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Haemostatic function and cardiovascular death: early results of a prospective study
Insights
Elevated levels of clotting factors, including factor VIIc, factor VIIIc, and fibrinogen, are linked to cardiovascular death. These haemostatic factors show a strong association with ischaemic heart disease (IHD) risk.
Area of Science:
- Cardiovascular Medicine
- Haematology
- Epidemiology
Background:
- Ischaemic heart disease (IHD) is a significant cause of mortality.
- The role of the haemostatic system in IHD pathogenesis requires further investigation.
Purpose of the Study:
- To investigate the association between haemostatic system components and cardiovascular death.
- To determine if specific clotting factors are predictive of IHD mortality.
Main Methods:
- Prospective cohort study (Northwick Park Heart Study) of 1510 men aged 40-64.
- Measurement of factor VIIc, factor VIIIc, and fibrinogen levels at recruitment.
- Analysis of mortality data, distinguishing cardiovascular deaths from other causes.
Main Results:
- Significantly higher mean levels of factor VIIc, factor VIIIc, and fibrinogen in men who died from cardiovascular disease compared to survivors.
- Independent associations of factor VIIc and fibrinogen with cardiovascular death were comparable to blood cholesterol.
- Clustering of high clotting factor levels (2-3 factors) was observed in 63% of cardiovascular disease deaths versus 23% of survivors.
- Clotting factor levels were not associated with cancer mortality, suggesting specificity for cardiovascular disease.
Conclusions:
- Elevated levels of factor VIIc, factor VIIIc, and fibrinogen are associated with an increased risk of cardiovascular death.
- These haemostatic factors may play a significant role in the pathogenesis of ischaemic heart disease.
- The findings support the epidemiological consistency of these factors in IHD development.
Abstract:
Components of the haemostatic system which may be involved in the pathogenesis of ischaemic heart disease (IHD) were measured in the Northwick Park Heart Study. Of 1510 white men aged 40-64 at recruitment, 49 have since died. 27 died from cardiovascular disease (IHD in all but 3), 18 from cancer, and 4 from other causes. The mean recruitment levels of factor VIIc, factor VIIIc, and fibrinogen were significantly higher in those who died of cardiovascular disease than in those who survived. The independent associations of factor VIIc and fibrinogen with cardiovascular death were at least as strong as the association of blood cholesterol with cardiovascular death. A clustering of two or three high clotting-factor values (factor VIIc, factor VIIIc, and fibrinogen) was present at recruitment in 63% of those who died of cardiovascular disease, compared with 23% of those who survived. The clotting-factor results appeared to be specific for cardiovascular disease: there was no evidence that high levels of factor VIIc, factor VIIIc, and fibrinogen were associated with death from cancer. The general epidemiology of factor VIIc, factor VIIIc, and fibrinogen is consistent with their having a role in the pathogenesis of IHD.