(Circulation. 1997;96:1102-1108.)
© 1997 American Heart Association, Inc.
Articles |
Prospective Study of Hemostatic Factors and Incidence of Coronary Heart Disease
The Atherosclerosis Risk in Communities (ARIC) Study
From the Division of Epidemiology, School of Public Health, University of Minnesota, Minneapolis (A.R.F.); Division of Hematology, University of Texas Medical School, Houston (K.K.W.); Collaborative Studies Coordinating Center, Chapel Hill, NC (W.D.R., L.E.C.); and NHLBI, NIH, Bethesda, Md (A.R.S.).
Correspondence to Dr Aaron R. Folsom, Division of Epidemiology, School of Public Health, University of Minnesota, Suite 300, 1300 S 2nd St, Minneapolis, MN 55454-1015. E-mail folsom{at}epivax.epi.umn.edu
Background Although hemostatic factors contribute to acute coronary syndromes and atherogenesis, few studies have prospectively evaluated the association between multiple hemostatic factors and coronary heart disease incidence.
Methods and Results The Atherosclerosis
Risk in Communities Study recruited 14 477 adults from 45 to 64 years
of age who were initially free of coronary heart disease.
Coronary disease risk factors and several plasma hemostatic
factors were measured, and incidence of coronary heart disease
was ascertained during an average follow-up of 5.2 years. Age-, race-,
and field center–adjusted relative risks of coronary heart
disease were significantly elevated (P
.05) per higher
value of fibrinogen (relative risk: men, 1.76; women, 1.54), white
blood cell count (men, 1.68; women, 2.23), factor VIII coagulant
activity (women, 1.25), and von Willebrand factor antigen (men,
1.20; women, 1.18). Adjustment for other risk factors attenuated these
associations for fibrinogen (adjusted relative risk: men, 1.48; women,
1.21), and it eliminated the white blood cell count, factor VIII, and
von Willebrand factor associations, consistent with the
other risk factors either confounding or partly operating through their
effects on the hemostatic variables. Adjusted standardized relative
risks of total mortality, ranging from 1.13 to 1.37, were also elevated
(P<.05) in relation to these four factors. There was no
association of coronary disease incidence with factor VII,
protein C, antithrombin III, or platelet count.
Conclusions Elevated levels of fibrinogen, white blood cell count, factor VIII, and von Willebrand factor are risk factors and may play causative roles in coronary heart disease. However, their measurement in healthy adults appears to add little to prediction of coronary events beyond that of more established risk factors.
Key Words: coagulation • coronary disease • von Willebrand factor • fibrinogen • leukocytes
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