© 1999 American Heart Association, Inc.
Thrombosis |
The Relationship of Fibrinogen and Factors VII and VIII to Incident Cardiovascular Disease and Death in the Elderly
Results From the Cardiovascular Health Study
From the Departments of Pathology and Biochemistry and the Laboratory for Clinical Biochemistry Research (R.P.T.), University of Vermont College of Medicine, Burlington, Vermont; the the Department of Biostatistics (A.M.A.), University of Washington, Seattle; the Departments of Internal Medicine and Public Health Sciences (W.E.), Bowman Gray School of Medicine, Winston-Salem, NC; the Departments of Medicine and Epidemiology (L.F.), Johns Hopkins University, Baltimore, Maryland; the Department of Epidemiology and Population Sciences (E.M.), London School of Hygiene and Tropical Medicine, London, UK; and the Division of Epidemiology and Clinical Applications (P.S.), National Heart, Lung, and Blood Institute, NIH, Bethesda, Maryland, for the Cardiovascular Health Study Investigators (see Acknowledgments for a full listing).
Correspondence to Russell P. Tracy, PhD, Laboratory for Clinical Biochemistry Research, University of Vermont, 55A South Park Drive, Colchester, VT 05446. E-mail rtracy{at}salus.uvm.edu
Abstract—Little is known
about the prospective associations of fibrinogen, factor VII, or factor
VIII with cardiovascular disease (CVD) and mortality in
the elderly. At baseline in the Cardiovascular Health
Study (5888 white and African American men and women; aged 
65 years),
we measured fibrinogen, factor VIII, and factor VII. We used
sex-stratified stepwise Cox survival analysis to determine
relative risks (RRs) for CVD events and all-cause mortality (up to 5
years of follow-up), both unadjusted and adjusted for CVD risk factors
and subclinical CVD. After adjustment, comparing the fifth quintile to
the first, fibrinogen was significantly associated in men with
coronary heart disease events (RR=2.1) and stroke or transient
ischemic attack (RR=1.3), and also with mortality within 2.5
years of follow-up (RR=5.8) and later (RR=1.7). Factor VIII was
significantly associated in men with coronary heart disease
events (RR=1.5) and mortality (RR=1.8), and in women with
stroke/transient ischemic attack (RR=1.4). For both factors,
values were higher in those who died, whether causes were CVD-related
or non–CVD-related, but highest in CVD death. Factor VII exhibited
associations with incident angina (RR=1.44) in men and with death in
women (RR, middle quintile compared with first=0.66). However, in
general, factor VII was not consistently associated with CVD
events in this population. We conclude that, if confirmed in other
studies, the measurement of fibrinogen and/or factor VIII may help
identify older individuals at higher risk for CVD events and
mortality.
Key Words: atherosclerosis • cardiovascular diseases • fibrinogen • risk factors • thrombosis
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