title: Haemostatic factors, lipoproteins and long-term mortality in a multi-ethnic population of Gujarati, African-Caribbean and European origin.
abstract: OBJECTIVE
  To examine the relations between haemostatic factors and lipoproteins with mortality in British Europeans, African-Caribbeans (AfC) and Gujarati Indians.
  
  
  METHODS
  A prospective cohort study of 331 subjects (40-79 years), followed-up over 26 years for mortality. Apolipoprotein-A1 (Apo-A1), apolipoprotein-B (Apo-B), factor VII coagulant activity (FVIIc), fibrinogen and von Willebrand Factor (vWF) were measured at baseline in 118 Europeans, 100 AfC and 113 Gujaratis. Aortic pulse wave velocity (aPWV) was measured in 174 participants.
  
  
  RESULTS
  147 (44.4%) subjects died during a median of 24 years follow-up with 69 cardiovascular deaths. Women at baseline had higher, and AfC males the lowest FVIIc and Apo-A1 levels. Baseline age-sex and ethnicity adjusted FVIIc levels were higher in those who died (131.0 vs. 117.4%; P = 0.048). In similarly adjusted partial correlations, Apo-A1 was inversely related to arterial stiffness (ρ = -0.23, P = 0.04). Over the 26 years follow-up, participants below the median (i.e. with lower concentration) of FVIIc, Fibrinogen, Apo-B and vWF had better survival rates than those with higher concentrations; those with higher concentrations of Apo-A1 had better survival. In Cox multivariable regression analyses including sex, ethnicity and aPWV, independently increased risk of all-cause mortality came only from SBP (per 5 mmHg); P = 0.011), age (per year); P < 0.0001 and FVIIc at 7% (per 10-unit; HR 1.07 (1.02, 1.12); P = 0.008. Separately, Apo-A1 (HR 0.12 (0.02, 0.75; P = 0.029) was independently associated with a very significant 88% reduction in all-cause mortality.
  
  
  CONCLUSIONS
  Despite a relatively small sample size, long-term follow-up suggests an independent effect of the prothrombotic state (via FVIIc) and apo-A1 (a constituent of HDL) on mortality.
authors.affiliation: Institute of Cardiovascular Sciences, Core Technology Facility (3rd Floor), University of Manchester, 46 Grafton Street, Manchester M13 9NT, UK. Electronic address: simon.anderson@manchester.ac.uk.
authors.forename: S G
authors.initials: SG
authors.lastname: Anderson
authors.affiliation: Institute of Cardiovascular Sciences, Core Technology Facility (3rd Floor), University of Manchester, 46 Grafton Street, Manchester M13 9NT, UK.
authors.forename: D C
authors.initials: DC
authors.lastname: Hutchings
authors.affiliation: Institute of Cardiovascular Sciences, Core Technology Facility (3rd Floor), University of Manchester, 46 Grafton Street, Manchester M13 9NT, UK.
authors.forename: A H
authors.initials: AH
authors.lastname: Heald
authors.affiliation: Institute of Cardiovascular Sciences, Core Technology Facility (3rd Floor), University of Manchester, 46 Grafton Street, Manchester M13 9NT, UK.
authors.forename: C D
authors.initials: CD
authors.lastname: Anderson
authors.affiliation: Diabetes, Cardiovascular Medicine & Nutrition, King's College London, Franklin-Wilkins Building, 150 Stamford Street, London SE1 9NH, UK.
authors.forename: T A B
authors.initials: TA
authors.lastname: Sanders
authors.affiliation: Diabetes, Cardiovascular Medicine & Nutrition, King's College London, Franklin-Wilkins Building, 150 Stamford Street, London SE1 9NH, UK.
authors.forename: J K
authors.initials: JK
authors.lastname: Cruickshank
mesh_terms: D000328:Adult; D000368:Aged; D000886:Anthropometry; D000941:Antigens / Q000097:blood*; D016632:Apolipoprotein A-I / Q000097:blood*; D001055:Apolipoproteins B / Q000097:blood*; D044383:Black People / Q000706:statistics & numerical data; D002318:Cardiovascular Diseases / Q000208:ethnology*; D017691:Caribbean Region / Q000208:ethnology; D005006:Ethnicity / Q000706:statistics & numerical data; D005060:Europe / Q000208:ethnology; D005167:Factor VII; D005260:Female; D005340:Fibrinogen / Q000032:analysis; D005500:Follow-Up Studies; D006801:Humans; D007194:India / Q000208:ethnology; D053208:Kaplan-Meier Estimate; D008131:London / Q000453:epidemiology; D008297:Male; D008875:Middle Aged; D009026:Mortality; D016016:Proportional Hazards Models; D011446:Prospective Studies; D012307:Risk Factors; D012494:Sampling Studies; D019851:Thrombophilia / Q000097:blood / Q000208:ethnology; D059289:Vascular Stiffness; D044465:White People / Q000706:statistics & numerical data; D014841:von Willebrand Factor / Q000032:analysis*
chemical_list: D000941:Antigens; D016632:Apolipoprotein A-I; D001055:Apolipoproteins B; C042580:factor VII clotting antigen; D014841:von Willebrand Factor; D005167:Factor VII; D005340:Fibrinogen
keywords: Arterial stiffness; Ethnic groups; Haemostasis; Lipoproteins; Survival analysis