Tw. Meade et al., FIBRINOLYTIC-ACTIVITY, CLOTTING FACTORS, AND LONG-TERM INCIDENCE OF ISCHEMIC-HEART-DISEASE IN THE NORTHWICK-PARK-HEART-STUDY, Lancet, 342(8879), 1993, pp. 1076-1079
Fibrinolytic activity (FA) was measured by dilute blood clot lysis tim
e at entry to the Northwick Park Heart Study in 1382 white men aged 40
-64, of whom 179 subsequently experienced episodes of ischaemic heart
disease during a mean follow-up period of 16.1 years. There was a sign
ificant interaction between age and low FA (p = 0.02) with respect to
ischaemic heart disease: a difference of one standard deviation in FA
was associated with a difference of about 40% in ischaemic heart disea
se risk (p = 0.002) in those aged 40-54 at entry. The FA association r
emained after adjusting for plasma fibrinogen. High fibrinogen concent
rations themselves were also associated with ischaemic heart disease,
as was high factor VII activity with fatal events. Low FA in younger m
en may exert a long-term influence by impairing the removal of fibrin
deposits that contribute to atherogenesis. Low FA appears to be a lead
ing determinant of ischaemic heart disease in younger men and methods
of enhancing fibrinolytic activity, whether by life-style changes or p
harmacologically, should be considered.