Abstract
BackgroundActivation of blood coagulation and fibrinolysis may be associated with increased risk of coronary heart disease. We aimed to assess associations of circulating tissue plasminogen activator (t-PA) antigen, D-dimer and von Willebrand factor (VWF) with coronary heart disease risk.DesignProspective case-control study, systematic review and meta-analyses.MethodsMeasurements were made in 1925 people who had a first-ever nonfatal myocardial infarction or died of coronary heart disease during follow-up (median 19.4 years) and in 3616 controls nested within the prospective population-based Reykjavik Study.ResultsAge and sex-adjusted odds ratios for coronary heart disease per 1 standard deviation higher baseline level were 1.25 (1.18, 1.33) for t-PA antigen, 1.01 (0.95, 1.07) for D-dimer and 1.11 (1.05, 1.18) for VWF. After additional adjustment for conventional cardiovascular risk factors, corresponding odds ratios were 1.07 (0.99, 1.14) for t-PA antigen, 1.06 (1.00, 1.13) for D-dimer and 1.08 (1.02, 1.15) for VWF. When combined with the results from previous prospective studies in a random-effects meta-analysis, overall adjusted odds ratios were 1.13 (1.06, 1.21) for t-PA antigen (13 studies, 5494 cases), 1.23 (1.16, 1.32) with D-dimer (18 studies, 6799 cases) and 1.16 (1.10, 1.22) with VWF (15 studies, 6556 cases).ConclusionsConcentrations of t-PA antigen, D-dimer and VWF may be more modestly associated with first-ever CHD events than previously reported. More detailed analysis is required to clarify whether these markers are causal risk factors or simply correlates of coronary heart disease.
Highlights
Because myocardial infarction usually results from occlusive thrombosis of atherosclerotic plaque, it has been proposed that circulating levels of markers that reflect activated coagulation and fibrinolysis may be associated with coronary heart disease (CHD) risk [1,2]
Concentrations of tissue plasminogen activator (t-PA) antigen, D-dimer and von Willebrand factor (VWF) may be more modestly associated with first-ever CHD events than previously reported
More detailed analysis is required to clarify whether these markers are causal risk factors or correlates of coronary heart disease
Summary
Because myocardial infarction usually results from occlusive thrombosis of atherosclerotic plaque, it has been proposed that circulating levels of markers that reflect activated coagulation and fibrinolysis may be associated with coronary heart disease (CHD) risk [1,2]. Three such markers are tissue plasminogen activator (tPA) antigen, D-dimer and von Willebrand factor (VWF). We aimed to assess associations of circulating tissue plasminogen activator (t-PA) antigen, D-dimer and von Willebrand factor (VWF) with coronary heart disease risk
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