Individuals with coronary artery disease at a young age and features of the metabolic syndrome have an increased prothrombotic potential

Abstract

Background: The relation between coagulation and atherosclerosis has been extensively described. However, most literature on this issue shows conflicting results. Surprisingly, hypercoagulability is most pronounced in young patients with Coronary Artery Disease (CAD). It is known that obesity and hereby induced Metabolic Syndrome (MS), a risk factor for CAD, are related to a higher incidence of thrombo-embolic events. We hypothesized that individuals with CAD at a young age and features of MS have an increased prothtombotic potential. We analyzed this by measuring the Endogenous Thrombin Potential (ETP) in patients with CAD before the age of 51 in men and 56 in women and compared them to their healthy first-degree relatives. Furthermore, we studied whether the presence of the MS in these CAD patients further increased the prothrombotic potential. Methodology and principal findings: We included 118 patients with CAD at a young age and 50 healthy first-degree relatives. An adjusted General Linear Model (GLM) showed that there is a positive association between the peak thrombin levels and the presence of CAD at a young age (B = 9.40; p<0.05). Based on the NCEP guidelines we divided our patient group in CAD patients with and without MS, and compared them to healthy first-degree relatives without MS. The adjusted GLM showed that CAD patients with MS have increased ETP levels, both in comparison with healthy first degree relatives (B = 12.97; p<0.05) and with CAD patients without MS (B = 12.87; p<0.05). There was no difference in ETP levels between CAD patients without MS and healthy first-degree relatives (B = 0.10; p = ns). Conclusion: This study shows that individuals with CAD at a young age have an increased prothrombotic state. Furthermore, we show that the increased prohrombotic state in the young CAD patients is associated with the presence of the metabolic syndrome.