FACTOR-VII ACTIVITY AND ISCHEMIC-HEART-DISEASE - FATAL AND NONFATAL EVENTS

The Northwick Park Heart Study suggested that factor VII activity migh t be more strongly related to fatal than non-fatal events of ischaemic heart disease. We used polychotomous logistic regression to model sim ultaneously the probabilities of fatal events, non-fatal myocardial in farction, dying of causes other than ischaemic heart disease and of ev ent-free survival. We followed 1459 white men aged 40-64 at recruitmen t for a mean period of 16.1 years. Of these, 92 died of ischaemic hear t disease, 100 experienced non-fatal myocardial infarction, 173 died o f other causes, and 1094 men were alive. Factor VII activity was stron gly related to fatal events of ischaemic heart disease but not to non- fatal events (p=0.008). A difference of 1 SD in factor Via activity wa s associated with a difference of nearly 50% in the probability of dyi ng of ischaemic heart disease, but with no difference for non-fatal my ocardial infarction. This contrast was not seen for smoking, cholester ol, blood pressure, fibrinogen or factor VIII activity. High levels of VII activity may influence outcome at the time of plaque rupture and tissue factor release by enhancing thrombin production and thus fibrin deposition and platelet aggregability. The apparently differential ef fect of factor VII activity on fatal and non-fatal ischaemic heart dis ease may have important screening and prophylactic implications.