Fibrinolytic activation markers predict myocardial infarction in the elderly - The cardiovascular health study

Coagulation factor levels predict arterial thrombosis in epidemiological st udies, but studies of older persons are needed. We studied 3 plasma antigen ic markers of fibrinolysis, viz, plasminogen activator inhibitor-1 (PAI-1), fibrin fragment D-dimer, and plasmin-antiplasmin complex (PAP) for the pre diction of arterial thrombosis in healthy elderly persons over age 65. The study was a nested case-control study in the Cardiovascular Health Study co hort of 5201 men and women greater than or equal to 65 years of age who wer e enrolled from 1989 to 1990. Cases were 146 participants without baseline clinical Vascular disease who developed myocardial infarction, angina, or c oronary death during a follow-up of 2.4 years. Controls remained free of ca rdiovascular events and were matched 1:1 to cases with respect to sex, dura tion of follow-up, and baseline subclinical Vascular disease status. With i ncreasing quartile of D-dimer and PAP levels but not of PAI-1, there was an independent increased risk of myocardial infarction or coronary death, but not of angina. The relative risk for D-dimer above versus below the median value (greater than or equal to 120 mu g/L) was 2.5 (95% confidence interv al, 1.1 to 5.9) and for PAP above the median (greater than or equal to 5.25 nmol/L), 3.1 (1.3 to 7.7). Risks were independent of C-reactive protein an d fibrinogen concentrations. There were no differences in risk by sex or pr esence of baseline subclinical disease. D-dimer and PAP, but not PAI-1, pre dicted future myocardial infarction in men and women over age 65. Relations hips were independent of other risk factors, including inflammation markers . Results indicate a major role for these markers in identifying a high ris k of arterial disease in this age group.