Hemostatic Factors as Predictors of Ischemic Heart Disease and Stroke in the Edinburgh Artery Study

Abstract

Plasma fibrinogen is a consistent predictor of ischemic heart disease (IHD) in prospective studies, but there are fewer data relating other hemostatic variables to IHD and also to stroke. We therefore studied the relationships of plasma fibrinogen, von Willebrand factor antigen, tissue plasminogen activator (TPA) antigen, factor VII, and fibrin D-dimer to incidence of IHD and stroke and determined whether any associations could be explained by conventional risk factors and baseline heart disease. In the Edinburgh Artery study, 1592 men and women aged 55 to 74 years, randomly sampled from the general population, were followed prospectively over 5 years to detect fatal and nonfatal IHD and stroke events. During the 5 years, 268 new vascular events were identified. Baseline plasma fibrinogen was independently related to risk of stroke in multivariate analysis that adjusted for cigarette smoking, LDL-cholesterol, systolic blood pressure, and preexisting IHD (relative risk [RR] 1.52, 95% confidence interval [CI] 1.17, 1.98). TPA antigen, and fibrin D-dimer were also independently associated with risk of stroke (RR 1.69,95% CI 1.22,2.35 and RR 1.96, 95% CI 1.12,3.41, respectively). Significant relationships were found between TPA antigen and myocardial infarction (P < or = .05). In older men and women, increased coagulation activity and disturbed fibrinolysis are predictors of future vascular events (both IHD and stroke).

Endothelial Cell Markers and the Risk of Coronary Heart Disease

“…24 However, among the studies included in this analysis, the predictive ability of vWF depends strongly on the variables controlled for. [11][12][13][14][15]24 The precise mechanism by which vWF is associated with cardiovascular risk is unclear. vWF, an acute-phase reactant, could be only a marker of the inflammatory process, which is known to play a major role in CHD.…”

“…Several prospective studies of vWF conducted in healthy individuals are available but have produced mixed results. [11][12][13][14][15] Only a few data are available for TFPI in humans: f-TFPI levels are elevated in patients with unstable angina and increase the risk of a poor outcome. 16 Very recently, a case-control study indicated that low levels of f-TFPI were a risk factor for deep vein thrombosis.…”

Levels of plasma fibrinogen and D-dimer in subjects with white-coat hypertension

“…5 Similarly, elevations of Ddimer are associated with increased risk of future myocardial infarction, stroke, and peripheral vascular disease. 6 Several studies have shown that essential hypertension is associated with increased levels of plasma fibrinogen and D-dimer, indicating a decreased fibrinolytic capacity. 4 Hovewer, there has been no study about levels of plasma fibrinogen and D-dimer in subjects with WCHT in the literature.…”

Associations of Thrombotic-Hemostatic Factors with Cardiovascular Disease~!2009-10-29~!2009-12-22~!2010-04-08~!

“…Most of them have demonstrated weak associations of vW levels with the risk of CHD, turning into insignificant after adjustment for conventional risk factors [23,30,135,137,[141][142][143]. A large prospective study yielded encouraging results showing a moderately significant association between vW and CHD even after adjustment for baseline values of classical risk factors (OR in the top vs. the bottom third 1.82, 95% CI 1.37-2.41) [144].…”