Arteriosclerosis, Thrombosis, and Vascular Biology. 1997;17:3321-3325
© 1997 American Heart Association, Inc.
Articles |
Hemostatic Factors as Predictors of Ischemic Heart Disease and Stroke in the Edinburgh Artery Study
From the Wolfson Unit for Prevention of Peripheral Vascular Diseases, Department of Public Health Sciences, University of Edinburgh, Medical School, Edinburgh, Scotland (F.B.S., A.J.L., F.G.R.F., J.F.P), and the Haemostasis, Thrombosis and Vascular Medicine Unit, University Department of Medicine, Glasgow Royal Infirmary, Glasgow, Scotland (A.R., G.D.O.L.).
Correspondence to Felicity B. Smith, Wolfson Unit for Prevention of Peripheral Vascular Diseases, Department of Public Health Sciences, University of Edinburgh, Medical School, Teviot Place, Edinburgh EH8 9AG, Scotland, UK.
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
.05). In older men and women, increased coagulation
activity and disturbed fibrinolysis are predictors of
future vascular events (both IHD and stroke).
Key Words: tissue plasminogen activator • fibrin D-dimer • ischemic heart disease • stroke
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