Fibrinolytic activation markers predict myocardial infarction in the elderly - The cardiovascular health study
Fibrinolytic activation markers predict myocardial infarction in the elderly - The cardiovascular health study
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DOI：
10.1161/01.atv.19.3.493
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发表时间：
1999-03-01
影响因子：
8.7
通讯作者：
Tracy, RP
中科院分区：
文献类型：
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作者：
Cushman, M;Lemaitre, RN;Tracy, RP
在流行病学研究中，凝血因子水平可以预测动脉血栓形成，但需要对老年人进行研究。我们研究了3种血浆纤溶抗原标记物，即纤溶酶原激活物抑制物-1(PAI-1)、纤维蛋白片段D-二聚体和纤溶酶-抗纤溶酶复合体(PAP)对65岁以上健康老年人动脉血栓形成的预测。这项研究是心血管健康研究队列中嵌套的病例对照研究，队列中有5201名年龄大于或等于65岁的男性和女性，他们是从1989年到1990年登记的。研究对象为146名无基线临床血管疾病的受试者，他们在2.4年的随访期中发生了心肌梗死、心绞痛或冠状动脉死亡。对照组没有发生心血管事件，在性别、随访时间和基线亚临床血管疾病状态方面与患者1：1匹配。随着D-二聚体和PAP水平的增加而不是PAI-1水平的增加，心肌梗死或冠状动脉死亡的风险独立增加，但不会增加心绞痛的风险。D-二聚体高于或低于中位数(大于或等于120ug/L)的相对危险度为2.5(95%可信区间为1.1~5.9)，高于中位数(大于或等于5.25nmol/L)的相对危险度为3.1(1.3~7.7)。风险与C反应蛋白和纤维蛋白原浓度无关。不同性别或是否存在基线亚临床疾病的风险没有差异。D-二聚体和PAP，而不是PAI-1，可以预测65岁以上男性和女性未来的心肌梗死。关系独立于其他风险因素，包括炎症标记物。结果表明，这些标记物在确定该年龄段动脉疾病的高风险方面发挥了主要作用。
Coagulation factor levels predict arterial thrombosis in epidemiological studies, but studies of older persons are needed. We studied 3 plasma antigenic markers of fibrinolysis, viz, plasminogen activator inhibitor-1 (PAI-1), fibrin fragment D-dimer, and plasmin-antiplasmin complex (PAP) for the prediction of arterial thrombosis in healthy elderly persons over age 65. The study was a nested case-control study in the Cardiovascular Health Study cohort of 5201 men and women greater than or equal to 65 years of age who were enrolled from 1989 to 1990. Cases were 146 participants without baseline clinical Vascular disease who developed myocardial infarction, angina, or coronary death during a follow-up of 2.4 years. Controls remained free of cardiovascular events and were matched 1:1 to cases with respect to sex, duration of follow-up, and baseline subclinical Vascular disease status. With increasing quartile of D-dimer and PAP levels but not of PAI-1, there was an independent increased risk of myocardial infarction or coronary death, but not of angina. The relative risk for D-dimer above versus below the median value (greater than or equal to 120 mu g/L) was 2.5 (95% confidence interval, 1.1 to 5.9) and for PAP above the median (greater than or equal to 5.25 nmol/L), 3.1 (1.3 to 7.7). Risks were independent of C-reactive protein and fibrinogen concentrations. There were no differences in risk by sex or presence of baseline subclinical disease. D-dimer and PAP, but not PAI-1, predicted future myocardial infarction in men and women over age 65. Relationships were independent of other risk factors, including inflammation markers. Results indicate a major role for these markers in identifying a high risk of arterial disease in this age group.