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DOI: 10.1055/s-0038-1653783
Association of Variables of Coagulation, Fibrinolysis and Acute-phase with Atherosclerosis in Coronary and Peripheral Arteries and those Arteries Supplying the Brain
Publication History
Received14 September 1994
Accepted after revision 14 November 1994
Publication Date:
09 July 2018 (online)
![](https://www.thieme-connect.de/media/10.1055-s-00035024/199503/lookinside/thumbnails/10-1055-s-0038-1653783-1.jpg)
Summary
We investigated the vessel status of coronary and peripheral arteries and those arteries supplying the brain in 929 consecutive male patients admitted to a coronary rehabilitation unit. The severity of coronary atherosclerosis was scored using coronary angiography. Changes in extracranial brain vessels and manifest cerebrovascular disease (CVD) were determined by B-mode ultrasound and Doppler examination. Peripheral arterial disease (PAD) was diagnosed using base-line and stress oscillography. We assessed variables of coagulation, fibrinolysis, and the acute phase response.
There was a significant increase in plasma fibrinogen, plasminogen, d-dimer and C-reactive protein (CRP) with increasing severity of coronary heart disease. Compared to men with unaffected arteries, men with 3 diseased coronary arteries had 58% greater d-dimer concentrations. Patients with CVD and PAD, respectively, also had significantly higher fibrinogen, d-dimer and CRP concentrations. We did not find an association between plasminogen activator inhibitor activity and the severity of coronary atherosclerosis.
In conclusion, plasma fibrinogen, d-dimer and CRP concentrations were significantly related to atherosclerosis in the coronary, peripheral and extracranial brain arteries.
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References
- 1 Davies MJ, Woolf N, Robertson WB. Pathology of acute myocardial infarction with particular reference to occlusive coronary thrombi. Br Heart J 1976; 38: 659-664
- 2 Davies MJ, Thomas A. Thrombosis and acute coronary-artery lesions in sudden cardiac ischemic death. N Engl J Med 1984; 310: 1137-1140
- 3 Falk E. Unstable angina with fatal outcome; dynamic coronary thrombosis leading to infarction and/or sudden death. Circulation 1985; 71: 699-708
- 4 Woolf N. Thrombosis and atherosclerosis. Br Med Bull 1978; 34: 137-142
- 5 Smith EB, Staples EM, Dietz HS, Smith RH. Role of endothelium in sequestration of lipoprotein and fibrinogen in aortic lesions, thrombi and graft pseudo-intima. Lancet 1979; 2: 812-816
- 6 Bini A, Fenoglio JJ, Mesa-Tejada R, Kudryk B, Kaplan KL. Identification and distribution of fibrinogen, fibrin and fibrin(ogen) degradation products. Use of monoclonal antibodies Arteriosclerosis 1989; 9: 109-121
- 7 Ernst E, Resch KL. Fibrinogen as a cardiovascular risk factor: A meta-analysis and review of the literature. Ann Int Med 1993; 118: 956-963
- 8 Wilhelmsen L, Svärdsudd K, Korsan-Bengtsen K, Larsson B, Welin L, Tibblin G. Fibrinogen as a risk factor for stroke and myocardial infarction. N Engl J Med 1984; 311: 501-505
- 9 Chooi CC, Gallus A. Acute phase reaction, fibrinogen level, and thrombus size. Thromb Res 1989; 53: 493-501
- 10 Meade TW, Brozovic M, Chakrabarti RR, Haines AP, Imeson JD, Mellows S, Miller GJ, North WR S, Stirling Y, Thompson SG. Haemostatic function and ischaemic heart disease: Principal results of the Northwick Park Heart Study. Lancet 1986; 2: 533-537
- 11 Lewis HD, Davis JW, Archibald DG. et al. Protective effects of aspirin against acute myocardial infarction and death in men with unstable angina. N Engl J Med 1983; 309: 396-403
- 12 Second International Study of Infarct Survival. Randomized trial of intravenous streptokinase, oral aspirin, both or neither among 17,187 cases of suspected acute myocardial infarction. Lancet 1988; 2: 349-360
- 13 Hamsten A, Wiman B, De FaireU, Blombäck M. Increased plasma levels of a rapid inhibitor of tissue plasminogen activator in young survivors of myocardial infarction. N Engl J Med 1985; 313: 1557-1563
- 14 Munro JM, Cotran RS. The pathogenesis of atherosclerosis: atherogenesis and inflammation. Lab Invest 1988; 58: 249-261
- 15 Judkins MP. Selective coronary angiography. Radiology 1967; 89: 815-819
- 16 Sones FM. Cine arteriography. Mod Concepts Cardiovasc Dis 1962; 31: 735-742
- 17 World Health Organisation Regional Office for Europe. Myocardial infarction community registers. Public Health in Europe, no 5. Copenhagen: WHO; 1976
- 18 Heinrich J, Sandkamp M, Kokott R, Schulte H, Assmann G. Relationship of lipoprotein(a) to variables of coagulation and fibrinolysis in a healthy population. Clin Chem 1991; 37: 1950-1954
- 19 Clauss A. Gerinnungsphysiologische Schnellmethode zur Bestimmung des Fibrinogens. Acta Haematol 1957; 17: 237-246
- 20 Prevention of coronary heart disease: scientific background and new clinical guidelines. Recommendations of the European Atherosclerosis Society prepared by the International Task Force for Prevention of Coronary Heart Disease. Nutr Metab Cardiovasc Dis 1992; 2: 113-156
- 21 Liuzzo G, Biasucci LM, Gallimore JR, Grillo RL, Rebuzzi AG, Pepys MB, Maseri A. The prognostic value of C-reactive protein and serum amyloid A protein in severe unstable angina. New Engl J Med 1994; 331: 417-424
- 22 Eriksson H, Korsan-Bengtsen K, Welin L, Svärdsudd K, Larsson B, Tibblin G, Wilhelmsen L. 21-year follow up of CHD and total mortality among men born in 1913. In: Ernst E, Koenig W, Lowe GD O, Meade TW. (eds.) Fibrinogen: A “new” cardiovascular risk factor. Blackwell; Vienna: 1992: 115-119
- 23 Stone MC, Thorp JM. Plasma fibrinogen: A major coronary risk factor. J R Coll Gen Pract 1985; 35: 565-569
- 24 Meade TW, Brozovic M, Chakrabarti RR, Haines AP, Imeson JD, Mellows S, Miller GJ, North WR S, Stirling Y, Thompson SG. Haemostatic function and ischaemic heart disease: Principal results of the Northwick Park Heart Study. Lancet 1986; 2: 533-537
- 25 Kannel WB, Wolf PA, Castelli WP, d’Agostino RB. Fibrinogen and risk of cardiovascular disease: The Framingham Study. J Am Med Assoc 1987; 258: 1183-1186
- 26 Yarnell JW G, Baker IA, Sweetnam PM, Bainton D, O’Brien JR, Whitehead PJ, Elwood PC. Fibrinogen, viscosity and white blood cell count are risk factors for ischemic heart disease. Circulation 1991; 83: 836-844
- 27 Heinrich J, Balleisen L, Schulte H, Assmann G, van de Loo J. Fibrinogen and Factor VII in the Prediction of Coronary Risk Results from the PROCAM Study in Healthy Men. Arterioscler Thromb 1994; 14: 54-59
- 28 Lowe GD O, Drummond MM, Lorimer AR, Hutton I, Forbes CD, Prentice CR, Barbenei JC. Relation between extent of coronary artery disease and blood viscosity. Br Med J 1980; 281: 673-674
- 29 Hamsten A, Blombäck M, Wiman B, Svensson J, Szamosi A, De Faire U, Mettinger L. Haemostatic function in myocardial infarction. Br Heart J 1986; 55: 58-66
- 30 Handa K, Kono S, Saku K, Sasaki J, Kawano T, Sasaki Y, Hiroki T, Arakawa K. Plasma fibrinogen levels as an independent indicator of severity of coronary atherosclerosis. Atherosclerosis 1989; 77: 209-213
- 31 Bolibar I, Kienast J, Thompson SG, Matthias R, Niessner H, Fechtrup C. Relation of fibrinogen to presence and severity of coronary artery disease is independent of other coexisting heart disease. Am Heart J 1993; 125: 1601-1605
- 32 ECAT angina pectoris study group. ECAT angina pectoris study: baseline associations of haemostatic factors with extent of coronary arteriosclerosis and other coronary risk factors in 3000 patients with angina pectoris undergoing coronary angiography. Eur Heart J 1993; 14: 8-17
- 33 Tohgi H, Kawashima M, Tamura K, Suzuki H. Coagulation-fibrinolysis abnormalities in acute and chronic phases of cerebral thrombosis and embolism. Stroke 1990; 21: 1663-1667
- 34 Szirmai IG, Kamondi A, Magyar H, Juhasz C. Relation of laboratory and clinical variables to the grade of carotid atherosclerosis. Stroke 1993; 24: 1811-1816
- 35 Kienast J, Thompson SG, Raskino C, Pelzer H, Fechtrup C, Ostermann H, van deLoo. Prothrombin activation fragment 1+2 and thrombin antithrombin III complexes in patients with angina pectoris: relation to the presence and severity of coronary atherosclerosis. Thromb Haemostas 1993; 70: 550-553
- 36 De Buyzere M, Philippé J, Duprez D, Baele G, Clement DL. Coagulation system activation and increase of d-dimer levels in peripheral arterial occlusive disease. Am J Hematol 1993; 43: 91-94
- 37 Olofsson BO, Dahlén G, Nilsson TK. Evidence for increased levels of plasminogen activator inhibitor and tissue plasminogen activator in plasma of patients with angiographically verified coronary artery disease. Eur Heart J 1989; 10: 77-82
- 38 Huber K, Resch I, Stefenelli T, Lang I, Probst P, Kaindl F, Binder BR. Plasminogen activator inhibitor-1 levels in patients with chronic angina pectoris with or without angiographic evidence of coronary sclerosis. Thromb Haemostas 1990; 63: 336-339
- 39 Negri M, Sheiban I, Arigliano PL, Tonni S, Montresor G, Carlini S, Manzato F. Interrelation between angiographic severity of coronary artery disease and plasma levels of insulin, C-peptide and plasminogen activator inhibitor-1. Am J Cardiol 1993; 72: 397-401
- 40 Eisenberg PR, Sherman LA, Perez J, Jaffe AS. Relationship between elevated plasma levels of crosslinked fibrin degradation products (XL-FDP) and the clinical presentation of patients with myocardial infarction. Thromb Res 1987; 46: 109-120
- 41 Kruskal JB, Commerford PJ, Franks JJ, Kirsch RE. Fibrin and fibrinogen- related antigens in patients with stable and unstable coronary artery disease. N Engl J Med 1987; 317: 1361-1365
- 42 Vaziri ND, Kennedy SC, Kennedy D, Gonzales E. Coagulation, fibrinolytic, and inhibitory proteins in acute myocardial infarction and angina pectoris. Am J Med 1992; 93: 651-657
- 43 Cortellaro M, Cofrancesco E, Boschetti C. et al For the PLAT Group. Increased fibrin turnover and high PAI-1 activity as predictors of ischemic events in atherosclerotic patients Arterioscler Thromb 1993; 13: 1412-1417
- 44 Lassila R, Peltonen S, Lepäntalo M, Saarinen O, Kauhanen P, Manninen V. Severity of peripheral atherosclerosis is associated with fibrinogen and degradation of cross-linked fibrin. Arterioscler Thromb 1993; 13: 1738-1742
- 45 Fowkes FG, Lowe GD, Housley E, Rattray A, Rumley A, Elton RA, Macgregor IR, Dawes J. Crosslinked fibrin degradation products, progression of peripheral arterial disease, and risk of coronary heart disease. Lancet 1993; 342: 84-86
- 46 Speiser W, Speiser P, Minar E, Kominger C, Niessner H, Huber K, Schernthaner G, Ehringer H, Lechner K. Activation of coagulation and fibrinolysis in patients with arteriosclerosis: relation to localization of vessel disease and risk factors. Thromb Res 1990; 59: 77-88
- 47 Jafri SM, Ozawa T, Mammen E, Levine TB, Johnson C, Goldstein S. Platelet function, thrombin and fibrinolytic activity in patients with heart failure. Eur Heart J 1993; 14: 205-212
- 48 Takano K, Yamaguchi T, Uchida KMarkers, Keen GA, Grant A, Stirk C. Fate of fibrinogen in human arterial intima. Arteriosclerosis 1990; 10: 263-275
- 50 Ishida T, Tanaka k. Effects of fibrin and fibrinogen-degradation products on the growth of rabbit aortic smooth muscle cells in culture. Atherosclerosis 1982; 44: 161-174