Arteriosclerosis, Thrombosis, and Vascular Biology. 1999;19:493-498
© 1999 American Heart Association, Inc.
Original Contributions |
Fibrinolytic Activation Markers Predict Myocardial Infarction in the Elderly
The Cardiovascular Health Study
Abstract—Coagulation factor levels predict arterial thrombosis in epidemiological studies, but studies of older persons are needed. We studied 3 plasma antigenic markers of fibrinolysis, viz, plasminogen activator inhibitor-1 (PAI-1), fibrin fragment D-dimer, and plasmin-antiplasmin complex (PAP) for the prediction of arterial thrombosis in healthy elderly persons over age 65. The study was a nested case-control study in the Cardiovascular Health Study cohort of 5201 men and women
65 years of age who were enrolled from
1989 to 1990. Cases were 146 participants without baseline clinical
vascular disease who developed myocardial infarction, angina, or
coronary death during a follow-up of 2.4 years. Controls
remained free of cardiovascular events and were matched
1:1 to cases with respect to sex, duration of follow-up, and baseline
subclinical vascular disease status. With increasing quartile of
D-dimer and PAP levels but not of PAI-1, there was an
independent increased risk of myocardial infarction or coronary
death, but not of angina. The relative risk for D-dimer
above versus below the median value (120 µg/L) was 2.5 (95%
confidence interval, 1.1 to 5.9) and for PAP above the median (5.25
nmol/L), 3.1 (1.3 to 7.7). Risks were independent of C-reactive protein
and fibrinogen concentrations. There were no differences in risk by sex
or presence of baseline subclinical disease. D-dimer and PAP, but not
PAI-1, predicted future myocardial infarction in men and women over age
65. Relationships were independent of other risk factors, including
inflammation markers. Results indicate a major role for these markers
in identifying a high risk of arterial disease in this
age group.
Key Words: blood coagulation • fibrinolysis • myocardial infarction • elderly • risk factors
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