(Circulation. 2000;102:2816.)
© 2000 American Heart Association, Inc.
Clinical Investigation and Reports |
Comparison of Novel Hemostatic Factors and Conventional Risk Factors for Prediction of Coronary Heart Disease
From the Medical Research Council (J.A.C., G.J.M., T.W.M., D.J.H., J.P.M.), Epidemiology and Medical Care Unit, Wolfson Institute of Preventive Medicine, London, UK; the Department of Medicine (K.A.B., S.B., R.D.R.), Beth Israel Deaconess Medical Center, and the Boston VA Healthcare System (K.A.B.), Harvard Medical School, Boston, Mass; the Cardiovascular Biology Research Program (J.H.M.), Oklahoma Medical Research Foundation, Oklahoma City; and the Department of Biology (R.D.R.), Massachusetts Institute of Technology, Cambridge, Mass.
Correspondence to George J. Miller, MD, MRC Epidemiology and Medical Care Unit, Wolfson Institute of Preventive Medicine, Charterhouse Square, London EC1 M 6BQ, UK. E-mail g.miller{at}mds.qmw.ac.uk
Background—This study sought to assess whether novel markers of hemostatic activity are predictive of coronary heart disease (CHD) and improve risk assessment.
Methods and Results—Conventional CHD risk factors, the activation peptides of factor IX and factor X, factor VII activity and antigen, activated factor XII, prothrombin fragment 1+2, fibrinopeptide A, and fibrinogen were measured in 1153 men aged 50 to 61 years who were free of myocardial infarction at recruitment. Activated factor VII (VIIa) was measured in 829 men. During 7.8 years of follow-up, 104 had a CHD event. Baseline status was related to outcome by logistic regression by using a modified nested case-control design. Screening performance was judged from receiver operating characteristic curves. A high activated factor XII was associated with increased CHD risk, but low levels were not protective. Plasma VIIa and factor X activation peptide were independently and inversely related to risk. Plasma factor IX activation peptide and fibrinogen were positively associated with risk, but the relations were no longer statistically significant after adjustment for other factors, including VIIa and apoA-I. Other hemostatic markers were not associated with CHD risk.
Conclusions—Hemostatic status did not add significant predictive power to that provided by conventional CHD risk factors yet was able to substitute effectively for these factors.
Key Words: coronary disease • coagulation • risk factors • epidemiology
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