Haemorheological, platelet and endothelial indices in relation to global measures of cardiovascular risk in hypertensive patients: a substudy of the Anglo-Scandinavian Cardiac Outcomes Trial.
METHODS
We tested the hypothesis that there was a significant relationship between haemorheological markers [white blood cell count (WCC), plasma viscosity (PV), haematocrit (HCT) and fibrinogen], as well as plasma von Willebrand factor (vWf, an index of endothelial damage/dysfunction) and soluble P-selectin (sP-sel, an index of platelet activation), to five global measures of cardiovascular risk [i.e. Framingham coronary heart disease (CHD), stroke and cardiovascular death score, the Pocock cardiovascular risk score and the sum of individual risk factors].


RESULTS
Men with a high (> or = median, n = 156) Framingham 10-year CHD risk score had higher levels of WBC (P = 0.027), fibrinogen (P = 0.012) and vWF (P = 0.002) than 153 men with results < median. Men with a high 10-year stroke risk score had significantly higher levels of fibrinogen (P = 0.01) and vWF (P < 0.0001). In stepwise linear regression analysis in men, vWF and fibrinogen were independent predictors of the number of risk factors (P < 0.0001), whilst WCC, vWF and fibrinogen emerged as independent predictors of Framingham CHD risk (P < 0.0001), and fibrinogen and vWF predicted Framingham stroke risk (R(2) = 0.089, P < 0.0001). vWF, PV and fibrinogen were predictors of Pocock cardiovascular death risk (P < 0.0001) but vWF was the only independent predictor of Framingham cardiovascular death risk (P = 0.001).


CONCLUSIONS
Abnormal haemorheological factors (particularly high plasma fibrinogen levels) and endothelial damage/dysfunction (high vWF), but not platelet activation (sP-sel), are related to established cardiovascular and death risk scores. This relationship was most evident amongst male 'high-risk' hypertensive subjects.
Spencer
C G C
CG
Haemostasis, Thrombosis and Vascular Biology Unit, University Department of Medicine, City Hospital, Birmingham, UK.
Felmeden
D C
DC
Blann
A D
AD
Lip
G Y H
GY
D000368:Aged; D015415:Biomarkers / Q000097:blood; D001809:Blood Viscosity; D004730:Endothelium, Vascular / Q000378:metabolism; D005260:Female; D005340:Fibrinogen / Q000032:analysis; D006306:Health Surveys; D006400:Hematocrit; D006801:Humans; D006973:Hypertension / Q000097:blood* / Q000276:immunology / Q000378:metabolism; D007958:Leukocyte Count; D008297:Male; D008875:Middle Aged; D019007:P-Selectin / Q000097:blood; D015539:Platelet Activation; D011446:Prospective Studies; D012044:Regression Analysis; D018570:Risk Assessment / Q000379:methods; D015996:Survival Rate; D014841:von Willebrand Factor / Q000032:analysis
D015415:Biomarkers; D019007:P-Selectin; D014841:von Willebrand Factor; D005340:Fibrinogen