EPIDEMIOLOGY OF THROMBOTIC-HEMOSTATIC FACTORS AND THEIR ASSOCIATIONS WITH CARDIOVASCULAR-DISEASE

Abundant evidence proves that thrombosis is involved in the acute pres entation of coronary, cerebrovascular, and peripheral vascular disease s. However, the role of thrombotic factors in the development of the a therosclerotic lesions themselves has been more difficult to prove. Th is difficulty has been due, at least in part, to several methodologic issues in the study of hemostatic factors and cardiovascular disease ( CVD). These include the possibility that associations between CVD and hemostatic factors may not be causal but rather due to confounding by other factors, acting as part of an extended causal pathway or requiri ng interaction with other risk factors or atherosclerotic disease, or may result from disease rather than causing the disease. In addition, several challenges remain in the measurement of hemostatic factors. No netheless, a growing number of studies have examined the association o f CVD with coagulation factors (fibrinogen, factor VII, factor VIII, a nd platelet aggregability) and fibrinolytic factors [tissue plasminoge n activator, plasminogen activator inhibitor 1, lipoprotein(a), and pl asminogen or global fibrinolytic activity]. Of these, only for fibrino gen is there significant, strong, and consistent evidence of a causal association. Given the preliminary nature of these associations, any a ssociation between dietary factors and hemostatic factors other than f ibrinogen is difficult to invoke as evidence for a deleterious effect of diet on CVD risk via thrombogenic mechanisms.