral artery disease (PAD) without obstructive coronary artery disease. A total of 130 patients with PAD who were admitted to the cardiology outpatient department of Biruni University Health Center with complaints of chest pain and intermittent claudication, and whose coronary artery disease was excluded after coronary angiography, were included. GDF-15 levels were measured, and the TASC-2, Rutherford, and Fontaine classifications of patients with obstructive PAD patients were performed. Although there were no statistically significance between 5 Fontaine classes, 3 categories of Rutherford classification and 4 groups of TASC-2 in terms of BMI, platelet count, monocyte/HDL ratio, CRP, and GDF-15 levels were significantly increased. Furthermore, we also performed a regression analysis of parameters that reached statistical significance between the PAD(+) and PAD(-) groups to analyze the independent risk factors for obstructive PAD and lower extremity ulcers. Although none of the mentioned parameters were found to be independent risk factors for obstructive PAD, CRP ([P = .006, β: 1.098, OR [(95% CI): 1.027-1.174]) and GDF-15 ([P = .002, β: 1.002, OR [(95% CI): 1.004-1.010]) were shown to be independent risk factors for lower- extremity ulcers. Our prospective study postulated that CRP and GDF-15 levels are elevated in patients with obstructive PAD and they are independent risk factors for lower-extremity ulcers.