Fibrinolytic activation markers predict myocardial infarction in the elderly: The cardiovascular health study

Mary Cushman, Rozenn N. Lemaitre, Lewis H. Kuller, Bruce M. Psaty, Elizabeth M. Macy, A. Richey Sharrett, Russell P. Tracy

Research output: Contribution to journalArticlepeer-review

Abstract

Coagulation factor levels predict arterial thrombosis in epidemiological studies, but studies of older persons are needed. We studied 3 plasma antigenic markers of fibrinolysis, viz, plasminogen activator inhibitor-1 (PAI-1), fibrin fragment D-dimer, and plasmin-antiplasmin complex (PAP) for the prediction of arterial thrombosis in healthy elderly persons over age 65. The study was a nested case-control study in the Cardiovascular Health Study cohort of 5201 men and women ≥65 years of age who were enrolled from 1989 to 1990. Cases were 146 participants without baseline clinical vascular disease who developed myocardial infarction, angina, or coronary death during a follow-up of 2.4 years. Controls remained free of cardiovascular events and were matched 1:1 to cases with respect to sex, duration of follow-up, and baseline subclinical vascular disease status. With increasing quartile of D- dimer and PAP levels but not of PAI-1, there was an independent increased risk of myocardial infarction or coronary death, but not of angina. The relative risk for D-dimer above versus below the median value (≥120 μg/L) was 2.5 (95% confidence interval, 1.1 to 5.9) and for PAP above the median (≥5.25 nmol/L), 3.1 (1.3 to 7.7). Risks were independent of C-reactive protein and fibrinogen concentrations. There were no differences in risk by sex or presence of baseline subclinical disease. D-dimer and PAP, but not PAI-1, predicted future myocardial infarction in men and women over age 65. Relationships were independent of other risk factors, including inflammation markers. Results indicate a major role for these markers in identifying a high risk of arterial disease in this age group.

Original languageEnglish (US)
Pages (from-to)493-498
Number of pages6
JournalArteriosclerosis, thrombosis, and vascular biology
Volume19
Issue number3
DOIs
StatePublished - Mar 1999

Keywords

  • Blood coagulation
  • Elderly
  • Fibrinolysis
  • Myocardial infarction
  • Risk factors

ASJC Scopus subject areas

  • Cardiology and Cardiovascular Medicine

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