Platelet Indices and Risk of Death and Cardiovascular Events: Results from a Large Population-Based Cohort Study

Giuseppe Patti; Giuseppe Di Martino; Fabrizio Ricci; Giulia Renda; Sabina Gallina; Viktor Hamrefors; Olle Melander; Richard Sutton; Gunnar Engström; Raffaele De Caterina; Artur Fedorowski

doi:10.1055/s-0039-1694969

Thrombosis and Haemostasis, Table of Contents

Thromb Haemost 2019; 119(11): 1773-1784
DOI: 10.1055/s-0039-1694969

Cellular Haemostasis and Platelets

Georg Thieme Verlag KG Stuttgart · New York

Platelet Indices and Risk of Death and Cardiovascular Events: Results from a Large Population-Based Cohort Study

Authors

Giuseppe Patti

¹Department of Life, Health and Environmental Sciences, University of L'Aquila, L'Aquila, Italy
Giuseppe Di Martino

²Department of Medicine and Ageing Sciences, School of Hygiene and Preventive Medicine, “G. d'Annunzio” University, Chieti, Italy
Fabrizio Ricci

³Department of Clinical Sciences, Lund University, Malmö, Sweden

⁴Department of Neuroscience, Imaging and Clinical Sciences, Institute for Advanced Biomedical Technologies, “G. d'Annunzio” University, Chieti, Italy

⁵Fondazione Villa Serena per la Ricerca, Pescara, Italy
Giulia Renda

⁶Institute of Cardiology, “G. d'Annunzio” University, Chieti, Italy
Sabina Gallina

⁶Institute of Cardiology, “G. d'Annunzio” University, Chieti, Italy
Viktor Hamrefors

³Department of Clinical Sciences, Lund University, Malmö, Sweden

⁷Department of Internal Medicine, Skåne University Hospital, Malmö, Sweden
Olle Melander

³Department of Clinical Sciences, Lund University, Malmö, Sweden

⁷Department of Internal Medicine, Skåne University Hospital, Malmö, Sweden
Richard Sutton

⁸National Heart and Lung Institute, Imperial College London, Hammersmith Hospital Campus, London, United Kingdom
Gunnar Engström

³Department of Clinical Sciences, Lund University, Malmö, Sweden
Raffaele De Caterina

⁹Cardiology Division, Pisa University Hospital, University of Pisa, Pisa, Italy
Artur Fedorowski

³Department of Clinical Sciences, Lund University, Malmö, Sweden

¹⁰Department of Cardiology, Skåne University Hospital, Malmö, Sweden

Abstract

Studies evaluating the relationship between platelet indices and cardiovascular (CV) outcomes yielded conflicting results. We assessed the incidence of adverse events according to baseline quintiles of platelet indices in the prospective cohort of the Malmö Diet and Cancer Study. A total of 30,314 individuals (age 57 ± 8 years) were followed for a median of 16 years (468,490 person-years). Outcome measures included all-cause death, CV death, myocardial infarction (MI), and ischemic stroke. The fifth quintile of platelet count (> 274.6 × 10⁹/L) was associated with higher incidence of all-cause death (hazard ratio [HR] 1.20, 95% confidence interval [CI] 1.09–1.32, p < 0.001), CV death (HR 1.19, 95% CI 1.00–1.42; p = 0.044), MI (HR 1.32, 95% CI 1.12–1.54; p = 0.001), and ischemic stroke (HR 1.27, 95% CI 1.08–1.50, p = 0.004) compared with the first quintile (≤ 185 × 10⁹/L), and also associated with a lower survival, regardless of previous history of MI (p for interaction = 0.58) or stroke (p for interaction = 0.42). In the highest quintile, history of stroke had a higher risk of CV death (HR 3.18, 95% CI 1.54–6.54) compared with no previous stroke (HR 1.12, 95% CI 0.96–1.31). The risk of MI and stroke was greatest in the fifth quintile, regardless of previous MI or previous stroke, respectively. The risk of all adverse events was similar across different quintiles of mean platelet volume. In conclusion, elevated platelet count is associated with higher mortality and risk of CV events, regardless of previous MI and stroke. Platelet count may thus be a useful marker for further stratification of CV risk, and especially of death.

Keywords

population-based - platelet count - death - cardiovascular outcome

Full Text

References

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