Elevated plasma fibrin D-dimer as a risk factor for vascular dementia: the Three-City cohort study.
BACKGROUND
Hemostatic biomarkers have been associated with coronary heart disease (CHD) and stroke. However, few studies have investigated these associations in the elderly. Moreover, vascular factors may be involved in dementia. Data on the relationship between hemostatic biomarkers and dementia remain scarce.


OBJECTIVE
Our study aimed to investigate the relationship between hemostatic biomarkers and the risk of CHD, stroke and dementia in an elderly population.


METHODS
In the Three-City cohort study including men and women aged > or = 65, we investigated the association of fibrinogen, D-dimer and von Willebrand factor with the 4-year incidence of arterial disease (CHD, n = 199; and stroke, n = 111) and dementia (n = 218). Measurements were performed for all cases and for a random sample of the entire cohort (n = 1254). Hazards ratios (HR) compared the last quintile with the first of each parameter's distribution and P-values refer to the test for linear trend across quintiles.


RESULTS
Elevated fibrinogen was associated with the risk of CHD and myocardial infarction (HR = 2.20, P < 0.05 and 2.45 P < 0.05, respectively). Moreover, high D-dimer was associated with the risk of CHD among younger subjects (aged < 75, HR = 3.64, P < 0.01) but not older subjects (P for interaction = 0.01). Furthermore, the risk of vascular dementia (VaD) increased with D-dimer level (HR = 3.05, P < 0.01).


CONCLUSIONS
In the elderly, elevated fibrinogen and D-dimer levels were associated with incident arterial disease. In addition, high D-dimer level could represent a new risk factor for VaD.
Carcaillon
L
L
Inserm Unit 780, Cardiovascular Epidemiology, Villejuif. laure.carcaillon@inserm.fr
Gaussem
P
P
Ducimetière
P
P
Giroud
M
M
Ritchie
K
K
Dartigues
J F
JF
Scarabin
P Y
PY
D000367:Age Factors; D000368:Aged; D015415:Biomarkers / Q000097:blood; D015331:Cohort Studies; D015140:Dementia, Vascular / Q000097:blood* / Q000175:diagnosis / Q000209:etiology; D005260:Female; D005338:Fibrin Fibrinogen Degradation Products / Q000032:analysis*; D005340:Fibrinogen / Q000032:analysis; D006487:Hemostasis; D006801:Humans; D015994:Incidence; D008297:Male; D016491:Peripheral Vascular Diseases / Q000097:blood / Q000175:diagnosis / Q000209:etiology; D011446:Prospective Studies; D012307:Risk Factors; D020521:Stroke / Q000097:blood / Q000175:diagnosis / Q000209:etiology; D014841:von Willebrand Factor / Q000032:analysis
D015415:Biomarkers; D005338:Fibrin Fibrinogen Degradation Products; C036309:fibrin fragment D; D014841:von Willebrand Factor; D005340:Fibrinogen