Whincup P H, Danesh J, Walker M, Lennon L, Thomson A, Appleby P, Rumley A, Lowe G D O
Department of Public Health Sciences, St George's Hospital Medical School, London, UK.
Eur Heart J. 2002 Nov;23(22):1764-70. doi: 10.1053/euhj.2001.3237.
To determine whether circulating von Willebrand factor concentrations are prospectively related to risk of coronary heart disease in the general population.
We measured baseline von Willebrand factor values in the stored serum samples of 625 men with major coronary events and in 1266 controls 'nested' in a prospective study of 5661 men aged 40-59 years, recruited from general practices in 18 British towns in 1978-1980 and followed up for 16 years for fatal coronary heart disease and non-fatal myocardial infarction. We conducted a meta-analysis of previous relevant studies to place our results in context. Men in the top third of baseline von Willebrand factor values (tertile cutoff >126 IU.dl(-1)) had an odds ratio for coronary heart disease of 1.83 (95% confidence interval 1.43-2.35; 2P <0.0001) compared with those in the bottom third (tertile cutoff <90 IU.dl(-1)), after adjustments for age and town. The odds ratio was little changed after further adjustment for risk factors (1.82, 95% CI 1.37-2.41), and was not significantly different in an analysis restricted to the 404 cases and 1007 controls without baseline evidence of coronary heart disease (odds ratio 1.53, 95% CI 1.10-2.12). A meta-analysis of all relevant population-based prospective studies (including the present study) yielded a combined odds ratio of 1.5 (95% CI 1.1-2.0). von Willebrand factor values were strongly correlated with Helicobacter pylori seropositivity and circulating concentrations of C-reactive protein (2 P<0.0001 for each), but not with smoking, blood lipids, or most other measured risk factors.
Though circulating von Willebrand factor concentrations may be associated with incident coronary heart disease, further studies are needed to determine the extent to which this is causal.
确定在普通人群中，循环血管性血友病因子浓度是否与冠心病风险存在前瞻性关联。
我们检测了625例发生重大冠心病事件男性的储存血清样本中的血管性血友病因子基线值，并检测了1266例对照的该值，这些对照“嵌套”于一项对5661例年龄在40 - 59岁男性的前瞻性研究中，这些男性于1978 - 1980年从英国18个城镇的普通诊所招募，随访16年以观察致命性冠心病和非致命性心肌梗死情况。我们对先前的相关研究进行了荟萃分析，以将我们的结果置于相应背景中。在调整年龄和城镇因素后，血管性血友病因子基线值处于最高三分位数（三分位数临界值>126 IU.dl(-1)）的男性患冠心病的比值比为1.83（95%置信区间1.43 - 2.35；P<0.0001），而处于最低三分位数（三分位数临界值<90 IU.dl(-1)）的男性相比之下该比值比为1。在进一步调整危险因素后，比值比变化不大（1.82，95%置信区间1.37 - 2.41），并且在一项仅限于404例病例和1007例无冠心病基线证据的对照的分析中，该比值比无显著差异（比值比1.53，95%置信区间1.10 - 2.12）。对所有基于人群的相关前瞻性研究（包括本研究）进行的荟萃分析得出合并比值比为1.5（95%置信区间1.1 - 2.0）。血管性血友病因子值与幽门螺杆菌血清阳性及C反应蛋白的循环浓度密切相关（每项P<0.0001），但与吸烟、血脂或大多数其他测量的危险因素无关。
尽管循环血管性血友病因子浓度可能与冠心病发病有关，但需要进一步研究以确定其因果关系的程度。
