A study of hemostasis in ischemic cerebrovascular disease. V. A multivariate evaluation of risk indicators and predictors. Early results of a longitudinal study

Mettinger, K.L.

doi:10.1016/0049-3848(82)90168-2

Cited by 8 publications

(5 citation statements)

References 16 publications

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“…7 - 26 A correlation between high vWF:Ag levels and atherosclerosis, or recurrence of serious stroke, was found by Mettinger. 5 Other authors have found no such correlation in healthy subjects later suffering cardiovascular events. 6 - 27 Uchiyama et al 28 found increased vWF:Ag levels in patients with thromboembolic but not embolic (rheumatic valvular heart disease) stroke.…”

Section: Discussionmentioning

confidence: 87%

Coagulation factors and the increased risk of stroke in nonvalvular atrial fibrillation.

Gustafsson

Blombäck

Britton

et al. 1990

Stroke

248

117

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We studied whether hemostatic abnormalities contribute to the increased risk of stroke in patients with nonvalvular atrial fibrillation. Hemostatic function was studied in four agematched groups: 20 patients with nonvalvular atrial fibrillation and a previous ischemic stroke, 20 patients with nonvalvular atrial fibrillation without a previous stroke, 20 stroke patients with sinus rhythm, and 40 healthy controls. Both groups with nonvalvular atrial fibrillation had significantly higher concentrations of von Willebrand factor, factor VM:C, fibrinogen, D-dlmer (a fibrinolytic product), /3-thromboglobulin, and platelet factor 4; a significantly higher fibrinogen/antithrombin ratio; and significantly higher spontaneous amidolytic activity than the healthy controls. Prekallikrein levels were significantly lower in both groups with nonvalvular atrial fibrillation. Stroke patients with sinus rhythm had normal hemostatic function, normal concentrations of platelet-related factors, and a slightly increased concentration of fibrinopeptide A compared with the healthy controls. Both groups with nonvalvular atrial fibrillation differed from the stroke patients with sinus rhythm as they did from the healthy controls. No difference in hemostatic function was seen between the nonvalvular atrial fibrillation patients with and without a previous ischemic stroke. Thus, alterations in hemostatic function may contribute to the increased risk of stroke in patients with nonvalvular atrial fibrillation. (Stroke 1990^1:47-51) N onvalvular atrial fibrillation (NVAF) afflicts 2-4% of 70-year-old people, and its prevalence increases with age. 1 NVAF is an important risk factor for stroke. In the Framingham Study, NVAF was associated with a 5-6 times higher incidence of stroke compared with an age-, sex-, and blood pressure-matched control group without NVAF. 2Left atrial thrombosis causing stroke by arterial embolism has been thought to be the main pathogenetic mechanism in the association between NVAF and stroke. However, the precise mechanism is difficult to determine in individuals with NVAF. As pointed out in recent studies, a considerable proportion of strokes are probably due to atherothrombosis. 3 -4 Generalized atherosclerosis might be the common cause of both NVAF and stroke, thereby explaining the association. If this is true, it can be assumed that there are higher concen-

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Section: Discussionmentioning

confidence: 87%

Coagulation factors and the increased risk of stroke in nonvalvular atrial fibrillation.

Gustafsson

Blombäck

Britton

et al. 1990

Stroke

248

117

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“…Boniton-Kopp et al (7) noted a slight negative trend (not statistically significant), if any effect at all, between alcohol consumption and a2-antiplasmin. Mettinger (42) found no significant relation with a2-antiplasmin and alcohol consumption in 119 subjects with minor ischaemic cerebral lesions living in a district of Stockholm.…”

Section: Blood Fibrinolytic Activitymentioning

confidence: 92%

“…Data on PAI-1 are limited and provide at the very most a suggestion of alcohol dependence. Mettinger (42) found no relationship in the Stockholm population mentioned, and in a recent study among sedentary male workers recruited at the Free University of Amsterdam (aged [25][26][27][28][29][30][31][32][33][34][35][36][37][38][39][40] no correlation between PAI activity (after logarithmic transformation) and alcohol consumption was found (r = 0.0756, n = 57, P = 0.576). The average alcohol consumption was 1.43 ± 1.48 (SD) glasses per day.…”

Section: Blood Fibrinolytic Activitymentioning

confidence: 94%

Alcohol and fibrinolysis

Veenstra¹,

Wierik²,

Kluft³

1990

Fibrinolysis

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Epidemiological studies have shown an inverse relation between moderate alcohol use and the incidence of coronary heart disease. Potential mechanisms explaining that relation may be found in the haemostatic processes. One possible candidate is the fibrinolytic system which, as the natural anticoagulant system in the body, may be reinforced by moderate alcohol consumption. Such an effect might protect against thrombo-embolic complications.From epidemiological and experimental studies into the effects of alcohol consumption it can be concluded that the long-term effects of alcohol consumption on Fibrinolytic variables are moderate. The short-term or acute effects, however, are marked and involve two-to ten-fold changes in blood levels of some components.A recent study has shown that alcohol induces significant short-term increases in levels of the tissue-type plasminogen activator (t-PA). The data further support the notion that this increase is mainly effective with moderate alcohol consumption.It is postulated that this increased fibrinolysis potential can contribute to a reduction of the risk for thrombo-embolic disease in two ways. 1 ) The increase of t-PA, which lasts for 10-15 hours, can counteract new thrombotic events and enhance the removal of old clots locally in the vessels where t-PA is released by the endothelium. 2) The t-PA increase reaches a peak, in systemic activity in the early morning following an evening of moderate alcohol consumption. This peak coincides with the period of highest risk for myocardial infarction. It can be postulated that in moderate alcohol consumers the morning peak in frequency of infarctions is blunted, thus possibly explaining the lower risk in this group.Abbreviations dDAVP, desamino-D-arginine vasopression; LP(a), lipoprotein (a); PA, plasminogen activator; PAI-1, plasminogen activator inhibitor-1; t-PA, tissue-type plasminogen activator: u-PA, urokinase-type plasminogen activator.

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“…Studies of e$pecially cardiovascular heredity and metabolic abnormalities should preferably not have a retrospective design. Since many factors might be of intrinsic and constitutional nature, studies of case-control and longitudinal designs, already in progress (8)(9)(10)(11)(12)(13)(14)(15)(16), focus on biochemical abnormalities (8)(9)(10)(11)(12)(13)(14)(15)(16) and fibromuscular dysplasia (29)(30). Such studies appear essential to draw up further guidelines for early prevention.…”

Section: Discussionmentioning

confidence: 99%

“…During recent years, several reports of young stroke patients have provided essential information on possible etiological factors (1)(2)(3)(4)(5)(6)(7)(8)(9)(10)(11)(12)(13)(14)(15)(16). Several of these studies are, however, hampered by diagnostic inaccuracy as well as an undefined selection of patients.…”

mentioning

confidence: 99%

Stroke before 55 years of age at Karolinska Hospital 1973-77. A study of 399 well-defined cases

Mettinger

Söderström

Neiman

2009

Acta Neurologica Scandinavica

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Abstract– The etiological characteristics of cerebrovascular disease (CVD) before the age of 55 are reviewed in 399 patients admitted to the Department of Neurology, Karolinska Hospital, Stockholm, from 1973–77. The material was well‐defined with regard to subtypes of stroke as well as to the diseased population. The control material consists of 829 males and females of corresponding age randomly selected from the Stockholm population. In the ischemic group, 61% had angiographic evidence of atherosclerosis and, compared to controls, in most patient groups a significant (P < 0.05–0.001) association with hypertension, diabetes, heart disease and smoking was found as well as for female patients under age 40 the use of oral contraceptives (P < 0.001). In the hemorrhagic group, angiography demonstrated aneurysms in 76% of the patients with subarachnoidal bleeding but also atherosclerotic lesions in about 12 % of the whole group. This would imply that atherosclerosis is an important precursor also for hemorrhagic lesions, further supported by a significant (P < 0.01–0.001) association of hypertension, diabetes and smoking with this group.

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A study of hemostasis in ischemic cerebrovascular disease. V. A multivariate evaluation of risk indicators and predictors. Early results of a longitudinal study

Cited by 8 publications

References 16 publications

Coagulation factors and the increased risk of stroke in nonvalvular atrial fibrillation.

Coagulation factors and the increased risk of stroke in nonvalvular atrial fibrillation.

Alcohol and fibrinolysis

Stroke before 55 years of age at Karolinska Hospital 1973-77. A study of 399 well-defined cases

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