(Circulation. 1998;98:2241-2247.)
© 1998 American Heart Association, Inc.
Clinical Investigation and Reports |
High Plasminogen Activator Inhibitor and Tissue Plasminogen Activator Levels in Plasma Precede a First Acute Myocardial Infarction in Both Men and Women
Evidence for the Fibrinolytic System as an Independent Primary Risk Factor
From the Department of Medicine (A.M.T.), Department of Clinical Chemistry (T.K.N.), and Departments of Nutritional Research and Pathology (G.H.), Umeå University Hospital; Department of Medicine-Geriatric, Skellefteå County Hospital (J.-H.J., K.B.) and Department of Epidemiology and Public Health (L.W.), University of Umeå; and Department of Medicine, Luleå Hospital (F.H.), Sweden.
Correspondence to Anna Margrethe Thögersen, Department of Medicine, Umeå University Hospital, Umeå, S-901 85 Sweden. E-mail anna.margrethe.thogersen{at}medicin.umu.se
Background—In patients with established ischemic heart disease, prospective cohort studies have indicated that plasminogen activator inhibitor (PAI-1), the inhibitor of the fibrinolytic system, may predict cardiovascular events. So far, there have been no primary prospective studies of PAI-1.
Methods and Results—The aim of the present study was to test whether plasma levels of PAI-1, tissue-type plasminogen activator (tPA), von Willebrand factor (vWF), and thrombomodulin (TM) could predict the occurrence of a first acute myocardial infarction (AMI) in a population with high prevalence of coronary heart disease by use of a prospective nested case-control design. Mass concentrations of PAI-1 and tPA were significantly higher for the 78 subjects who developed a first AMI compared with the 156 references matched for age, sex, and sampling time; for tPA, this increase was independent of smoking habits, body mass index, hypertension, diabetes, cholesterol, and apolipoprotein A-I. The ratio of quartile 4 to 1 for tPA was 5.9 for a patient to develop a first AMI. The association between tPA and AMI was seen in both men and women. Increased levels of vWF were associated with AMI in a univariate analysis. High levels of TM were associated with AMI in women but not in men.
Conclusions—The plasma levels of PAI-1, tPA, and vWF are associated with subsequent development of a first AMI; for PAI-1 and tPA, this relation was found in both men and women. For tPA but not for PAI-1 and vWF, this association is independent of established risk factors.
Key Words: myocardial infarction • risk factors • plasminogen activators • von Willebrand factor
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 K. Lottermoser, H.-J. Hertfelder, M. Wehling, B. Schiermeyer, H. Vetter, and R. Dusing Effects of the mineralocorticoid fludrocortisone on fibrinolytic function in healthy subjects Journal of Renin-Angiotensin-Aldosterone System, December 1, 2000; 1(4): 357 - 360. [Abstract] [PDF]
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 T C F Sykes, C Fegan, and D Mosquera Thrombophilia, polymorphisms, and vascular disease Mol. Pathol., December 1, 2000; 53(6): 300 - 306. [Abstract] [Full Text]
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J. S. Park, H. H. Jung, W. S. Yang, S. B. Kim, W. K. Min, and H. S. Chi Effects of hormonal replacement therapy on lipid and haemostatic factors in post-menopausal ESRD patients Nephrol. Dial. Transplant., November 1, 2000; 15(11): 1835 - 1840. [Abstract] [Full Text] [PDF]
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A. Sonel, B. M. Sasseen, N. Fineberg, N. Bang, and R. L. Wilensky Prospective Study Correlating Fibrinopeptide A, Troponin I, Myoglobin, and Myosin Light Chain Levels With Early and Late Ischemic Events in Consecutive Patients Presenting to the Emergency Department With Chest Pain Circulation, September 5, 2000; 102(10): 1107 - 1113. [Abstract] [Full Text] [PDF]
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H. P. Kohler and P. J. Grant Plasminogen-Activator Inhibitor Type 1 and Coronary Artery Disease N. Engl. J. Med., June 15, 2000; 342(24): 1792 - 1801. [Full Text] [PDF]
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M. P Bedigian Improving the prognosis of diabetic patients: evaluating the role of intensive versus moderate blood pressure control with selective angiotensin II receptor blocker (ARB) therapy Journal of Renin-Angiotensin-Aldosterone System, June 1, 2000; 1(2_suppl): S25 - S28. [Abstract] [PDF]
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 D. A. Lane and P. J. Grant Role of hemostatic gene polymorphisms in venous and arterial thrombotic disease Blood, March 1, 2000; 95(5): 1517 - 1532. [Full Text] [PDF]
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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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J. L. Anderson, J. B. Muhlestein, J. Habashi, J. F. Carlquist, T. L. Bair, S. P. Elmer, and B. P. Davis Lack of association of a common polymorphism of the plasminogen activator inhibitor-1 gene with coronary artery disease and myocardial infarction J. Am. Coll. Cardiol., November 15, 1999; 34(6): 1778 - 1783. [Abstract] [Full Text] [PDF]
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G. W. de Valk-de Roo, C. D.A. Stehouwer, J. Lambert, C. G. Schalkwijk, M. J. van der Mooren, C. Kluft, and C. Netelenbos Plasma Homocysteine Is Weakly Correlated with Plasma Endothelin and von Willebrand Factor but not with Endothelium-dependent Vasodilatation in Healthy Postmenopausal Women Clin. Chem., August 1, 1999; 45(8): 1200 - 1205. [Abstract] [Full Text] [PDF]
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J. D. Mills, M. W. Mansfield, and P. J. Grant Tissue Plasminogen Activator, Fibrin D-Dimer, and Insulin Resistance in the Relatives of Patients With Premature Coronary Artery Disease Arterioscler Thromb Vasc Biol, April 1, 2002; 22(4): 704 - 709. [Abstract] [Full Text] [PDF]
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