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Published on: August 14, 2017
Von Willebrand factor and ADAMTS13 plasma in older patients with high CHA2DS2-VASc Score with and without atrial
1Heart Center, Beijing Chao-Yang Hospital, Affiliated to Capital Medical University, Beijing, China. zf1979@139.com.
Insights
Atrial fibrillation (AF) has a limited effect on von Willebrand factor (vWF) in elderly patients, with age being a more significant factor in endothelial function and stroke risk. Further research is needed to improve stroke risk scoring systems.
Area of Science:
- Cardiology
- Vascular Biology
- Geriatrics
Background:
- Ischemic stroke risk increases with cardiovascular risk factors, but the incremental contribution of atrial fibrillation (AF) alongside age and other factors remains unclear.
- Von Willebrand factor (vWF) is a key biomarker for endothelial dysfunction, relevant to thrombotic events.
Purpose of the Study:
- To investigate the relationship between atrial fibrillation (AF), age, cardiovascular risk factors, and biomarkers of endothelial dysfunction (vWF and ADAMTS13) in older patients.
- To determine if vWF and ADAMTS13 levels differ between older patients with and without AF, particularly in relation to the CHA2DS2-VASc score and age.
Main Methods:
- A cohort of 196 elderly patients (≥60 years) with and without non-valvular AF were recruited.
- Plasma levels of vWF and ADAMTS13 were measured.
- Statistical analyses, including Spearman correlations, were performed to assess relationships between biomarkers, AF status, CHA2DS2-VASc score, and age.
Main Results:
- Significant correlations were found between plasma vWF and ADAMTS13 levels and the CHA2DS2-VASc score in both AF and non-AF groups.
- In patients aged 60-74, vWF and ADAMTS13 levels differed significantly between those with and without AF.
- However, in patients aged ≥75, no significant differences in vWF or ADAMTS13 levels were observed between AF and non-AF groups, suggesting age is a more dominant factor.
Conclusions:
- Atrial fibrillation (AF) appears to have a limited impact on vWF levels in the very elderly (≥75 years), with age being a more critical determinant of endothelial function.
- The CHA2DS2-VASc score is a predictor of stroke risk, especially in older patients without AF.
- Findings suggest a need to consider AF as a risk factor and potentially refine stroke risk scoring systems in elderly populations.
Objective:
Ischemic stroke risk rises with the increasing cardiovascular risk factors in patients with and without AF. How atrial fibrillation (AF) incrementally contributes to the risk for ischemic stroke with increasing age and multiple cardiovascular risk factors is unclear. Von Willebrand factor (vWF) is a biomarker of endothelial dysfunction.
Patients And Methods:
We suggested that in older patients with high CHA2DS2-VASc Score, the vWF and ADAMTS13 would be comparable between patients with and without AF. Consecutive 196 old patients (≥ 60 years, 45.9% with concomitant AF) with and without non-valve atrial fibrillation were recruited from April 2014 to April 2016. Data on baseline clinical characteristics were recorded at study entry. Plasma ADAMTS13 levels and plasma vWF levels were determined. Statistical analyses were performed using SPSS19.0 statistical software package.
Results:
There were significant correlations between plasma vWf levels, ADMATS13 and CHA2DS2- VASc Score in older patients with and without AF (with AF: Spearman, r = 0.215, p < 0.05; without AF: Spearman, r = 0.197, p < 0.05). Results of research indices in our older patients were as follows: vWf 180. 79 ± 28.27 IU/dL in AF and 153.5 ± 35.54 in non AF with p < 0.001, ADAMTS13 431.5 ± 160.33 IU/dL in AF and 536.7 ± 169.96 in non AF with p < 0.05. Results of research indices in our older patients (≥ 75 year) were as follows: vWf 181.4 ± 22.04 in AF and 174.1 ± 29.45 in non AF, and ADMATS-13 412.9 ± 130.76 IU/dL in AF and 451.7 ± 153.18 in non AF. There were no differences (p > 0.05). CHA2DS2-VASc Score can predict stroke risk in old patients without atrial fibrillation. At high CHA2DS2-VASc Score, the levels of vWF and ADAMTS13 have difference in old patients (60-74) with and without AF, but in such older patients, age (≥ 75 year), there were no differences. In elderly patients, atrial fibrillation has a limited effect on VWF, and the age is an important factor affecting the endothelial function.
Conclusions:
For elderly patients with a high incidence rate of stroke and thrombosis, we should pay more attention to the thrombotic events, and atrial fibrillation can be used as one of the risk factors involved and improving the risk scoring system of stroke.
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