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(Circulation. 1997;96:1102-1108.)
© 1997 American Heart Association, Inc.


Articles

Prospective Study of Hemostatic Factors and Incidence of Coronary Heart Disease

The Atherosclerosis Risk in Communities (ARIC) Study

Aaron R. Folsom, MD; Kenneth K. Wu, MD; Wayne D. Rosamond, PhD; A. Richey Sharrett, MD, DrPH; ; Lloyd E. Chambless, PhD

From the Division of Epidemiology, School of Public Health, University of Minnesota, Minneapolis (A.R.F.); Division of Hematology, University of Texas Medical School, Houston (K.K.W.); Collaborative Studies Coordinating Center, Chapel Hill, NC (W.D.R., L.E.C.); and NHLBI, NIH, Bethesda, Md (A.R.S.).

Correspondence to Dr Aaron R. Folsom, Division of Epidemiology, School of Public Health, University of Minnesota, Suite 300, 1300 S 2nd St, Minneapolis, MN 55454-1015. E-mail folsom{at}epivax.epi.umn.edu

Background Although hemostatic factors contribute to acute coronary syndromes and atherogenesis, few studies have prospectively evaluated the association between multiple hemostatic factors and coronary heart disease incidence.

Methods and Results The Atherosclerosis Risk in Communities Study recruited 14 477 adults from 45 to 64 years of age who were initially free of coronary heart disease. Coronary disease risk factors and several plasma hemostatic factors were measured, and incidence of coronary heart disease was ascertained during an average follow-up of 5.2 years. Age-, race-, and field center–adjusted relative risks of coronary heart disease were significantly elevated (P<=.05) per higher value of fibrinogen (relative risk: men, 1.76; women, 1.54), white blood cell count (men, 1.68; women, 2.23), factor VIII coagulant activity (women, 1.25), and von Willebrand factor antigen (men, 1.20; women, 1.18). Adjustment for other risk factors attenuated these associations for fibrinogen (adjusted relative risk: men, 1.48; women, 1.21), and it eliminated the white blood cell count, factor VIII, and von Willebrand factor associations, consistent with the other risk factors either confounding or partly operating through their effects on the hemostatic variables. Adjusted standardized relative risks of total mortality, ranging from 1.13 to 1.37, were also elevated (P<.05) in relation to these four factors. There was no association of coronary disease incidence with factor VII, protein C, antithrombin III, or platelet count.

Conclusions Elevated levels of fibrinogen, white blood cell count, factor VIII, and von Willebrand factor are risk factors and may play causative roles in coronary heart disease. However, their measurement in healthy adults appears to add little to prediction of coronary events beyond that of more established risk factors.


Key Words: coagulation • coronary disease • von Willebrand factor • fibrinogen • leukocytes




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N. Aleksic, C. Ahn, Y.-W. Wang, H. Juneja, A. R. Folsom, E. Boerwinkle, and K. K. Wu
Factor XIIIA Val34Leu Polymorphism Does Not Predict Risk of Coronary Heart Disease: The Atherosclerosis Risk in Communities (ARIC) Study
Arterioscler Thromb Vasc Biol, February 1, 2002; 22(2): 348 - 352.
[Abstract] [Full Text] [PDF]


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Arterioscler. Thromb. Vasc. Bio.Home page
V. Salomaa, V. Rasi, S. Kulathinal, E. Vahtera, M. Jauhiainen, C. Ehnholm, and J. Pekkanen
Hemostatic Factors as Predictors of Coronary Events and Total Mortality: The FINRISK '92 Hemostasis Study
Arterioscler Thromb Vasc Biol, February 1, 2002; 22(2): 353 - 358.
[Abstract] [Full Text] [PDF]


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CirculationHome page
M. Pahor, L. V. Franse, S. R. Deitcher, W. C. Cushman, K. C. Johnson, R. I. Shorr, K. Kottke-Marchant, R. P. Tracy, G. W. Somes, and W. B. Applegate
Fosinopril Versus Amlodipine Comparative Treatments Study: A Randomized Trial to Assess Effects on Plasminogen Activator Inhibitor-1
Circulation, January 29, 2002; 105(4): 457 - 461.
[Abstract] [Full Text] [PDF]


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CLIN APPL THROMB HEMOSTHome page
J. Borawski and M. Mysiwiec
Effects of Recombinant Erythropoietin Therapy on Circulating Endothelial Markers in Hemodialysis Patients
Clinical and Applied Thrombosis/Hemostasis, January 1, 2002; 8(1): 77 - 84.
[Abstract] [PDF]


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British Journal of Diabetes & Vascular DiseaseHome page
J. D Mills and P. J Grant
Insulin resistance, haemostatic factors and cardiovascular risk
The British Journal of Diabetes & Vascular Disease, January 1, 2002; 2(1): 19 - 26.
[Abstract] [PDF]


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HypertensionHome page
V. Palmieri, A. Celentano, M. J. Roman, G. de Simone, M. R. Lewis, L. Best, E. T. Lee, D. C. Robbins, B. V. Howard, and R. B. Devereux
Fibrinogen and Preclinical Echocardiographic Target Organ Damage: The Strong Heart Study
Hypertension, November 1, 2001; 38(5): 1068 - 1074.
[Abstract] [Full Text] [PDF]


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Am J EpidemiolHome page
C. D. Lee, A. R. Folsom, F. J. Nieto, L. E. Chambless, E. Shahar, and D. A. Wolfe
White Blood Cell Count and Incidence of Coronary Heart Disease and Ischemic Stroke and Mortality from Cardiovascular Disease in African-American and White Men and Women: Atherosclerosis Risk in Communities Study
Am. J. Epidemiol., October 15, 2001; 154(8): 758 - 764.
[Abstract] [Full Text] [PDF]


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Nephrol Dial TransplantHome page
J. Borawski, B. Naumnik, K. Pawlak, and M. Mysliwiec
Endothelial dysfunction marker von Willebrand factor antigen in haemodialysis patients: associations with pre-dialysis blood pressure and the acute phase response
Nephrol. Dial. Transplant., July 1, 2001; 16(7): 1442 - 1447.
[Abstract] [Full Text] [PDF]


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Arterioscler. Thromb. Vasc. Bio.Home page
K. Yano, J. S. Grove, R. Chen, B. L. Rodriguez, J. D. Curb, and R. P. Tracy
Plasma Fibrinogen as a Predictor of Total and Cause-Specific Mortality in Elderly Japanese-American Men
Arterioscler Thromb Vasc Biol, June 1, 2001; 21(6): 1065 - 1070.
[Abstract] [Full Text] [PDF]


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Arterioscler. Thromb. Vasc. Bio.Home page
P. W. Kamphuisen, J. C. J. Eikenboom, and R. M. Bertina
Elevated Factor VIII Levels and the Risk of Thrombosis
Arterioscler Thromb Vasc Biol, May 1, 2001; 21(5): 731 - 738.
[Full Text] [PDF]


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CirculationHome page
K. K. Wu, N. Aleksic, C. Ahn, E. Boerwinkle, A. R. Folsom, and H. Juneja
Thrombomodulin Ala455Val Polymorphism and Risk of Coronary Heart Disease
Circulation, March 13, 2001; 103(10): 1386 - 1389.
[Abstract] [Full Text] [PDF]


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Arterioscler. Thromb. Vasc. Bio.Home page
M. Cushman, J. P. Costantino, R. P. Tracy, K. Song, L. Buckley, J. D. Roberts, and D. N. Krag
Tamoxifen and Cardiac Risk Factors in Healthy Women : Suggestion of an Anti-inflammatory Effect
Arterioscler Thromb Vasc Biol, February 1, 2001; 21(2): 255 - 261.
[Abstract] [Full Text] [PDF]


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Am J EpidemiolHome page
D. F. Geffken, M. Cushman, G. L. Burke, J. F. Polak, P. A. Sakkinen, and R. P. Tracy
Association between Physical Activity and Markers of Inflammation in a Healthy Elderly Population
Am. J. Epidemiol., February 1, 2001; 153(3): 242 - 250.
[Abstract] [Full Text] [PDF]


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CirculationHome page
J. A. Cooper, G. J. Miller, K. A. Bauer, J. H. Morrissey, T. W. Meade, D. J. Howarth, S. Barzegar, J. P. Mitchell, and R. D. Rosenberg
Comparison of Novel Hemostatic Factors and Conventional Risk Factors for Prediction of Coronary Heart Disease
Circulation, December 5, 2000; 102(23): 2816 - 2822.
[Abstract] [Full Text] [PDF]


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Arterioscler. Thromb. Vasc. Bio.Home page
E. M. Bladbjerg, A.-M. Munster, P. Marckmann, N. Keller, and J. Jespersen
Dietary Factor VII Activation Does Not Increase Plasma Concentrations of Prothrombin Fragment 1+2 in Patients With Stable Angina Pectoris and Coronary Atherosclerosis
Arterioscler Thromb Vasc Biol, November 1, 2000; 20(11): 2494 - 2499.
[Abstract] [Full Text] [PDF]


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CirculationHome page
N. Aleksic, H. Juneja, A. R. Folsom, C. Ahn, E. Boerwinkle, L. E. Chambless, and K. K. Wu
Platelet PlA2 Allele and Incidence of Coronary Heart Disease : Results From the Atherosclerosis Risk In Communities (ARIC) Study
Circulation, October 17, 2000; 102(16): 1901 - 1905.
[Abstract] [Full Text] [PDF]


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NEJMHome page
D. Girelli, C. Russo, P. Ferraresi, O. Olivieri, M. Pinotti, S. Friso, F. Manzato, A. Mazzucco, F. Bernardi, and R. Corrocher
Polymorphisms in the Factor VII Gene and the Risk of Myocardial Infarction in Patients with Coronary Artery Disease
N. Engl. J. Med., September 14, 2000; 343(11): 774 - 780.
[Abstract] [Full Text] [PDF]


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Am J EpidemiolHome page
S. Sato, M. Nakamura, M. Iida, Y. Naito, A. Kitamura, T. Okamura, Y. Nakagawa, H. Imano, M. Kiyama, H. Iso, et al.
Plasma Fibrinogen and Coronary Heart Disease in Urban Japanese
Am. J. Epidemiol., September 1, 2000; 152(5): 420 - 423.
[Abstract] [Full Text] [PDF]


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Arterioscler. Thromb. Vasc. Bio.Home page
L. F. Bielak, G. G. Klee, P. F. Sheedy II, S. T. Turner, R. S. Schwartz, and P. A. Peyser
Association of Fibrinogen With Quantity of Coronary Artery Calcification Measured by Electron Beam Computed Tomography
Arterioscler Thromb Vasc Biol, September 1, 2000; 20(9): 2167 - 2171.
[Abstract] [Full Text] [PDF]


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Am J EpidemiolHome page
C. R. Isasi, T. J. Starc, R. P. Tracy, R. Deckelbaum, L. Berglund, and S. Shea
Inverse Association of Physical Fitness with Plasma Fibrinogen Level in Children The Columbia University BioMarkers Study
Am. J. Epidemiol., August 1, 2000; 152(3): 212 - 218.
[Abstract] [Full Text] [PDF]


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Arterioscler. Thromb. Vasc. Bio.Home page
J. C. Souto, L. Almasy, E. Muniz-Diaz, J. M. Soria, M. Borrell, L. Bayen, J. Mateo, P. Madoz, W. Stone, J. Blangero, et al.
Functional Effects of the ABO Locus Polymorphism on Plasma Levels of von Willebrand Factor, Factor VIII, and Activated Partial Thromboplastin Time
Arterioscler Thromb Vasc Biol, August 1, 2000; 20(8): 2024 - 2028.
[Abstract] [Full Text] [PDF]


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ANN INTERN MEDHome page
I. Saito, A. R. Folsom, F. L. Brancati, B. B. Duncan, L. E. Chambless, and P. G. McGovern
Nontraditional Risk Factors for Coronary Heart Disease Incidence among Persons with Diabetes: The Atherosclerosis Risk in Communities (ARIC) Study
Ann Intern Med, July 18, 2000; 133(2): 81 - 91.
[Abstract] [Full Text] [PDF]


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J Am Coll CardiolHome page
G. Montalescot, J. P. Collet, L. Lison, R.e. Choussat, A. Ankri, E. Vicaut, K. Perlemuter, F. Philippe, G.e. Drobinski, and D. Thomas
Effects of various anticoagulant treatments on von Willebrand factor release in unstable angina
J. Am. Coll. Cardiol., July 1, 2000; 36(1): 110 - 114.
[Abstract] [Full Text] [PDF]


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Arterioscler. Thromb. Vasc. Bio.Home page
M. Kumari, M. Marmot, and E. Brunner
Social Determinants of von Willebrand Factor : The Whitehall II Study
Arterioscler Thromb Vasc Biol, July 1, 2000; 20(7): 1842 - 1847.
[Abstract] [Full Text] [PDF]


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Arterioscler. Thromb. Vasc. Bio.Home page
R. Klein, A. R. Sharrett, B. E. K. Klein, L. E. Chambless, L. S. Cooper, L. D. Hubbard, and G. Evans
Are Retinal Arteriolar Abnormalities Related to Atherosclerosis? : The Atherosclerosis Risk in Communities Study
Arterioscler Thromb Vasc Biol, June 1, 2000; 20(6): 1644 - 1650.
[Abstract] [Full Text] [PDF]


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BloodHome page
M. Pinotti, R. Toso, D. Girelli, D. Bindini, P. Ferraresi, M. L. Papa, R. Corrocher, G. Marchetti, and F. Bernardi
Modulation of factor VII levels by intron 7 polymorphisms: population and in vitro studies
Blood, June 1, 2000; 95(11): 3423 - 3428.
[Abstract] [Full Text] [PDF]


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BloodHome page
J. M. Soria, L. Almasy, J. C. Souto, I. Tirado, M. Borell, J. Mateo, S. Slifer, W. Stone, J. Blangero, and J. Fontcuberta
Linkage analysis demonstrates that the prothrombin G20210A mutation jointly influences plasma prothrombin levels and risk of thrombosis
Blood, May 1, 2000; 95(9): 2780 - 2785.
[Abstract] [Full Text] [PDF]


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Arterioscler. Thromb. Vasc. Bio.Home page
D. Feng, G. H. Tofler, M. G. Larson, C. J. O’Donnell, I. Lipinska, C. Schmitz, P. A. Sutherland, M. T. Johnstone, J. E. Muller, R. B. D’Agostino, et al.
Factor VII Gene Polymorphism, Factor VII Levels, and Prevalent Cardiovascular Disease : The Framingham Heart Study
Arterioscler Thromb Vasc Biol, February 1, 2000; 20(2): 593 - 600.
[Abstract] [Full Text] [PDF]


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Arterioscler. Thromb. Vasc. Bio.Home page
A. R. Folsom, K. K. Wu, M. Rasmussen, L. E. Chambless, N. Aleksic, and F. J. Nieto
Determinants of Population Changes in Fibrinogen and Factor VII Over 6 Years : The Atherosclerosis Risk in Communities (ARIC) Study
Arterioscler Thromb Vasc Biol, February 1, 2000; 20(2): 601 - 606.
[Abstract] [Full Text] [PDF]


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JAMAHome page
J. B. Meigs, M. A. Mittleman, D. M. Nathan, G. H. Tofler, D. E. Singer, P. M. Murphy-Sheehy, I. Lipinska, R. B. D'Agostino, and P. W. F. Wilson
Hyperinsulinemia, Hyperglycemia, and Impaired Hemostasis: The Framingham Offspring Study
JAMA, January 12, 2000; 283(2): 221 - 228.
[Abstract] [Full Text] [PDF]


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Arterioscler. Thromb. Vasc. Bio.Home page
A. Jager, V. W. M. van Hinsbergh, P. J. Kostense, J. J. Emeis, J. S. Yudkin, G. Nijpels, J. M. Dekker, R. J. Heine, L. M. Bouter, and C. D. A. Stehouwer
von Willebrand Factor, C-Reactive Protein, and 5-Year Mortality in Diabetic and Nondiabetic Subjects : The Hoorn Study
Arterioscler Thromb Vasc Biol, December 1, 1999; 19(12): 3071 - 3078.
[Abstract] [Full Text] [PDF]


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CirculationHome page
M. Cushman, C. Legault, E. Barrett-Connor, M. L. Stefanick, C. Kessler, H. L. Judd, P. A. Sakkinen, and R. P. Tracy
Effect of Postmenopausal Hormones on Inflammation-Sensitive Proteins : The Postmenopausal Estrogen/Progestin Interventions (PEPI) Study
Circulation, August 17, 1999; 100(7): 717 - 722.
[Abstract] [Full Text] [PDF]


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CirculationHome page
A. R. Folsom, W. D. Rosamond, E. Shahar, L. S. Cooper, N. Aleksic, F. J. Nieto, M. L. Rasmussen, and K. K. Wu
Prospective Study of Markers of Hemostatic Function With Risk of Ischemic Stroke
Circulation, August 17, 1999; 100(7): 736 - 742.
[Abstract] [Full Text] [PDF]


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Arterioscler. Thromb. Vasc. Bio.Home page
G. Mariani, J. Conard, F. Bernardi, R. Bertina, V. V. Garcia, H. Prydz, M. Samama, P. M. Sandset, M. Puopolo, M. V. Ciarla, et al.
Oral Contraceptives Highlight the Genotype-Specific Association Between Serum Phospholipids and Activated Factor VII
Arterioscler Thromb Vasc Biol, August 1, 1999; 19(8): 2024 - 2028.
[Abstract] [Full Text] [PDF]


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Arterioscler. Thromb. Vasc. Bio.Home page
R. P. Tracy, A. M. Arnold, W. Ettinger, L. Fried, E. Meilahn, and P. Savage
The Relationship of Fibrinogen and Factors VII and VIII to Incident Cardiovascular Disease and Death in the Elderly : Results From the Cardiovascular Health Study
Arterioscler Thromb Vasc Biol, July 1, 1999; 19(7): 1776 - 1783.
[Abstract] [Full Text] [PDF]


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Arterioscler. Thromb. Vasc. Bio.Home page
G. Maresca, A. Di Blasio, R. Marchioli, and G. Di Minno
Measuring Plasma Fibrinogen to Predict Stroke and Myocardial Infarction : An Update
Arterioscler Thromb Vasc Biol, June 1, 1999; 19(6): 1368 - 1377.
[Abstract] [Full Text] [PDF]


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Arterioscler. Thromb. Vasc. Bio.Home page
S. P. Wamala, M. A. Murray, M. Horsten, M. Eriksson, K. Schenck-Gustafsson, A. Hamsten, A. Silveira, and K. Orth-Gomer
Socioeconomic Status and Determinants of Hemostatic Function in Healthy Women
Arterioscler Thromb Vasc Biol, March 1, 1999; 19(3): 485 - 492.
[Abstract] [Full Text] [PDF]