Folsom Aaron R, Delaney Joseph A C, Lutsey Pamela L, Zakai Neil A, Jenny Nancy S, Polak Joseph F, Cushman Mary
Division of Epidemiology and Community Health, School of Public Health, University of Minnesota, Minneapolis, Minnesota, USA.
Am J Hematol. 2009 Jun;84(6):349-53. doi: 10.1002/ajh.21429.
To examine the associations of three understudied hemostatic factors--D-dimer, factor VIII(c), and plasmin-antiplasmin (PAP) complex--with incident cardiovascular disease (CVD) and all cause mortality in the Multiethnic Study of Atherosclerosis cohort. Hemostatic factors were measured at baseline in 45-84-year-old patients (n = 6,391) who were free of clinically recognized CVD. Over 4.6 years of follow-up, we identified 307 CVD events, 207 hard coronary heart disease events, and 210 deaths. D-dimer, factor VIII(c), and PAP were not associated with CVD incidence after adjustment for other risk factors. In contrast, each factor was associated positively with total mortality, and D-dimer and factor VIII(c) were associated positively with cancer mortality. When modeled as ordinal variables and adjusted for risk factors, total mortality was greater by 33% (95% CI 15-54) for each quartile increment of D-dimer, 26% (11-44) for factor VIIIc, and 20% (4-38) for PAP. This prospective cohort study did not find D-dimer, factor VIII(c), or PAP to be risk factors for CVD. Instead, elevated levels of these three hemostatic factors were associated independently with increased risk of death. Elevated D-dimer and factor VIII(c) were associated with increased cancer death.
在动脉粥样硬化多族裔研究队列中，研究三种较少被研究的止血因子——D-二聚体、凝血因子VIII(c)和纤溶酶-抗纤溶酶（PAP）复合物——与心血管疾病（CVD）发病及全因死亡率之间的关联。对45至84岁无临床确诊CVD的患者（n = 6391）在基线时测量止血因子。在4.6年的随访中，我们确定了307例CVD事件、207例严重冠心病事件和210例死亡病例。在调整其他风险因素后，D-二聚体、凝血因子VIII(c)和PAP与CVD发病率无关。相比之下，每个因子都与总死亡率呈正相关，D-二聚体和凝血因子VIII(c)与癌症死亡率呈正相关。当作为有序变量建模并调整风险因素后，D-二聚体每增加一个四分位数，总死亡率增加33%（95%CI 15 - 54），凝血因子VIII(c)增加26%（11 - 44），PAP增加20%（4 - 38）。这项前瞻性队列研究未发现D-二聚体、凝血因子VIII(c)或PAP是CVD的风险因素。相反，这三种止血因子水平升高与死亡风险增加独立相关。D-二聚体和凝血因子VIII(c)升高与癌症死亡增加相关。
