Wolfson Institute of Preventive Medicine, Barts and the London School of Medicine and Dentistry, Queen Mary University of London, London, UK.
J Thromb Haemost. 2012 Mar;10(3):352-8. doi: 10.1111/j.1538-7836.2012.04617.x.
In England and Wales, approximately 20% extra deaths from coronary heart disease (CHD) occur between December and March, among older people. Circulating concentrations of tissue plasminogen activator (t-PA), von Willebrand factor (VWF) and fibrin D-dimer are associated with arterial disease, and tend to peak in winter. The potential contributions of these hemostatic activation measures to excess winter mortality are unknown.
To estimate contributions of hemostatic factors to excess winter mortality.
Seasonal patterns in t-PA, VWF and D-dimer were investigated in 4088 men aged 60-79 years from 24 British towns. Data on established coronary risk factors were collected by questionnaire, physical examination and blood sampling. The adjusted mean increase in hemostatic markers during winter months, after adjustment for a range of coronary risk factors, was combined with associations of each marker with CHD mortality obtained from 9 years' follow-up of participants, to predict degree of excess CHD winter mortality. Associations of hemostatic markers with CHD incidence from large meta-analyses were also used.
All three markers showed peaks in winter; the adjusted mean increases during winter months were 0.21, 0.15 and 0.12 standard deviations for t-PA, VWF and log(D-dimer), respectively. Predicted excess hazard ratios for winter CHD mortality were 3.0%, 2.4% and 3.1%, respectively, in combination, representing an 8.6% excess. This increased to 14% when applying meta-analysis estimates.
Seasonal patterns in three hemostatic markers predict at least 8.6% excess CHD mortality in winter in Great Britain, potentially accounting for over half the excess observed in recent years.
在英格兰和威尔士，老年人中约有 20%的冠心病（CHD）额外死亡发生在 12 月至 3 月期间。组织型纤溶酶原激活物（t-PA）、血管性血友病因子（VWF）和纤维蛋白 D-二聚体的循环浓度与动脉疾病有关，并且往往在冬季达到峰值。这些止血激活措施对冬季超额死亡率的潜在贡献尚不清楚。
估计止血因素对冬季超额死亡率的贡献。
在 24 个英国城镇的 4088 名 60-79 岁男性中研究了 t-PA、VWF 和 D-二聚体的季节性模式。通过问卷调查、体格检查和采血收集了已确立的冠心病危险因素数据。在调整了一系列冠心病危险因素后，冬季月份止血标志物的平均调整增幅，与参与者 9 年随访获得的每个标志物与 CHD 死亡率的相关性相结合，以预测 CHD 冬季超额死亡率的程度。还使用大型荟萃分析中止血标志物与 CHD 发生率的相关性。
所有三种标志物均在冬季达到峰值；t-PA、VWF 和 log(D-二聚体)的冬季平均增幅分别为 0.21、0.15 和 0.12 个标准差。三种标志物联合预测冬季 CHD 死亡率的超额危险比分别为 3.0%、2.4%和 3.1%，代表 8.6%的超额。当应用荟萃分析估计值时，这一数字增加到 14%。
三种止血标志物的季节性模式预测英国冬季至少有 8.6%的 CHD 死亡率超额，这可能占近年来观察到的超额死亡的一半以上。
