title: Associations of von Willebrand factor, fibrin D-dimer and tissue plasminogen activator with incident coronary heart disease: British Women's Heart and Health cohort study.
abstract: BACKGROUND
  Associations of three markers of thrombotic tendency, von Willebrand factor, tissue plasminogen activator antigen and fibrin D-dimer, with coronary heart disease have been reported in meta-analyses. It is not known, however, whether findings are generalizable to older women.
  
  
  METHODS
  Prospective cohort of 3582 women aged 60-79 years randomly selected from 23 towns without evidence of cardiovascular disease at entry into the British Women's Heart and Health Study.
  
  
  METHODS
  Women were followed for 4.7 years for incident coronary heart disease. Cox proportional hazard models were used to compare the hazard ratio of coronary heart disease per doubling for each thrombotic factor.
  
  
  RESULTS
  In models adjusting for age and town only there was no association between von Willebrand factor or D-dimer and incidence of coronary heart disease, but there was a positive association of tissue plasminogen activator: coronary heart disease hazard ratio per doubling was 1.37 (95% confidence interval: 1.08-1.75). Adjustment for potential confounders (socio-economic position, smoking, lung function, physical activity, alcohol consumption, body mass index, waist-to-hip ratio) attenuated association to 1.20 (0.92-1.58). Further adjustment for risk factors that may be part of the same pathophysiological process linking tissue plasminogen activator to coronary heart disease (high density lipoprotein cholesterol, triglycerides, blood pressure, fasting glucose, insulin, C-reactive protein, fibrinogen) attenuated the hazard ratio to 1.05 (0.79-1.40).
  
  
  CONCLUSIONS
  In older women, tissue plasminogen activator was associated with incident coronary heart disease, but does not appear to be an independent risk factor for coronary heart disease as the association was attenuated by adjustment for confounding and other metabolic and vascular risk factors.
authors.affiliation: Department of Social Medicine, University of Bristol, Canynge Hall, Whiteladies Road, Bristol, UK. m.t.may@bristol.ac.uk
authors.forename: Margaret
authors.initials: M
authors.lastname: May
authors.forename: Debbie A
authors.initials: DA
authors.lastname: Lawlor
authors.forename: Rita
authors.initials: R
authors.lastname: Patel
authors.forename: Ann
authors.initials: A
authors.lastname: Rumley
authors.forename: Gordon
authors.initials: G
authors.lastname: Lowe
authors.forename: Shah
authors.initials: S
authors.lastname: Ebrahim
mesh_terms: D000368:Aged; D015415:Biomarkers; D015331:Cohort Studies; D003327:Coronary Disease / Q000097:blood*; D005260:Female; D005338:Fibrin Fibrinogen Degradation Products / Q000378:metabolism*; D006801:Humans; D008875:Middle Aged; D012307:Risk Factors; D010959:Tissue Plasminogen Activator / Q000097:blood*; D006113:United Kingdom; D014841:von Willebrand Factor / Q000378:metabolism*
chemical_list: D015415:Biomarkers; D005338:Fibrin Fibrinogen Degradation Products; C036309:fibrin fragment D; D014841:von Willebrand Factor; D010959:Tissue Plasminogen Activator