Haemostatic Variables in Pacific Islanders Apparently Free from Stroke and Ischaemic Heart Disease – The Kitava Study

Staffan Lindeberg; Erik Berntorp; Roland Carlsson; Mats Eliasson; Peter Marckmann

doi:10.1055/s-0038-1655913

Thrombosis and Haemostasis, Table of Contents

Thromb Haemost 1997; 77(01): 094-098
DOI: 10.1055/s-0038-1655913

Coagulation

Schattauer GmbH Stuttgart

Haemostatic Variables in Pacific Islanders Apparently Free from Stroke and Ischaemic Heart Disease – The Kitava Study

Staffan Lindeberg

¹The Department of Community Health Sciences, Lund University, Lund, Sweden

,

Erik Berntorp

²The Department of Coagulation Disorders, Malmö University Hospital, Malmö, Sweden

,

Roland Carlsson

³The Department of Medicine, Central Hospital, Karlstad, Sweden

,

Mats Eliasson

⁴The Department of Medicine, Luleå Hospital and Umeå University, Sweden

,

Peter Marckmann

⁵The Research Department of Human Nutrition, Royal veterinary and Agricultural University, Frederiksberg, Denmark

› Author Affiliations

Abstract

PDF Download

Summary

We cross-sectionally measured plasminogen activator inhibitor-1 (PAI-1) activity, fibrinogen, factor VII (FVII:C) and VIII (FVIII:C) coagulant activity, and von Willebrand factor antigen (VWF:Ag) in 162 traditional horticulturalists older than 40 years from the tropical island of Kitava, Papua New Guinea, where the intake of western food is negligible and where stroke and ischaemic heart disease appear to be absent. Identical analyses were made in Swedish subjects of comparable ages.

Kitavans had markedly lower PAI-1 activity, with 85% of males and 100% of females having PAI-1 activity ≤5 U/ml, as compared with 22 and 14% in Swedish males and females (p <0.0001). Surprisingly, Kitavans also had higher FVII:C, FVIII: C and VWF: Ag. Fibrinogen was 10% lower in Kitavan males while 25% higher in Kitavan females.

The very low PAI-1 activity in Kitavans may explain some of their apparent freedom from cardiovascular disease and probably relates to their extreme leanness.

PDF (1739 kb)

References

References
1 Lindeberg S, Lundh B. Apparent absence of stroke and ischaemic heart disease in a traditional Melanesian island: a clinical study in Kitava. J Intern Med 1993; 233: 269-275
2 Lindeberg S, Nilsson-Ehle P, Terént A, Vessby B, Scherstén B. Cardiovascular risk factors in a Melanesian population apparently free from stroke and ischaemic heart disease – the Kitava study. J Intern Med 1994; 236: 331-340
3 Ernst E, Resch KL. Fibrinogen as a cardiovascular risk factor: a metaanalysis and review of the literature. Ann Intern Med 1993; 118: 956-963
4 Meade TW, Mellows S, Brozovic M, Miller GJ, Chakrabarti RR, North WR, Haines AP, Stirling Y, Imeson JD, Thompson SG. Haemostatic function and ischaemic heart disease: principal results of the Northwick Park Heart Study. Lancet 1986; 02: 533-537
5 Folsom AR, Wu KK, Shahar E, Davis CE. Association of hemostatic variables with prevalent cardiovasscular disease and asymptomatic carotid artery atherosclerosis. The Atherosclerosis Risk in Communities (ARIC) Study Investigators. Arterioscler Thromb 1993; 13: 1829-1836
6 Cortellaro M, Boschetti C, Cofrancesco E, Zanussi C, Catalano M, de GG, Gabrielli L, Lombardi B, Specchia G, Tavazzi L, Cortellaro M, Boschetti C, Cofrancesco E, Zanussi C, Catalano M, Gabrielli L, Lombardi B, Specchia G, Tavazzi L, Tremoli F, Della VolpeA, Polli E. and the PLAT Study Group The PLAT Study: hemostatic function in relation to atherothrombotic ischemic events in vascular disease patients. Principal results. PLAT Study Group. Progetto Lombardo Atero-Trombosi (PLAT) Study Group. Arterioscler Thromb 1992; 12: 1063-1070
7 Conlan MG, Folsom AR, Finch A, Davis CE, Sorlie P, Marcucci G, Wu K. Associations of factor VIII and von Willebrand factor with age, race, sex, and risk factors for atherosclerosis. Thromb Haemost 1993; 70: 380-385
8 Hamsten A, de FaireU, Walldius G, Dahlen G, Szamosi A, Landou C, Blombäck M, Wiman B. Plasminogen activator inhibitor in plasma: risk factor for recurrent myocardial infarction. Lancet 1987; 02: 3-9
9 Gram J, Jespersen J. A selective depression of tissue plasminogen activator (t-PA) activity in euglobulins characterises a risk group among survivors of acute myocardial infarction. Thromb Haemost 1987; 57: 137-139
10 Lindgren A, Lindoff C, Norrving B, Åstedt B, Johansson B. Tissue plasminogen activator and plasminogen activator inhibitor-1 in stroke patients. Stroke 1996; 27: 1066-1071
11 Lindeberg S, Vessby B. Fatty acid composition of cholesterol esters and serum tocopherols in Melanesians apparently free from cardiovascular disease – the Kitava study. Nutr Metab Cardiovasc Dis 1995; 05: 45-53
12 Chmielewska J, Rånby M, Wiman B. Evidence for a rapid inhibitor to plasminogen activator in plasma. Thromb Res 1983; 31: 427-436
13 Becker U, Bartl K, Wahlefeld AW. A functional photometric assay for plasma fibrinogen. Thromb Res 1984; 35: 475-484
14 Holmberg L, Nilsson IM. Genetic variants of von Willebrand’s disease. Br MedJ 1972; 03: 317-320
15 Afifi AA, Clark V. Computer-Aided Multivariate Analysis. 02. ed. New York: Van Nostrand Reinhold Co; 1990: 505
16 Connelly JB, Cooper JA, Meade TW. Strenuous exercise, plasma fibrinogen, and factor VII activity. Br Heart J 1992; 67: 351-354
17 Folsom AR, Wu KK, Davis CE, Conlan MG, Sorlie PD, Szklo M. Population correlates of plasma fibrinogen and factor VII, putative cardiovascular risk factors. Atherosclerosis 1991; 91: 191-205
18 Rankinen T, Rauramaa R, Väisänen S, Penttilä IM, Uusitupa M. Relation of habitual diet and cardiorespiratory fitness to blood coagulation and fibrinolytic factors. Thromb Haemost 1994; 71: 180-183
19 Juhan-Vague I, Alessi MC. Plasminogen activator inhibitor-1 and atherothrombosis. Thromb Haemost 1993; 70: 138-143
20 Eliasson M, Evrin P-E, Lundblad D. Fibrinogen and fibrinolytic variables in relation to anthropometry, lipids and blood pressure. The Northern Sweden MONICA Study. J Clin Epidemiol 1994; 47: 513-524
21 Marckmann P, Sandström B, Jespersen J. Low-fat, high-fiber diet favorably affects several independent risk markers of ischemic heart disease: observations on blood lipids, coagulation, and fibrinolysis from a trial of middle-aged Danes. Am J Clin Nutr 1994; 59: 935-939
22 Jerling JC, Vorster HH, Oosthuizen W, Silvis N, Venter CS. Differences in plasminogen activator inhibitor 1 activity between Blacks and Whites may be diet related. Haemostasis 1994; 24: 364-368
23 Meade TW, Stirling Y, Thompson SG, Vickers MV, Woolf L, Ajdukiewicz AB, Stewart G, Davidson JF, Walker ID, Douglas AS, Richardson IM, Weir RD, Aromaa A, Impivaara O, Maatela J, Hladovec J. An international and interregional comparison of haemostatic variables in the study of ischaemic heart disease. Report of a working group. Int J Epidemiol 1986; 15: 331-336
24 Iso H, Folsom AR, Wu KK, Finch A, Munger RG, Sato S, Shimamoto T, Terao A, Komachi Y. Hemostatic variables in Japanese and Caucasian men. Plasma fibrinogen, factor VIIc, factor VIIIc, and voon Willebrand factor and their relations to cardiovascular disease risk factors. Am J Epidemiol 1989; 130: 925-934
25 Connelly JB, Roderick PJ, Cooper JA, Meade TW, Miller GJ. Positive association between self-reported fatty food consumption and factor VIII coagulant activity, a risk factor for coronary heart disease, in 4246 middle-aged men. Thromb Haemost 1993; 70: 250-252
26 Miller GJ, Martin JC, Webster J, Wilkes H, Miller NE, Wilkinson WH, Meade TW. Association between dietary fat intake and plasma factor VII coagulant activity – a predictor of cardiovascular mortality. Atherosclerosis 1986; 60: 269-277
27 Marckmann P, Sandström B, Jespersen J. Fasting blood coagulation and fibrinolysis of young adults unchanged by reduction in dietary fat content. Arterioscler Thromb 1992; 12: 201-205
28 Mutanen M, Krusius T, Rasanen L, Freese R, Vahtera E, Viikari JS. Habitual diet, platelet function, fibrinogen and factor VII coagulant activity in young Finns. J Intern Med 1995; 237: 577-583
29 Miller GJ. Fibrinogen, Factor VII and other Haemostatic Variables: roles in Primary and Secondary Prevention of Coronary Heart Disease. Cardiovascular Risk Factors 1993; 2: 361-367
30 Marckmann P, Sandström B, Jespersen J. Favorable long-term effect of a low-fat/high-fiber diet on human blood coagulation and fibrinolysis. Arterioscler Thromb 1993; 13: 505-511
31 Tholstrup T, Marckmann P, Jespersen J, Sandström B. Fat high in stearic acid favorably affects blood lipids and factor VII coagulant activity in comparison with ffats high in palmitic acid or high in myristic and Iauric acids. Am J Clin Nutr 1994; 59: 371-377
32 Tholstrup T, Marckmann P, Jespersen J, Vessby B, Jart A, Sandström B. Effect on blood lipids, coagulation, and fibrinolysis of a fat high in myristic acid and a fat high in palmitic acid. Am J Clin Nutr 1994; 60: 919-925
33 Mettinger KL. A study of hemostasis in ischemic cerebrovascular disease. Abnormalities in factor VIII and antithrombin. Thromb Res 1982; 26: 183-192
34 Winocour PH, Neil AW, Farrer M, Kesteven P, Laker MF, Millar JP, Alberti KGMM. Serum insulin, haemostatic function and cardiovascular risk factors in normoglycaemic men and women. Nutr Metab Cardiovasc Dis 1993; 03: 165-172
35 Nilsson TK, Norberg B, Wållberg-Jonsson S, Rantapää DahlqvistS. Von Willebrand factor in plasma as risk indicator for cardiovascular events. J Intern Med 1991; 229: 557-578
36 Silveira AM, Elgue G, Hamsten A, Blombäck M. von Willebrand factor in plasma and urine of men with premature coronary artery disease. Thromb Haemost 1992; 67: 161-165
37 Blann AD, McCollum CN. Adverse influence of cigarette smoking on the endothelium. Thromb Haemost 1993; 70: 707-711
38 Balleisen L, Bailey J, Epping PH, Schulte H, van deLooJ. Epidemiological study on factor VII, factor VIII and fibrinogen in an industrial population: I. Baseline data on the relation to age, gender, body-weight, smoking, alcohol, pill-using, and menopause. Thromb Haemost 1985; 54: 475-479
39 Krobot K, Hense HW, Cremer P, Eberle E, Keil U. Determinants of plasma fibrinogen: relation to body weight, waist-to-hip ratio, smoking, alcohol, age, and sex. Results from the second MONICA Augsburg survey 1989-1990. Arterioscler Thromb 1992; 12: 780-788
40 Eliasson M, Asplund K, Evrin PE, Lundblad D. Relationship of cigarette smoking and snuff dipping to plasma fibrinogen, fibrinolytic variables and serum insulin. The Northern Sweden MONICA Study. Atherosclerosis 1995; 113: 41-53
41 Keys A. Seven Countries. A Multivariate Analysis of Death and Coronary Hearrt Disease. Harvard University Press; Cambridge, Mass: 1980: 381
42 Margetts BM, Jackson AA. Interactions between people's diet and their smoking habits: the dietary and nutritional survey of British adults. B M J 1993; 307: 1381-1384