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Fibrinolytic activation markers predict myocardial infarction in the elderly. The Cardiovascular Health Study

M Cushman1, R N Lemaitre, L H Kuller

  • 1Department of Medicine and Pathology, University of Vermont, Colchester, VT, USA.

Arteriosclerosis, Thrombosis, and Vascular Biology
|March 12, 1999
PubMed

Insights

Plasma markers D-dimer and plasmin-antiplasmin complex (PAP) predict arterial thrombosis in healthy elderly individuals over 65. These fibrinolysis markers identify high risk for myocardial infarction and coronary death, independent of other factors.

Area of Science:

  • Gerontology
  • Cardiovascular Medicine
  • Hematology

Background:

  • Coagulation factors are known predictors of arterial thrombosis in general populations.
  • Limited research exists on these markers' predictive value for arterial thrombosis specifically in elderly individuals.
  • Fibrinolysis markers, including PAI-1, D-dimer, and PAP, are implicated in thrombotic processes.

Purpose of the Study:

  • To investigate the predictive value of plasma fibrinolysis markers for arterial thrombosis in healthy elderly individuals (age >/=65).
  • To assess whether D-dimer, PAI-1, and PAP levels predict myocardial infarction, angina, or coronary death in this demographic.
  • To determine if these associations are independent of other risk factors like inflammation markers.

Main Methods:

  • A nested case-control study design was employed within the Cardiovascular Health Study cohort.
  • Participants included 5201 men and women aged 65 and older, enrolled between 1989-1990.
  • Cases (n=146) developed arterial thrombotic events, while controls were matched for sex, follow-up duration, and baseline subclinical disease.

Main Results:

  • Elevated levels of D-dimer and PAP, but not PAI-1, were independently associated with an increased risk of myocardial infarction or coronary death.
  • The relative risk for D-dimer above the median was 2.5, and for PAP above the median was 3.1.
  • These associations remained significant and independent of C-reactive protein and fibrinogen levels, and showed no sex differences.

Conclusions:

  • Plasma D-dimer and PAP levels are significant predictors of future myocardial infarction and coronary death in elderly men and women.
  • PAI-1 did not demonstrate predictive value for arterial thrombosis in this age group.
  • These fibrinolysis markers play a crucial role in identifying elderly individuals at high risk for arterial disease.

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