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Plasminogen activator inhibitor and the risk of cardiovascular disease: The Framingham Heart Study

G H Tofler1, J Massaro2, C J O'Donnell3

  • 1Royal North Shore Hospital, Sydney University, Australia.

Thrombosis Research
|February 21, 2016
PubMed

Insights

Plasminogen activator inhibitor (PAI-1) and tissue plasminogen activator (TPA) levels predict cardiovascular disease (CVD) risk in individuals without prior CVD. Serial increases in PAI-1 further elevate CVD risk, highlighting the role of fibrinolysis.

Area of Science:

  • Cardiovascular Medicine
  • Hematology
  • Biochemistry

Background:

  • Plasminogen activator inhibitor (PAI-1) is a key regulator of fibrinolysis.
  • Its independent predictive value for cardiovascular disease (CVD) in individuals without prior CVD remains unclear.

Purpose of the Study:

  • To investigate whether PAI-1 predicts CVD risk in individuals without a history of CVD.
  • To assess the predictive value of tissue plasminogen activator (TPA) antigen.
  • To determine the impact of serial changes in PAI-1 on CVD risk.

Main Methods:

  • Plasma PAI-1 and TPA antigen levels were measured in 3203 subjects without prior CVD.
  • Follow-up averaged 10 years, with PAI-1 remeasured after 4 years.
  • Statistical analyses included hazard ratios and C statistic assessment.

Main Results:

  • Elevated PAI-1 and TPA levels were significantly associated with incident CVD (p<0.001).
  • After adjusting for conventional risk factors, higher PAI-1 and TPA quartiles showed increased CVD risk (HRs up to 2.6 and 2.9, respectively).
  • Serial increases in PAI-1 were associated with a trend towards increased risk (p=0.050).

Conclusions:

  • PAI-1 and TPA antigen levels predict CVD events independently of established risk factors.
  • A serial increase in PAI-1 is linked to further elevated CVD risk.
  • These findings underscore the significance of fibrinolytic potential in CVD pathogenesis.
Abstract

Keywords:
Cardiovascular diseasesMyocardial infarctionPlasminogen activator inhibitor 1Tissue plasminogen activator

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