FIBRIN D-DIMER, TISSUE-PLASMINOGEN ACTIVATOR, PLASMINOGEN-ACTIVATOR INHIBITOR, AND THE RISK OF MAJOR ISCHEMIC-HEART-DISEASE IN THE CAERPHILLY STUDY

Plasma levels of fibrin D-dimer, tissue plasminogen activator (tPA) an d plasminogen activator inhibitor (PAI) have been associated with isch aemic heart disease (MD). However their associations with incident MD in samples of the general population are not established. D-dimer anti gen, tPA antigen and PAI activity were measured in stored, fasting pla sma samples from 1,998 men aged 45-65 examined between 1984 and 1988, during the first re-examination of the Caerphilly Study cohort. These variables were related to major MD events (myocardial infarction or IH D death) which occurred in 129 men during a follow-up period which ave raged 61 months. Mean fibrin D-dimer was higher in men who developed M D events (90 vs. 71 ng/ml; age-adjusted logarithmic mean difference 0. 21; 95% CI 0.11, 0.30; p < 0.0001). This association remained after ad justing for baseline LHD and for other risk factors including fibrinog en: the adjusted relative odds of MD in the highest fifth of D-dimer w ere 3.5 (95% CI 1.8, 6.9; p = 0.0003). Mean tPA antigen was also highe r in men who developed IHD (12.6 vs. 11.6 ng/ml; mean difference 0.9; 95% CI 0.2, 1.7; p = 0.02); however this difference largely disappeare d after adjusting for other risk factors. PAI activity was not associa ted with risk of IHD.