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Relation of coagulation factor XI with incident coronary heart disease and stroke: the Cardiovascular Health Study
Duke Appiah1, Oluwaseun E Fashanu, Susa R Heckbert
1aDivision of Epidemiology & Community Health, University of Minnesota, Minneapolis, Minnesota bDepartment of Epidemiology, School of Public Health, University of Washington, Seattle, Washington cDepartment of Medicine, University of Vermont, Burlington, Vermont dDepartments of Medicine, Epidemiology and Health Services, University of Washington; Group Health Research Institute, Group Health Cooperatives, Seattle, Washington, USA.
Insights
Coagulation factor XI (FXI) levels were not significantly associated with increased risk of coronary heart disease (CHD) or stroke in elderly adults. This study investigated FXI
Area of Science:
- Cardiovascular Science
- Hematology
- Epidemiology
Background:
- The role of coagulation factor XI (FXI) in arterial thrombosis is not fully understood.
- FXI is a key protein in the intrinsic pathway of blood coagulation.
Purpose of the Study:
- To investigate the association between plasma levels of coagulation factor XI (FXI) and the risk of incident coronary heart disease (CHD), ischemic stroke, and hemorrhagic stroke.
- To determine if FXI is an independent risk factor for cardiovascular events.
Main Methods:
- Prospective cohort study using data from 3394 elderly adults in the Cardiovascular Health Study.
- Plasma FXI antigen levels were measured, and participants were followed for cardiovascular events over a median of 13 years.
- Multivariable Cox proportional hazards models were used to assess the association between FXI levels and event incidence, adjusting for traditional cardiovascular risk factors.
Main Results:
- Higher FXI levels were observed in Black individuals and women, and were positively associated with HDL, total cholesterol, BMI, and diabetes.
- During follow-up, 1232 incident CHD, 473 ischemic stroke, and 84 hemorrhagic stroke events occurred.
- No statistically significant association was found between higher FXI levels and increased risk of CHD (HR 1.02, 95% CI 0.96-1.08), ischemic stroke (HR 0.94, 95% CI 0.85-1.04), or hemorrhagic stroke (HR 0.85, 95% CI 0.65-1.10) per one SD increment of FXI.
Conclusions:
- In this cohort of elderly adults, higher plasma levels of coagulation factor XI were not associated with an increased risk of incident coronary heart disease or stroke.
- These findings suggest that FXI may not be a significant predictor of arterial thrombotic events in older populations.
- Further research may be needed to clarify the role of FXI in specific thrombotic contexts or in different demographic groups.
Abstract:
: The role of coagulation factor XI (FXI) in the cause of arterial thrombotic events remains uncertain. We examined the association of FXI with incident coronary heart disease (CHD), ischemic stroke, and hemorrhagic stroke. Data were from 3394 adults (mean age: 74.5 years) enrolled in the Cardiovascular Health Study who had FXI antigen from plasma samples drawn in 1992-1993 and were followed for cardiovascular events until 30 June 2013. Approximately 63% of participants were women and 17% were black. FXI levels were higher in blacks and women, showed positive associations with high-density lipoprotein and total cholesterol, BMI and diabetes, and negative associations with age and alcohol intake. During median follow-up of 13 years, we identified 1232 incident CHD, 473 ischemic stroke, and 84 hemorrhagic stroke events. In multivariable Cox models adjusted for traditional cardiovascular disease risk factors, the hazard ratio per one SD (32.2 mg/dl) increment of FXI was 1.02 (95% confidence interval: 0.96-1.08) for CHD; 0.94 (0.85-1.04) for ischemic stroke, and 0.85 (0.65-1.10) for hemorrhagic stroke. In this prospective cohort of elderly adults, there was no statistically significant association of higher FXI levels with incident CHD and stroke.
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