ASSOCIATIONS OF FIBRINOGEN, FACTOR-VII AND PAI-1 WITH BASE-LINE FINDINGS AMONG 10,500 MALE PARTICIPANTS IN A PROSPECTIVE-STUDY OF MYOCARDIAL-INFARCTION - THE PRIME STUDY
Py. Scarabin et al., ASSOCIATIONS OF FIBRINOGEN, FACTOR-VII AND PAI-1 WITH BASE-LINE FINDINGS AMONG 10,500 MALE PARTICIPANTS IN A PROSPECTIVE-STUDY OF MYOCARDIAL-INFARCTION - THE PRIME STUDY, Thrombosis and haemostasis, 80(5), 1998, pp. 749-756
The contribution of coagulation factors and fibrinolytic Variables to
the development of ischaemic arterial disease is still not clearly est
ablished. The PRIME study is a prospective cohort study of myocardial
infarction in men aged 50-59 years and recruited from three MONICA fie
ld centers in France (Lille, Strasbourg and Toulouse) and the center i
n Northern Ireland (Belfast). Baseline examination included measuremen
t of plasma fibrinogen, factor VII, and PAI-1 activity in over 10,500
participants. We investigated the associations of these haemostatic va
riables with cardiovascular risk factors, prevalent atherosclerotic di
sease and geographical area. Fibrinogen level increased with age, smok
ing, waist-to-hip ratio, LDL-cholesterol, and it decreased with educat
ional level, leisure physical activity, alcohol intake and HDL-cholest
erol. Factor Vn activity increased with body mass index, waist-to-hip
ratio, triglycerides, HDL- and LDL-cholesterol. PAI-1 activity increas
ed with body mass index, waist-to-hip ratio, triglycerides, alcohol in
take, smoking, and decreased with leisure physical activity. PAI-1 lev
el was higher in diabetic subjects than in subjects without diabetes.
Cardiovascular risk factors explained 8%, 9%, and 26% of the total var
iance in fibrinogen, factor VII, and PAI-1, respectively. Compared wit
h participants without prevalent cardiovascular disease, those with pr
evious myocardial infarction (n = 280), angina pectoris (n = 230), or
peripheral vascular disease (n = 19) had significantly higher levels o
f fibrinogen, but those with stroke (n = 67) had not. PAI-1 activity s
howed a similar pattern of association. The odds ratio for cardiovascu
lar disease associated with a rise of a one standard deviation in fibr
inogen and PAI-I was 1.31 (95% confidence interval: 1.20 to 1.42, p <
0.001) and 1.38 (95% confidence interval: 1.27 to 1.49, p < 0.001), re
spectively. After adjustment for cardiovascular risk factors, these as
sociations were attenuated but remained highly significant. There was
no significant association between factor VII activity and prevalent c
ardiovascular disease. Fibrinogen level and, to a lesser extent, facto
r VII and PAI-1 activity were higher in Northern Ireland than France a
fter adjustment for the main cardiovascular risk factors. These geogra
phical variations are consistent with the 2 to 3-fold higher incidence
of myocardial infarction in Northern Ireland than France. Our results
provide further epidemiological evidence for a possible role of fibri
nogen and PAI-1 in the pathogenesis of coronary heart disease.