Ossei-Gerning N, Wilson I J, Grant P J
Unit of Molecular Vascular Medicine, Leeds General Infirmary, UK.
Thromb Haemost. 1998 Apr;79(4):736-40.
Women with coronary artery disease (CAD) have a prognosis at least as bad and possibly worse than men. Differences in classical risk factors do not fully account for these findings and there is evidence that circulating levels of haemostatic factors may predict CAD risk. In this study sex differences in haemostatic risk factors were examined in relation to coronary stenosis. 609 (420 men, 69%) subjects admitted for coronary angiography for suspected CAD were recruited. Levels of Factor VII:C (FVII:C), fibrinogen, plasminogen activator inhibitor-1 (PAI-1) and von Willebrand factor (vWF) were estimated in 296 subjects from one centre. Of these, women (n = 107) had higher levels of FVII:C (134% vs 117%, p < 0.0005), and fibrinogen (3.4 g/l vs 3.2 g/l p = 0.01) than men (n = 189) and these differences remained after adjusting for other covariates. In subjects with angiographically significant atheroma these differences in haemostatic factors (n = 50 for women vs n = 147 for men) were exaggerated, (FVII:C 139% vs 117, p < 0.0001, fibrinogen 3.7 g/l vs 3.3 g/l p = 0.003), PAI-1 (26.2 ng/ml vs 19.7 ng/ml, p = 0.02) with a trend towards higher levels of vWF in the women. Women with significant atheroma at angiography (n = 50) had higher levels of PAI-1 (25.0 ng/ml vs 13.4 ng/ml p < 0.0001) and vWF (1.25 IU/ml vs 1.06 IU/ml, p = 0.02) and a trend towards higher levels of both fibrinogen and FVII:C than women with normal or in significant coronary vessel disease (n = 57). Elevated circulating levels of PAI-1, vWF, fibrinogen and FVII:C in women with angiographically proven CAD may contribute to an adverse cardiovascular risk factor profile and the poorer prognosis in females than male patients with proven coronary artery disease.
患有冠状动脉疾病（CAD）的女性预后至少与男性一样差，甚至可能更差。经典风险因素的差异并不能完全解释这些发现，并且有证据表明止血因子的循环水平可能预测CAD风险。在本研究中，研究了止血风险因素的性别差异与冠状动脉狭窄的关系。招募了609名因疑似CAD而接受冠状动脉造影的受试者（420名男性，占69%）。对来自一个中心的296名受试者的凝血因子VII：C（FVII：C）、纤维蛋白原、纤溶酶原激活物抑制剂-1（PAI-1）和血管性血友病因子（vWF）水平进行了评估。其中，女性（n = 107）的FVII：C水平（134%对117%，p < 0.0005）和纤维蛋白原水平（3.4 g/l对3.2 g/l，p = 0.01）高于男性（n = 189），在调整其他协变量后，这些差异仍然存在。在血管造影显示有明显动脉粥样硬化的受试者中，这些止血因子的差异（女性n = 50，男性n = 147）被放大（FVII：C 139%对117，p < 0.0001，纤维蛋白原3.7 g/l对3.3 g/l，p = 0.003），PAI-1（26.2 ng/ml对19.7 ng/ml，p = 0.02），女性的vWF水平有升高趋势。血管造影显示有明显动脉粥样硬化的女性（n = 50）的PAI-1水平（25.0 ng/ml对13.4 ng/ml，p < 0.0001）和vWF水平（1.25 IU/ml对1.06 IU/ml，p = 0.02）更高，并且纤维蛋白原和FVII：C水平均有高于冠状动脉血管正常或无明显病变的女性（n = 57）的趋势。血管造影证实患有CAD的女性中，PAI-1、vWF、纤维蛋白原和FVII：C的循环水平升高可能导致不良的心血管风险因素谱，并且女性的预后比经证实患有冠状动脉疾病的男性患者更差。
