Plasma fibrinogen and factor VII as risk factors for cardiovascular disease.
The importance of the thrombotic component of coronary heart disease is increasingly recognised, and in particular the role of the coagulation system in this process. The Northwick Park Heart study was the first major prospective study to identify both fibrinogen and factor VIIc as risk factors, as powerful as total cholesterol in predicting ischaemic events. Since then, a number of epidemiological studies have confirmed the importance of fibrinogen, not just in CHD but in stroke as well. A variety of environmental factors are known to influence levels of factor VII and fibrinogen and therefore support their role in the development of coronary thrombosis. Both are known to increase with age and body weight and are relatively elevated in diabetes. Fibrinogen is strongly related to smoking habit and a substantial proportion of the IHD risk associated with smoking is mediated through this relationship. There is a dose response effect between number of cigarettes smoked and level of fibrinogen and an inverse relationship with time since cessation of the habit. Factor VII is known to correlate with total cholesterol level, and there is a relationship between dietary variability of fat intake and factor VII, which is likely to play an important role in the risk of CHD. The case for using either anticoagulation or anti platelet agents in secondary prevention of myocardial infarction is now clear, but there are still uncertainties in primary prevention which relate to the ideal dose intensity of either aspirin or anti-coagulation and the type of patient most likely to benefit. The ongoing Thrombosis Prevention Trial identifies middle-aged males at high risk of a myocardial infarction.(ABSTRACT TRUNCATED AT 250 WORDS)
Kelleher
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MCR Epidemiology and Medical Care Unit, Northwick Park Hospital, Harrow, Middlesex.
D000368:Aged; D001241:Aspirin / Q000008:administration & dosage; D001777:Blood Coagulation / Q000187:drug effects / Q000502:physiology*; D003328:Coronary Thrombosis / Q000097:blood / Q000188:drug therapy / Q000209:etiology*; D004041:Dietary Fats / Q000008:administration & dosage / Q000009:adverse effects; D004359:Drug Therapy, Combination; D005167:Factor VII / Q000502:physiology*; D005340:Fibrinogen / Q000502:physiology*; D006801:Humans; D002542:Intracranial Embolism and Thrombosis / Q000097:blood / Q000188:drug therapy / Q000209:etiology*; D008297:Male; D008875:Middle Aged; D012307:Risk Factors; D012907:Smoking / Q000009:adverse effects / Q000097:blood; D014859:Warfarin / Q000008:administration & dosage
D004041:Dietary Fats; D014859:Warfarin; D005167:Factor VII; D005340:Fibrinogen; D001241:Aspirin