Wu K K, Folsom A R, Heiss G, Davis C E, Conlan M G, Barnes R
University of Texas Medical School, Houston 77030.
Ann Epidemiol. 1992 Jul;2(4):471-80. doi: 10.1016/1047-2797(92)90097-a.
Several population studies have shown that plasma levels of fibrinogen and factor VII are significantly associated with ischemic cardiovascular events. However, there is little information regarding the association of hemostatic factors with early atherosclerosis. To evaluate this, we compared the plasma concentrations of several coagulation proteins (fibrinogen, factor VII, factor VIII, von Willebrand factor, protein C, and antithrombin III) between 385 case patients, defined by high-resolution B-mode ultrasonography as having carotid arterial wall thickening, and 385 age-, race-, and sex-matched control subjects. These case patients and control subjects were selected from participants in a prospective population investigation, the Atherosclerosis Risk in Communities (ARIC) Study, who were examined between May 1987 and May 1989. Plasma fibrinogen, factor VII, protein C, and antithrombin III levels were significantly higher in case patients than in control subjects (P < 0.05). Factor VIII and von Willebrand factor were not different. These findings were supported by quartile distribution and univariate analysis. However, only fibrinogen remained significantly associated with carotid atherosclerosis on multivariate analysis taking other atherosclerosis risk factors into consideration. A one standard deviation increase in fibrinogen (67 mg/dL) was associated with a 1.6-fold increase in the odds of carotid atherosclerosis univariately (P < 0.001) and with a 1.3-fold increase in the odds multivariately (P = 0.010). Further analysis revealed that the association of fibrinogen with carotid atherosclerosis was somewhat stronger in cigarette smokers than in nonsmokers. This early case-control analysis of the ARIC Study demonstrates a significant association between plasma fibrinogen concentration and early atherosclerosis in the carotid arteries. In the context of published findings from population studies, our results indicate that plasma fibrinogen concentrations may be a useful marker for identifying individuals at high risk of developing arterial thrombotic disorders.
多项人群研究表明，血浆纤维蛋白原和凝血因子VII水平与缺血性心血管事件显著相关。然而，关于止血因子与早期动脉粥样硬化之间关联的信息却很少。为了评估这一点，我们比较了385例经高分辨率B型超声检查确定为颈动脉壁增厚的病例患者与385例年龄、种族和性别相匹配的对照受试者之间几种凝血蛋白（纤维蛋白原、凝血因子VII、凝血因子VIII、血管性血友病因子、蛋白C和抗凝血酶III）的血浆浓度。这些病例患者和对照受试者选自一项前瞻性人群调查——社区动脉粥样硬化风险（ARIC）研究的参与者，他们在1987年5月至1989年5月期间接受了检查。病例患者的血浆纤维蛋白原、凝血因子VII、蛋白C和抗凝血酶III水平显著高于对照受试者（P < 0.05）。凝血因子VIII和血管性血友病因子无差异。这些发现得到了四分位数分布和单变量分析的支持。然而，在考虑其他动脉粥样硬化风险因素的多变量分析中，只有纤维蛋白原仍与颈动脉粥样硬化显著相关。纤维蛋白原增加一个标准差（67 mg/dL），单变量分析时颈动脉粥样硬化的几率增加1.6倍（P < 0.001），多变量分析时增加1.3倍（P = 0.010）。进一步分析表明，吸烟者中纤维蛋白原与颈动脉粥样硬化的关联比不吸烟者略强。ARIC研究的这项早期病例对照分析表明，血浆纤维蛋白原浓度与颈动脉早期动脉粥样硬化之间存在显著关联。结合人群研究已发表的结果来看，我们的结果表明，血浆纤维蛋白原浓度可能是识别发生动脉血栓性疾病高危个体的有用标志物。
