[The risk indices for atherothrombotic disease: the coagulation factors].
During the last decade interesting data have been collected on the epidemiological significance of some coagulation factors as risk indices for major cardiovascular events and, also, for the prognosis of atherothrombotic disease. The factors for which evidence is most convincing include: plasma fibrinogen, coagulation factor VII, and an inhibitor of fibrinolysis, namely the plasminogen activator inhibitor PAI-1. These data have been provided by studies of primary predictivity, in which the said parameters were measured in healthy subjects whose cardiovascular outcome was followed. Studies of secondary predictivity, or prevalence studies have also been extremely helpful. In these, the coagulation factors measured in patients already suffering from atherothrombotic disease were correlated with its severity, extension and outcome. From these data, the plasma fibrinogen level emerges as the coagulation parameter best correlated with cardiovascular events, that is, as both a primary and a secondary predictor. The predictive power of plasma fibrinogen level appears to be no less significant than that of blood cholesterol. Although a few methodological problems must still be overcome, hyperfibrinogenemia is gaining increasing consideration as a new, important risk factor for cardiovascular events. It is however premature to consider the said parameters not only as risk indices but also as causal factors of atherothrombotic disease. In fact, their pathogenic and causal role, although supported by high biological plausibility, has not yet been confirmed by interventional studies aimed at assessing whether or not therapeutic lowering of these values is associated with reduced cardiovascular risk.
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Cattedra di Fisiopatologia Medica, Università degli Studi di Bologna.
D000367:Age Factors; D001161:Arteriosclerosis / Q000097:blood / Q000453:epidemiology*; D001779:Blood Coagulation Factors / Q000032:analysis*; D006801:Humans; D015849:Plasminogen Inactivators / Q000097:blood; D015995:Prevalence; D011379:Prognosis; D012307:Risk Factors; D012737:Sex Factors; D013927:Thrombosis / Q000097:blood / Q000453:epidemiology*
D001779:Blood Coagulation Factors; D015849:Plasminogen Inactivators
Indici di rischio per la malattia aterotrombotica: i fattori della coagulazione.