Contribution of novel biomarkers to incident stable angina and acute coronary syndrome: the PRIME Study.
OBJECTIVE
To compare whether novel inflammatory and haemostatic biomarkers are more predictive of well-characterized incident acute coronary syndrome (ACS) than stable angina (SA).


RESULTS
We used data from the PRIME Study, a prospective cohort of 9758 asymptomatic middle-aged men recruited in Northern Ireland and France between 1991 and 1993. A nested case-control study was established with the baseline plasma sample of 269 incident cases and 538 matched controls. Odds ratios (ORs) for SA and ACS were estimated by conditional logistic regression analysis. After 5 years of follow-up, 107 incident SA and 162 ACS cases were validated. After adjustment for traditional risk factors, higher circulating levels of hs-CRP, ICAM1, interleukin 6 and interleukin 18 were equally predictive of SA and ACS (all P-values of OR comparison >0.05). In contrast, elevated levels of fibrinogen, von Willebrand factor, and possibly higher level of D-dimers and lower level of tissue factor pathway inhibitor were associated with ACS only. The comparison of the ORs showed a statistically significant difference for von Willebrand factor only [OR(4th vs. 1st quartile) = 2.99 (1.49-6.02) for ACS vs. 0.80 (0.33-1.94) for SA; P(z test) = 0.02].


CONCLUSIONS
This is the first population-based study suggesting that higher levels of circulating haemostatic markers and of von Willebrand factor, in particular, are significantly more predictive of incident ACS than SA.
Empana
Jean-Philippe
JP
INSERM, Unit 909, Faculty of Medicine, Univ Paris-V, F-94807 Villejuif, France.
Canoui-Poitrine
Florence
F
Luc
Gerald
G
Juhan-Vague
Irene
I
Morange
Pierre
P
Arveiler
Dominique
D
Ferrieres
Jean
J
Amouyel
Philippe
P
Bingham
Annie
A
Montaye
Michelle
M
Ruidavets
Jean-Bernard
JB
Haas
Bernadette
B
Evans
Alun
A
Ducimetiere
Pierre
P
D054058:Acute Coronary Syndrome / Q000097:blood / Q000175:diagnosis* / Q000209:etiology; D000787:Angina Pectoris / Q000097:blood / Q000175:diagnosis* / Q000209:etiology; D015415:Biomarkers / Q000032:analysis / Q000097:blood; D004812:Epidemiologic Methods; D005338:Fibrin Fibrinogen Degradation Products / Q000032:analysis; D005340:Fibrinogen / Q000032:analysis; D005602:France; D006801:Humans; D008074:Lipoproteins / Q000097:blood; D008297:Male; D008875:Middle Aged; D009203:Myocardial Infarction / Q000097:blood / Q000175:diagnosis* / Q000209:etiology; D009660:Northern Ireland; D014841:von Willebrand Factor / Q000032:analysis
D015415:Biomarkers; D005338:Fibrin Fibrinogen Degradation Products; D008074:Lipoproteins; C036309:fibrin fragment D; C051928:lipoprotein-associated coagulation inhibitor; D014841:von Willebrand Factor; D005340:Fibrinogen