Relationship of waist and hip circumference with coagulation and fibrinolysis in postmenopausal women

Abstract

The contribution of obesity to the occurrence of cardiovascular events may not be wholly related to its influence on traditional risk factors. Coagulation and fibrinolysis may also influence cardiovascular risk, but the relationship of adiposity with these processes is unclear. The aim of the present study was to investigate the relationships of BMI (body mass index), waist circumference, hip circumference and WHR (waist-to-hip ratio) with VIIc (factor VII activity), plasma markers of thrombin generation [F1+2 (prothrombin fragment 1+2)], fibrin formation [SF (soluble fibrin)] and fibrin turnover (D-dimer), and PAI-1 (plasminogen activator inhibitor-1; a marker of fibrinolytic inhibitory capacity). The study cohort was 80 healthy postmenopausal women who were not diabetic, current smokers or taking hormone therapy and who had a fasting sample of blood collected. VIIc, F1+2, SF and PAI-1 were all positively correlated with BMI, waist circumference and WHR, whereas D-dimer was positively correlated with waist circumference and WHR, but not BMI. WHR was the strongest correlate of all the markers except for PAI-1, which was most closely related to BMI. Hip circumference became a negative correlate of F1+2 and D-dimer after adjusting for waist circumference. The relationships of WHR with F1+2 and SF, but not with VIIc and D-dimer, were independent of traditional risk factors. The positive association between waist circumference and markers of thrombin generation, fibrin production and fibrin turnover suggests that abdominal adiposity may contribute to atherothrombosis by activating intravascular coagulation. In contrast, a larger hip circumference appears to have a protective affect against coagulation activation.

Body Composition as Determinant of Thrombin Generation in Plasma

“…14 In addition, an association has been found between prothrombin 1.2 fragments and waist circumference in postmenopausal women. 7 In the latter study, a trend towards an inverse association between hip circumference and prothrombin 1.2 fragments was described. Such an inverse association with hip circumference was also observed in our study, but more strongly so in men.…”

“…5 Indeed, thrombin is one of the key players in the coagulation cascade, 6 and in vivo markers of thrombin generation have been positively associated with waist circumference in postmenopausal women. 7 Recently, several new methods have become available that quantitatively measure thrombin generation in vitro after activation of the coagulation cascade with tissue factor (TF), phospholipids, and calcium chloride (CaCl 2 ). 8 The Calibrated Automated Thrombogram (CAT) method is one such method.…”

Difficulties in diagnosing pulmonary embolism in the obese patient: A literature review

“…A normal high-sensitivity quantitive D-dimer is useful in ruling out PE in a patient with a low or moderate clinical probability of PE determined by a validated clinical decision rule. 24,[32][33][34][35] D-dimer values are elevated in obese patients, and there are studies showing a positive correlation between D-dimer values and waist circumference 16 and BMI. 36 BNP and troponin levels are used as markers for right ventricular stress and are employed in some protocols as part of a risk stratification program to determine whether thrombolytic therapy should be considered.…”

“…D-dimer measurement several weeks after discontinuing the anticoagulation has been used to assess the ongoing risk of thromboembolic disease in the general population. 64 However, the usefulness of this approach in the obese population who may have chronically elevated D-dimer levels 16,36 is unclear. The bleeding risk is 2-3% per year and the mortality per bleeding episode is 11-13% in patients anticoagulated for thromboembolic disease.…”

Cardiovascular disease among diabetic women with bilateral oophorectomy.

“…(16,242,247,248). Additionally, VAT secretes larger quantities of pro-inflammatory cytokines such as TNF - and interleukin-6 which increase the level of the acute phase reactant C-reactive protein (242,247), and contributes to atherothrombosis through the activation of intravascular coagulation and fibrinolysis (249). Finally VAT may directly influence atherosclerosis by accelerating the progression of coronary calcification (71).…”