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History of hypertension and enhanced thrombogenic activity in postinfarction patients
Yazid Y Fadl1, Wojciech Zareba, Arthur J Moss
1Cardiology Unit, Department of Medicine, University of Rochester Medical Center, Box 653, Rochester, NY 14642, USA.
Insights
Hypertension in heart attack survivors increases blood clotting factors, particularly d-dimer. This enhanced thrombogenic activity elevates the risk of future cardiac events in both hypertensive and non-hypertensive patients post-myocardial infarction.
Area of Science:
- Cardiology
- Thrombosis Research
- Hypertension Studies
Background:
- Hypertension is a known risk factor for cardiac events, linked to endothelial dysfunction and increased thrombogenicity.
- Limited data exist on hypertension's association with thrombogenic activity and its prognostic significance in stable patients post-myocardial infarction (MI).
Purpose of the Study:
- To investigate thrombogenic, lipid, and inflammatory factors in hypertensive versus non-hypertensive patients after MI.
- To evaluate the prognostic significance of these factors for predicting cardiac events in both patient groups.
Main Methods:
- Measured thrombogenic factors (d-dimer, fibrinogen, PAI-1, vWF, Factor VII, Factor VIIa), lipids, and inflammatory markers (hsCRP, SAA) in 461 hypertensive and 582 non-hypertensive patients 2 months post-MI.
- Assessed cardiac events over a 2-year follow-up period.
- Utilized multivariate analysis to identify independent predictors of outcomes.
Main Results:
- Hypertensive patients exhibited higher levels of d-dimer, fibrinogen, PAI-1, and vWF compared to non-hypertensive patients.
- Elevated d-dimer was independently associated with a history of hypertension.
- d-Dimer levels significantly predicted recurrent cardiac events in both hypertensive and non-hypertensive patients post-MI.
Conclusions:
- Patients with hypertension following MI demonstrate enhanced thrombogenic activity.
- Increased d-dimer levels in post-MI patients, regardless of hypertensive status, are associated with a higher risk of recurrent cardiac events.
Abstract:
Hypertension is a risk factor for coronary thrombosis and death in cardiac patients mediated in part by endothelial damage or dysfunction and increased thrombogenicity. However, there are no data regarding the association between hypertension and thrombogenic activity in stable patients after myocardial infarction and limited data about the prognostic significance of thrombogenic factors in hypertensive patients after infarction. Therefore, levels of thrombogenic, lipid, and inflammatory factors were measured 2 months after an acute myocardial infarction in 461 hypertensive and 582 nonhypertensive patients. Thrombogenic factors included d-dimer, fibrinogen, plasminogen activator inhibitor-1, von Willebrand factor, factor VII, and factor VIIa. Lipid variables included cholesterol (total, HDL, LDL), triglyceride, lipoprotein (a), apolipoprotein-A1, and apolipoprotein-B. The prognostic significance of these factors for predicting cardiac events during a 2-year follow-up was evaluated in hypertensive and nonhypertensive patients. In comparison with nonhypertensive patients, those with hypertension had higher levels of d-dimer (607 versus 453 mg/L, P<0.001), fibrinogen (3.64 versus 3.43 g/L, P<0.001), plasminogen activator inhibitor-1 (29.7 versus 27.3 ng/mL, P=0.01), von Willebrand factor (159 versus 141 IU/dL; P<0.001), and higher levels of inflammatory markers (hsCRP and SAA). In multivariate analysis after adjustment for clinical covariates, elevated d-dimer was the only factor independently associated with a history of hypertension (OR, 1.38, P=0.05). d-Dimer was associated with an increased risk of recurrent cardiac events in both hypertensive (hazard ratio=3.02, P=0.005) and nonhypertensive (hazard ratio=2.42, P=0.02) patients. Thus, patients after infarction with a history of hypertension have enhanced thrombogenic activity, which predisposes them to recurrent cardiac events.