title: Gender-related differences in thrombogenic factors predicting recurrent cardiac events in patients after acute myocardial infarction. The THROMBO Investigators.
abstract: Thrombosis contributes to recurrent coronary events in patients after acute myocardial infarction (AMI), but prognostic significance of thrombogenic factors by gender is unknown. This study aimed to determine gender-related differences in the prognostic significance of thrombogenic factors for predicting cardiac events (nonfatal reinfarction or cardiac death) in postinfarction patients. Blood levels of the following factors were measured 2 months after AMI in 791 men and 254 women: fibrinogen, von Willebrand factor, factor VII and VIIa, plasminogen activator inhibitor, D-dimer, cholesterol, apolipoprotein A-1, apolipoprotein B, lipoprotein(a), triglycerides, and high-density lipoprotein cholesterol. After adjustment for clinical covariates, levels of apolipoprotein A, high-density lipoprotein cholesterol, fibrinogen, and factor VIIa were significantly higher in postinfarction women than men. During a mean 26-month follow-up, there were 67 cardiac events (8.5%) in men and 14 (5.5%) in women (p = 0.11). In the multivariate Cox model, elevated levels of factor VIIa were a significant predictor of cardiac events in women (p = 0.022) but not in men (p = 0.80), with significant gender-related effect (hazard ratio 2.80 vs 0.92, respectively; p <0.05). D-dimer had prognostic value in men (p = 0. 006) but not in women (p = 0.36), although the difference between hazard ratios for men and women was not significant (2.35 vs 1.58, respectively; p = 0.49). In conclusion, elevated levels of factor VIIa are associated with an increased risk of recurrent cardiac events in postinfarction women, but not in men. D-dimer is more predictive for cardiac events in postinfarction men than women. These observations indicate possible gender-related differences in the pathophysiologic mechanisms of recurrent cardiac events.
authors.affiliation: Cardiology Unit, University of Rochester Medical Center, Rochester, NY 14642, USA.
authors.forename: V G
authors.initials: VG
authors.lastname: Kalaria
authors.forename: W
authors.initials: W
authors.lastname: Zareba
authors.forename: A J
authors.initials: AJ
authors.lastname: Moss
authors.forename: G
authors.initials: G
authors.lastname: Pancio
authors.forename: V J
authors.initials: VJ
authors.lastname: Marder
authors.forename: J H
authors.initials: JH
authors.lastname: Morrissey
authors.forename: H J
authors.initials: HJ
authors.lastname: Weiss
authors.forename: C E
authors.initials: CE
authors.lastname: Sparks
authors.forename: H
authors.initials: H
authors.lastname: Greenberg
authors.forename: E
authors.initials: E
authors.lastname: Dwyer
authors.forename: R
authors.initials: R
authors.lastname: Goldstein
authors.forename: L F
authors.initials: LF
authors.lastname: Watelet
mesh_terms: D001053:Apolipoproteins / Q000097:blood; D001779:Blood Coagulation Factors / Q000032:analysis*; D005260:Female; D005500:Follow-Up Studies; D006331:Heart Diseases / Q000401:mortality; D006801:Humans; D008055:Lipids / Q000097:blood*; D008297:Male; D015999:Multivariate Analysis; D009203:Myocardial Infarction / Q000097:blood* / Q000453:epidemiology; D011379:Prognosis; D016016:Proportional Hazards Models; D012008:Recurrence; D012307:Risk Factors; D012727:Sex Characteristics
chemical_list: D001053:Apolipoproteins; D001779:Blood Coagulation Factors; D008055:Lipids