Abstract
AimsChronic heart failure (HF) is associated with activation of blood coagulation but there is a lack of prospective studies on the association between coagulation markers and incident HF in general populations. We have examined the association between the coagulation markers fibrinogen, von Willebrand Factor (VWF), Factors VII, VIII and IX, D-dimer, activated protein C (APC) and activated partial thromboplastin time (aPPT) with NT-proBNP and incident HF. Methods and resultsProspective study of 3366 men aged 60–79years with no prevalent HF, myocardial infarction or venous thrombosis and who were not on warfarin, followed up for a mean period of 13years, in whom there were 203 incident HF cases. D-dimer and vWF were significantly and positively associated with NT-proBNP (a marker of neurohormonal activation and left ventricular wall stress) even after adjustment for age, lifestyle characteristics, renal dysfunction, atrial fibrillation (AF) and inflammation (C-reactive protein). By contrast Factor VII related inversely to AF and NT-proBNP even after adjustment. No association was seen however between the coagulation markers VWF, Factor VII, Factor VIII, Factor IX, D-dimer, APC resistance or aPPT with incident HF in age-adjusted analyses. Fibrinogen was associated with incident HF but this was abolished after adjustment for HF risk factors. ConclusionCoagulation activity is not associated with the development of HF. However D-dimer and vWF were significantly associated with NT-proBNP, suggesting that increased coagulation activity is related to cardiac stress; and the increased coagulation seen in HF patients may in part be a consequence of neurohormonal activation.
Highlights
It is well established that patients with chronic heart failure (HF) have systemic activation of blood coagulation, which may partly reflect systemic activation of inflammation, and which may increase their risk of arterial and venous thromboembolic events and with adverse prognosis [1,2,3,4]
To assess the possible role of coagulation activation in pathogenesis of HF, we have examined the associations of these coagulation markers with incident HF, in those men who had no baseline diagnosis of HF or arterial or venous thrombosis or who were taking warfarin
Elevated D-dimer and vWF were significantly associated with higher prevalence of atrial fibrillation (AF), but this was attenuated after adjustment for age (p = 0.10 for trend for both variables)
Summary
It is well established that patients with chronic heart failure (HF) have systemic activation of blood coagulation, which may partly reflect systemic activation of inflammation, and which may increase their risk of arterial and venous thromboembolic events and with adverse prognosis [1,2,3,4]. Such patients have increased levels of fibrinogen and the Factor VIII – von Willebrand factor (VWF) complex; and elevated levels of coagulation activation markers including fibrin D-dimer [1,2,3,4]. We examined their associations with baseline levels of NT-proBNP, and with the presence of atrial fibrillation at baseline, to investigate associations with cardiac stress
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