Cushman M, Lemaitre R N, Kuller L H, Psaty B M, Macy E M, Sharrett A R, Tracy R P
Department of Medicine and Pathology, University of Vermont, Colchester, VT, USA.
Arterioscler Thromb Vasc Biol. 1999 Mar;19(3):493-8. doi: 10.1161/01.atv.19.3.493.
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 >/=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 (>/=120 microg/L) was 2.5 (95% confidence interval, 1.1 to 5.9) and for PAP above the median (>/=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.
在流行病学研究中，凝血因子水平可预测动脉血栓形成，但仍需针对老年人的研究。我们研究了3种纤维蛋白溶解的血浆抗原标志物，即纤溶酶原激活物抑制剂-1（PAI-1）、纤维蛋白降解产物D-二聚体和纤溶酶-抗纤溶酶复合物（PAP），以预测65岁以上健康老年人的动脉血栓形成。该研究是一项巢式病例对照研究，研究对象来自1989年至1990年入组的心血管健康研究队列中的5201名年龄≥65岁的男性和女性。病例为146名无基线临床血管疾病的参与者，他们在2.4年的随访期间发生了心肌梗死、心绞痛或冠状动脉死亡。对照者未发生心血管事件，并且在性别、随访时间和基线亚临床血管疾病状态方面与病例1:1匹配。随着D-二聚体和PAP水平（而非PAI-1水平）四分位数的增加，心肌梗死或冠状动脉死亡的独立风险增加，但心绞痛风险未增加。D-二聚体高于中位数（≥120μg/L）与低于中位数相比的相对风险为2.5（95%置信区间，1.1至5.9），PAP高于中位数（≥5.25nmol/L）时相对风险为3.1（1.3至7.7）。这些风险独立于C反应蛋白和纤维蛋白原浓度。在性别或基线亚临床疾病存在与否方面，风险无差异。D-二聚体和PAP（而非PAI-1）可预测65岁以上男性和女性未来的心肌梗死。这些关系独立于其他风险因素，包括炎症标志物。结果表明这些标志物在识别该年龄组动脉疾病高风险方面起主要作用。
