HEMOSTATIC FACTORS AS PREDICTORS OF ISCHEMIC-HEART-DISEASE AND STROKEIN THE EDINBURGH-ARTERY-STUDY

Plasma fibrinogen is a consistent predictor of ischemic heart disease (IHD) in prospective studies, but there are fewer data relating other hemostatic variables to IHD and also to stroke. We therefore studied t he relationships of plasma fibrinogen, von Willebrand factor antigen, tissue plasminogen activator (TPA) antigen, factor VII, and fibrin D-d imer to incidence of IHD and stroke and determined whether any associa tions could be explained by conventional risk factors and baseline hea rt disease. In the Edinburgh Artery study, 1592 men and women aged 55 to 74 years, randomly sampled from the general population, were follow ed prospectively over 5 years to detect fatal and nonfatal IHD and str oke events. During the 5 years, 268 new vascular events were identifie d. Baseline plasma fibrinogen was independently related to risk of str oke in multivariate analysis that adjusted for cigarette smoking, LDL- cholesterol, systolic blood pressure, and preexisting IHD (relative ri sk [RR] 1.52, 95% confidence interval [CI] 1.17,1.98). TPA antigen, an d fibrin D-dimer were also independently associated with risk of strok e (RR 1.69, 95% CI 1.22,2.35 and RR 1.96, 95% CI 1.12,3.41, respective ly). Significant relationships were found between TPA antigen and myoc ardial infarction (P less than or equal to.05). In older men and women , increased coagulation activity and disturbed fibrinolysis are predic tors of future vascular events (both MD and stroke).