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von Willebrand factor and soluble E-selectin in the prediction of cardiovascular disease progression in
A D Blann1, J P Miller, C N McCollum
1University Department of Medicine, City Hospital, Birmingham, UK.
Insights
Increased von Willebrand factor levels predict future cardiovascular events in patients with atherosclerosis risk factors. This endothelial cell product indicates a poor prognosis, even in non-cardiovascular disease development.
Area of Science:
- Cardiovascular Medicine
- Hematology
- Biomarkers
Background:
- Endothelial cell dysfunction is implicated in atherosclerosis.
- Von Willebrand factor (vWF) and soluble E-selectin are markers of endothelial activation.
Purpose of the Study:
- To investigate the predictive value of vWF and soluble E-selectin for cardiovascular events in a lipid clinic cohort.
- To assess the association of these markers with existing vascular disease and smoking status.
Main Methods:
- Prospective follow-up study of 162 patients.
- Measurement of vWF, soluble E-selectin, serum lipids, lipoprotein(a), blood pressure.
- Classification by symptomatic vascular disease and smoking status.
Main Results:
- In univariate analysis, existing vascular disease, elevated vWF, high LDL cholesterol, older age, and low soluble E-selectin predicted events.
- Multivariate analysis revealed only elevated vWF as a significant predictor of future vascular events (P < 0.001).
- Higher vWF levels were observed in patients developing non-cardiovascular disease (P < 0.05).
Conclusions:
- Elevated von Willebrand factor is a strong independent predictor of poor prognosis in patients with atherosclerosis or its risk factors.
- vWF may serve as a crucial biomarker for both cardiovascular and non-cardiovascular disease progression.
Abstract:
Two specific endothelial cell products, von Willebrand factor and soluble E-selectin, were measured together with serum lipids, lipoprotein(a), systolic and diastolic blood pressure (SHP, DBP) in a follow up study of 162 patients attending a dedicated lipid clinic. Patients were further classified by the presence or absence of symptomatic vascular disease and smoking. After a mean of 49 months, 45 patients experienced a cardiovascular event (fatal or nonfatal myocardial infarction, stroke, or arterial surgery) and 11 developed non-cardiovascular diseases, including cancer. In univariate analysis, existing vascular disease (P < 0.01), increased levels of von Willebrand factor (P < 0.0001) and low density lipoprotein cholesterol (P < 0.02), greater age (P < 0.01), and lower levels of soluble E-selectin (P < 0.03) were all predictive of future vascular events. However, in multivariate analysis, only increased von Willebrand factor was predictive (P < 0.001). von Willebrand factor was also higher in patients who developed non-cardiovascular disease relative to those free of disease (P < 0.05). Our data support the hypothesis that increased levels of von Willebrand factor are an indicator of poor prognosis in patients with atherosclerosis or its risk factors.