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Platelet aggregation and incident ischaemic heart disease in the Caerphilly cohort
P C Elwood1, S Renaud, A D Beswick
1MRC Epidemiology Unit, Llandough Hospital, Penarth, South Glamorgan, UK.
Insights
Measures of platelet aggregation to thrombin and ADP did not predict ischemic heart disease (IHD) events in middle-aged men. While a trend suggested prediction of early IHD, it was not statistically significant.
Area of Science:
- Cardiovascular Medicine
- Hematology
- Epidemiology
Background:
- Platelets play a role in myocardial infarction.
- Evidence linking platelet function tests to infarction prediction is limited.
Purpose of the Study:
- To investigate the predictive value of platelet aggregation measures for incident ischemic heart disease (IHD).
Main Methods:
- Platelet aggregation to thrombin and adenosine diphosphate (ADP) was measured in platelet-rich plasma from 2176 men (aged 49-65) in the Caerphilly cohort study.
- Exclusion criteria included inadequate fasting and recent antiplatelet medication use.
- Ischemic heart disease events were tracked over five years.
Main Results:
- No platelet aggregation measure significantly predicted incident IHD.
- A non-significant trend suggested potential prediction of early IHD events (within 500 days) based on adenosine diphosphate (ADP) response.
- The predictive value did not appear to increase for events occurring 1000 or more days after testing.
Conclusions:
- Platelet aggregation to thrombin and ADP in platelet-rich plasma was not found to be predictive of IHD in this cohort.
- Further research may be needed to explore the temporal relationship between platelet function and cardiovascular events.
Background:
Platelets are involved in myocardial infarction but evidence of prediction of infarction by measures of platelet function are sparce.
Methods:
Platelet aggregation to thrombin and to ADP in platelet rich plasma was recorded for 2176 men aged 49-65 years in the Caerphilly cohort study.
Results:
Results from 364 men were excluded, 80 of whom had not fasted before venepuncture; most of the others were excluded because antiplatelet medication had been taken shortly before the platelet tests. During the five years following the platelet tests 113 ischaemic heart disease (IHD) events which fulfilled the World Health Organisation criteria were identified--42 fatal and 71 non-fatal. No measure of platelet aggregation was found to be significantly predictive of incident IHD. The possibility that platelet function is predictive for only a limited time after it is characterised, and that prediction falls off with time, was tested. When IHD events are grouped by their time of occurrence after aggregation had been measured, the test results show a gradient suggestive of prediction of early IHD events. Thus, 24% of the men who had an event within 500 days of the test had had a high secondary response to ADP while only 12% of those whose IHD event had been 1000 or more days after the test had shown a high platelet response at baseline. The trend in these proportions is not significant.
Conclusions:
Platelet aggregation to thrombin and ADP in platelet rich plasma was recorded in the Caerphilly cohort study. No measure of aggregation was found to be predictive of IHD.