Dietary factors in thrombosis and hemostasis: summary and conclusions

Patients who develop thrombotic vascular occlusions usually have underlying vascular disease. However, the interplay among lipids, atherogenesis, and thrombosis has proven difficult to define in humans. The evidence for a contribution from individual dietary lipids to thrombogenesis was reviewed in the preceding section of this supplement. Although feeding long-chain fatty acids in animal models may increase the propensity to thrombosis in animal models, the implications of this observation for human diets are obscure. This may reflect the multiple pro- and anticoagulant species that may be regulated by dietary constituents. The role of lipids in the regulation of gene expression is emerging; however, it is unknown what relevance such observations may have for dietary lipids. The study of thrombosis in vivo and, particularly, investigations of the propensity to thrombosis is confounded in many cases by ex vivo platelet activation. Evidence for a prothrombotic state is still controversial. Even the association of elevated fibrinogen with the incidence of coronary disease may not reflect a causative mechanism. Limited information is available as to health benefits of individual lipids, although drugs that lower cholesterol unequivocally reduce the incidence of cardiovascular death, even in patients with moderate hypercholesterolemia.