(Circulation. 2001;103:2323.)
© 2001 American Heart Association, Inc.
Brief Rapid Communications |
Fibrin D-Dimer and Coronary Heart Disease
Prospective Study and Meta-Analysis
From the Clinical Trial Service Unit and Epidemiological Studies Unit, Nuffield Department of Medicine, University of Oxford, Oxford (J.D.); Department of Public Health Sciences, St George’s Hospital Medical School, London (P.W.); Department of Primary Care and Population Sciences, Royal Free and University College of London Medical School (M.W., L.L., A.T.); ICRF Cancer Epidemiology Unit, Radcliffe Infirmary, Oxford (P.A.); and the University Department of Medicine, Glasgow Royal Infirmary, Glasgow (A.R., G.D.O.L.), UK.
Correspondence to Dr Danesh, Clinical Trial Service Unit, University of Oxford, Radcliffe Infirmary, Harkness Building, Oxford OX2 6HE, England.
Background—It is unknown whether modest increases of fibrin D-dimer, a circulating marker of fibrin turnover, are relevant to coronary heart disease (CHD) in the general population.
Methods and Results—We measured serum concentrations of D-dimer antigen in the stored baseline blood samples of 630 CHD cases and 1269 controls "nested" in a prospective cohort of 5661 men who were monitored for 16 years, and we conducted a meta-analysis of previous relevant studies to place our findings in context. In a comparison of men in the top third compared with those in the bottom third of baseline fibrin D-dimer values (tertile cutoffs, >94 versus <49 ng/mL), the odds ratio for CHD was 1.67 (95% CI, 1.31 to 2.13; P<0.0001) after adjustments for age and town. The odds ratio increased slightly after further adjustment for smoking, other classic risk factors, and indicators of socioeconomic status (1.79; 95% CI, 1.36 to 2.36). Strong correlations were observed of fibrin D-dimer values with circulating concentrations of C-reactive protein and serum amyloid A protein but not with smoking, blood lipids, blood pressure, and other risk factors.
Conclusion—Although there may be an association between circulating D-dimer values and CHD, further studies are needed to determine the extent to which this is causal.
Key Words: heart diseases • epidemiology • coagulation • fibrinolysis
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