Department of Hematology, Erasmus University Medical Center, Room Na823, PO Box 2040, 3000CA Rotterdam, The Netherlands.
Department of Cardiology, Erasmus University Medical Center, Rotterdam, The Netherlands.
Atherosclerosis. 2018 Feb;269:144-150. doi: 10.1016/j.atherosclerosis.2018.01.014. Epub 2018 Jan 16.
It is as yet unknown whether antithrombin levels are associated with arterial thromboembolism (ATE) at a young age. To investigate the association between antithrombin levels and premature and recurrent ATE, we performed a case-control study and a subsequent nested cohort study of premature coronary heart disease (CHD) patients.
In the case-control study, we included 571 patients who had a recent premature ATE, including CHD and ischemic stroke (IS), and 461 healthy controls. The association between antithrombin levels (dichotomized: ≤median vs. >median) and ATE was investigated. Subsequently we studied the association between antithrombin levels and recurrent cardiac events, ATE or death in a nested cohort of 323 CHD patients.
Low antithrombin levels (≤median, 1.04 IU/mL) are associated with an increased risk of ATE (OR 1.46; 95% CI:1.09-1.96), after adjustment for classical cardiovascular risk factors. This was observed in the subgroups of CHD patients (1.43; 1.01-2.02) and IS patients (1.48; 1.01-2.19). CHD patients with low antithrombin levels had a higher risk of recurrent cardiac events (HR 2.16, 95% CI:1.07-4.38). Especially in women with low antithrombin levels, the risk of recurrent cardiac events was high (HR 5.97, 95% CI 1.31-27.13) as was the risk of recurrent ATE or death (HR 4.22, 95% CI 1.19-15.00).
Individuals with relatively low antithrombin levels have an increased risk for ATE at a younger age. CHD patients with low antithrombin levels, especially women, have a higher risk of recurrent cardiac events.
目前尚不清楚抗凝血酶水平与年轻时的动脉血栓栓塞（ATE）是否有关。为了研究抗凝血酶水平与早发性和复发性 ATE 的关系，我们进行了一项病例对照研究和一项早发性冠心病（CHD）患者的嵌套队列研究。
在病例对照研究中，我们纳入了 571 例近期发生早发性 ATE 的患者，包括 CHD 和缺血性卒中（IS），以及 461 例健康对照者。研究了抗凝血酶水平（二分法：≤中位数与>中位数）与 ATE 的关系。随后，我们在 323 例 CHD 患者的嵌套队列中研究了抗凝血酶水平与复发性心脏事件、ATE 或死亡的关系。
低抗凝血酶水平（≤中位数，1.04 IU/mL）与 ATE 风险增加相关（OR 1.46；95%CI：1.09-1.96），校正了经典心血管危险因素后仍然如此。这在 CHD 患者（1.43；1.01-2.02）和 IS 患者（1.48；1.01-2.19）亚组中观察到。低抗凝血酶水平的 CHD 患者发生复发性心脏事件的风险较高（HR 2.16，95%CI：1.07-4.38）。特别是在低抗凝血酶水平的女性中，复发性心脏事件的风险较高（HR 5.97，95%CI 1.31-27.13），复发性 ATE 或死亡的风险也较高（HR 4.22，95%CI 1.19-15.00）。
抗凝血酶水平相对较低的个体年轻时发生 ATE 的风险增加。低抗凝血酶水平的 CHD 患者，尤其是女性，发生复发性心脏事件的风险较高。
