Relationship of coagulation and fibrinolytic variables with arterial structure and function in Africans.
BACKGROUND
Although both coagulation and fibrinolysis are associated with cardiovascular disease (CVD) the underlying nature and pathways of many of these associations are still unclear. Our aim was to determine which of the current or 5-year prior levels of total fibrinogen, fibrinogen γ', plasminogen activator inhibitor-1 (PAI-1act) and global fibrinolytic potential were the stronger determinant of arterial structure and function.


METHODS
This prospective study consisted of 2010 Africans over the age of 35 years with 5-year follow-up data available for 1288 participants. Cardiovascular measurements included arterial stiffness, blood pressure and carotid intima media thickness.


RESULTS
Fibrinogen γ' showed stronger associations with blood pressure than total fibrinogen also in the presence of other CVD risk factors. PAI-1act was positively associated with blood pressure both cross-sectionally and prospectively, with the longitudinal association being the stronger determinant, also after adjustment for known CVD risk factors. Clot lysis time (CLT) was positively associated, both prospectively and cross-sectionally, with intima media thickness and negatively with markers of arterial stiffness but not after adjustment for known CVD risk factors.


CONCLUSIONS
Fibrinogen γ' was more strongly associated with CVD function than total fibrinogen. PAI-1act was significantly associated with blood pressure with changes in PAI-1 levels preceding changes in blood pressure. Different mechanisms may be at play determining arterial wall stiffness/thickening and blood pressure as observed from the opposing associations with PAI-1act and CLT. CLT was not independently related to cardiovascular measures as its associations were weakened in the presence of other known CVD risk factors.
Centre of Excellence for Nutrition, North-West University, Potchefstroom, South Africa. Electronic address: marlien.pieters@nwu.ac.za.
M
M
Pieters
Department of Human Nutrition, Wageningen University and Research Centre, Wageningen.
H
H
Boshuizen
Centre of Excellence for Nutrition, North-West University, Potchefstroom, South Africa.
Z
Z
de Lange
Hypertension in Africa Research Team (HART), North-West University, Potchefstroom, South Africa.
A E
AE
Schutte
Hypertension in Africa Research Team (HART), North-West University, Potchefstroom, South Africa.
R
R
Schutte
Africa Unit for Transdisciplinary Health Research, North-West University, Potchefstroom, South Africa.
M
M
Greeff
Theme Thrombosis, Division of Cardiovascular and Diabetes Research, Multidisciplinary Cardiovascular Research Centre and Leeds Institute for Genetics, Health and Therapeutics, School of Medicine, University of Leeds, UK.
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RA
Ariëns
D000349:Africa / Q000453:epidemiology; D044383:Black People; D001777:Blood Coagulation; D002318:Cardiovascular Diseases / Q000097:blood* / Q000453:epidemiology / Q000208:ethnology*; D015331:Cohort Studies; D018450:Disease Progression; D005260:Female; D063285:Fibrin Clot Lysis Time; D005340:Fibrinogen / Q000378:metabolism*; D005342:Fibrinolysis / Q000502:physiology*; D006801:Humans; D008297:Male; D011446:Prospective Studies; D012307:Risk Factors
D005340:Fibrinogen
Arterial structure and function; Cardiovascular disease; Disease progression; Fibrin clot lysis time; Fibrinogen