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Thrombin, Inflammation, and Cardiovascular Disease: MI and CVD death

Thrombin, Inflammation, and Cardiovascular Disease: MI and CVD deathIs There a Hypercoagulable State That Predisposes to CVD?
Meade and colleagues at the Northwick Park Heart Study produced pioneering research into the molecular epidemiology of coagulation and fibrinolysis, which suggested that a preexisting hypercoagulable state might be present in those most at risk for MI and CVD death. While the research that followed their work has provided little support for this as a general condition—for example, it does not appear that elevations in factor VIIc levels are a major risk factor, as they originally proposed—their results for fibrinogen and factor VIIIc have held up in many other studies. We now interpret these results for fibrinogen and factor VIII as probably best supportive of inflammation rather than hypercoagulability.
The plasma level of the fibrin degradation product d-dimer is an integrated marker of coagulant and subsequent fibrinolytic activity. As the population under study becomes older and has greater atherosclerotic burden, d-dimer does predict events. In studies of older middle-aged men with mixed health status and in a study of men with peripheral vascular disease, d-dimer levels were predictive of CVD events. In addition, in the elderly cohort of the Cardiovascular Health Study, where most individuals had moderate-to-extensive vascular disease, d-dimer and the marker of plasmin activation, plasmin-antiplasmin complex, were strongly predictive of events. comments
In contrast, studies of d-dimer as a CVD risk factor in younger, healthier populations have been negative. In preliminary findings, d-dimer levels did not predict early calcification in younger people. Also, levels were not associated with incident events in a healthy middle-aged population, such as the Physician’s Health Study.