Abstract
Aims:The extent to which hemostatic and inflammatory biomarkers are related to angina pectoris as compared with myocardial infarction (MI) remains uncertain. We examined the relationship between a wide range of inflammatory and hemostatic biomarkers, including markers of activated coagulation, fibrinolysis and endothelial dysfunction and viscosity, with incident myocardial infarction (MI) or coronary heart disease (CHD) death and incident angina pectoris uncomplicated by MI or CHD death in older men. Methods:A prospective study of 3217 men aged 60–79 years with no baseline CHD (angina or MI) and who were not on warfarin, followed up for 7 years during which there were 198 MI/CHD death cases and 220 incident uncomplicated angina cases. Results:Inflammatory biomarkers [C-reactive protein (CRP), interleukin-6, fibrinogen], plasma viscosity and hemostatic biomarkers [von Willebrand factor (VWF) and fibrin D-dimer] were associated with a significant increased risk of MI/CHD death but not with uncomplicated angina even after adjustment for age and conventional risk factors. Adjustment for CRP attenuated the relationships between VWF, fibrin D-dimer and plasma viscosity with MI/CHD death. Comparisons of differing associations with risk of MI/CHD deaths and uncomplicated angina were significant for the inflammatory markers (P < 0.05) and marginally significant for fibrin D-dimer (P = 0.05). In contrast, established risk factors including blood pressure and high-density lipoprotein (HDL)-cholesterol were associated with both MI/CHD death and uncomplicated angina. Conclusion:Circulating biomarkers of inflammation and hemostasis are associated with incident MI/CHD death but not incident angina uncomplicated by MI or CHD death in older men.
Highlights
It is well established that inflammation plays a major role in the development and progression of atherosclerosis, including plaque rupture which initiates coronary thrombosis and myocardial infarction (MI) [1]
Inflammatory biomarkers (CRP, IL-6, fibrinogen), plasma viscosity, D-dimer and von Willebrand factor (VWF) remained significantly associated with MI/coronary heart disease (CHD) death after adjustment for age, smoking, BMI, physical activity, alcohol intake, systolic blood pressure, high-density lipoprotein (HDL)-cholesterol, history of diabetes and stroke
As IL-6 and fibrinogen both reflect markers of inflammation, adjustments were not made for C-reactive protein (CRP) for these variables. In this prospective study of British men aged 60–79 years without baseline evidence of CHD, we have confirmed the results of previous studies [2,3,4,5,6,7,8,9,10,11,12,13] that circulating biomarkers of inflammation, endothelial dysfunction, coagulation and fibrinolysis (CRP, IL-6, fibrinogen, plasma viscosity, VWF and fibrin D-dimer) are associated with risk of incident major CHD events (MI or CHD death), after adjustment for traditional CHD risk factors
Summary
It is well established that inflammation plays a major role in the development and progression of atherosclerosis, including plaque rupture which initiates coronary thrombosis and myocardial infarction (MI) [1]. Endothelial dysfunction and fibrinolysis have been associated with risk of coronary heart disease (CHD) [2,3,4,5,6,7,8,9,10,11,12,13]. The term CHD covers all forms of atherosclerotic disease of the coronary arteries with MI/coronary death as the most serious manifestation and with angina (unstable or stable) as a specific symptom complex indicating myocardial ischemia. Information on the association of these circulating biomarkers with the risk of uncomplicated angina events is limited
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