Download PDF
Thromb Haemost 2000; 84(04): 553-558
DOI: 10.1055/s-0037-1614066
Review Article
Schattauer GmbH

Blood Rheology, Cardiovascular Risk Factors, and Cardiovascular Disease: The West of Scotland Coronary Prevention Study

Gordon Lowe
1   From the Department of Medicine, University of Glasgow, Glasgow, UK
,
Ann Rumley
1   From the Department of Medicine, University of Glasgow, Glasgow, UK
,
John Norrie
2   The Department of Biostatistics, University of Glasgow, Glasgow, UK
,
Ian Ford
2   The Department of Biostatistics, University of Glasgow, Glasgow, UK
,
James Shepherd
3   The Department of Clinical Biochemistry, University of Glasgow, Glasgow, UK
,
Stuart Cobbe
4   The Department of Medical Cardiology, University of Glasgow, University of Glasgow, Glasgow, UK
,
Peter Macfarlane
4   The Department of Medical Cardiology, University of Glasgow, University of Glasgow, Glasgow, UK
,
Christopher Packard
3   The Department of Clinical Biochemistry, University of Glasgow, Glasgow, UK
,
The West of Scotland Coronary Prevention Study Group › Author AffiliationsWe thank Dr. A J Lee for information from the Scottish Heart Health Study/ Glasgow MONICA study; and Susan Lennie, Pamela McColl and Karen McLaughlin for technical assistance. The study was supported by a research grant from Bristol-Myers Squibb, Princeton, New Jersey.
Further Information

Publication History

Received 22 February 2000

Accepted after resubmission 21 April 2000

Publication Date:
11 December 2017 (online)

Also available at
    Permissions and Reprints

Summary

The West of Scotland Coronary Prevention Study (WOSCOPS) showed that pravastatin reduced the risk of coronary heart disease (CHD) events in 6,595 middle-aged hypercholesterolaemic men aged 45–64 years without prior myocardial infarction followed for an average of 4.9 years. We hypothesised prospectively (a) that baseline levels of haemorheological variables were related to baseline and incident CHD and to mortality; and (b) that reduction in lipoproteins by pravastatin would lower plasma and blood viscosity, a potential contributory mechanism to CHD events. We therefore studied plasma and blood viscosity, fibrinogen, haematocrit, and blood cell counts at baseline and 1 year. At baseline, plasma and blood viscosity were related to risk factors, CHD measures, and claudication. On univariate analysis, baseline levels of all rheological variables (except platelet count) were related to incident CHD; CHD mortality; and total mortality. On multivariate analysis including baseline CHD and risk factors, plasma and blood viscosity, haematocrit and white cell count each remained significantly associated with incident CHD; while fibrinogen remained an independent predictor of mortality (all p < 0.03). After one year, lipoprotein reduction by pravastatin was associated with significant reductions (about one quarter of a standard deviation) in plasma viscosity (mean difference 0.02 mPa.s, p <0.001) and in blood viscosity (mean difference 0.06 mPa.s, p <0.001), but was not associated with significant changes in other rheological variables. We therefore suggest that pravastatin therapy, which reduces elevated lipoproteins in hypercholesterolaemic men, may lower risks of CHD and mortality partly by lowering plasma and blood viscosity. Further studies are required to test this hypothesis.

Key words

Rheology - viscosity - coronary heart disease - lipoproteins - pravastatin

* Members of the West of Scotland Coronary Prevention Study Group: J. Shepherd, S. Cobbe, I. Ford, C. Packard, P. Macfarlane, A. R. Lorimer, J. H. McKillop and C. G. Isles


 

  • References

  • 1 Shepherd J, Cobbe SM, Ford I. et al. Prevention of coronary heart disease with pravastatin in men with hypercholesterolaemia. N Engl J Med 1995; 333: 1301-7.
    CrossrefPubMedSearch in Google Scholar
  • 2 West of Scotland Coronary Prevention Study Group. Baseline risk factors and their association with outcome in the West of Scotland Coronary Prevention Study. Am J Cardiol 1997; 79: 750-62.
    PubMedSearch in Google Scholar
  • 3 Levine GN, Keaney Jr JF, Vita JA. Cholesterol reduction in cardiovascular disease. Clinical benefits and possible mechanisms. N Engl J Med 1995; 332: 512-21.
    CrossrefPubMedSearch in Google Scholar
  • 4 Treasure CB, Kline JL, Weintraub WS. et al. Beneficial effects of cholesterol-lowering therapy on the coronary endothelium in patients with coronary artery disease. N Engl J Med 1995; 332: 481-7.
    CrossrefPubMedSearch in Google Scholar
  • 5 Lowe GDO. Blood rheology and vascular disease. In: Bloom AL, Forbes CD, Thomas DP, Tuddenham EGD. Haemostasis and Thrombosis. 03. edn. Edinburgh: Churchill Livingstone; 1994: 1169-88.
    Search in Google Scholar
  • 6 Vaughan CJ, Murphy MB, Buckley BM. Statins do more than just lower cholesterol. Lancet 1996; 348: 1079-82.
    CrossrefPubMedSearch in Google Scholar
  • 7 Lowe GDO, McArdle BM, Stromberg P. et al. Increased blood viscosity and fibrinolytic inhibitor in type II hyperlipoproteinaemia. Lancet 1982; i: 472-5.
    PubMedSearch in Google Scholar
  • 8 Lowe GDO, Smith WCS, Tunstall-Pedoe H. et al. Cardiovascular risk and haemorheology: results from the Scottish Heart Health Study and the MONICA-Project, Glasgow. Clin Hemorheol 1988; 08: 518-24.
    PubMedSearch in Google Scholar
  • 9 Lowe GDO, Wood DA, Douglas JT. et al. Relationships of plasma viscosity, coagulation and fibrinolysis to coronary risk factors and angina. Thromb Haemost 1991; 65: 339-43.
    Thieme ConnectPubMedSearch in Google Scholar
  • 10 Yarnell JWG, Baker IA, Sweetnam PM. et al. Fibrinogen, viscosity and white blood cell count are major risk factors for ischemic heart disease. The Caerphilly and Speedwell Collaborative Heart Disease Studies. Circulation 1991; 83: 836-44.
    CrossrefPubMedSearch in Google Scholar
  • 11 Koenig W, Sund M, Ernst E, Mraz W, Hombach V, Keil U. Association between rheology and components of lipoproteins in human blood. Circulation 1992; 85: 2197-204.
    CrossrefPubMedSearch in Google Scholar
  • 12 Sweetnam PM, Thomas HF, Yarnell JWG, Beswick AD, Baker ID, Elwood PC. Fibrinogen, viscosity and the 10-year incidence of ischaemic heart disease. The Caerphilly and Speedwell Studies. Europ Heart J 1996; 17: 1814-20.
    CrossrefPubMedSearch in Google Scholar
  • 13 Lowe GDO, Lee AJ, Rumley A, Price JF, Fowkes FGR. Blood viscosity and risk of cardiovascular events: the Edinburgh Artery Study. Br J Haematol 1997; 96: 168-73.
    CrossrefPubMedSearch in Google Scholar
  • 14 Koenig W, Sund M, Filipiak B, Doring A, Lowel H, Ernst E. Plasma viscosity and the risk of coronary heart disease: results from the MONICAAugsburg cohort study, 1984 to 1992. Arterioscler Thromb Vasc Biol 1998; 18: 768-72.
    CrossrefPubMedSearch in Google Scholar
  • 15 West of Scotland Coronary Prevention Study Group. A coronary primary prevention study of Scottish men age 45-64 years: trial design. J Clin Epidemiol 1992; 45: 849-60.
    CrossrefPubMedSearch in Google Scholar
  • 16 West of Scotland Coronary Prevention Study Group. Screening experience and baseline characteristics in the West of Scotland Coronary Prevention Study. Am J Cardiol 1995; 76: 485-91.
    CrossrefPubMedSearch in Google Scholar
  • 17 Thorpe JM, Horstall GB, Stone MC. A new red-sensitive micronephelometer. Med Bio Eng 1967; 05: 51-6.
    PubMedSearch in Google Scholar
  • 18 Stone MC, Thorpe JM. Plasma fibrinogen: a major coronary risk factor. J Roy Coll Gen Pract 1985; 35: 565-9.
    PubMedSearch in Google Scholar
  • 19 Whittington RB, Harkness J. Whole-blood viscosity, as determined by plasma viscosity, hematocrit, and shear. Biorheology 1982; 19: 175-84.
    CrossrefPubMedSearch in Google Scholar
  • 20 Collett D. Modelling survival data in medical research. London: Chapman and Hall; 1994
    Search in Google Scholar
  • 21 Lowe GDO, Fowkes FGR, Dawes J. et al. Blood viscosity, fibrinogen and activation of coagulation and leukocytes in peripheral arterial disease and the normal population in the Edinburgh Artery Study. Circulation 1993; 87: 1915-20.
    CrossrefPubMedSearch in Google Scholar
  • 22 Danesh J, Collins R, Appleby P, Peto R. Fibrinogen, C-reactive protein, albumin or white cell count: meta-analyses of prospective studies of coronary heart disease. JAMA 1998; 279: 1477-82.
    CrossrefPubMedSearch in Google Scholar
  • 23 Danesh J, Collins R, Peto R, Lowe GDO. Haematocrit, viscosity, erythrocyte sedimentation rate: meta-analyses of prospective studies of coronary heart disease. Europ Heart J 2000; 21: 515-20.
    CrossrefPubMedSearch in Google Scholar
  • 24 Woodward M, Lowe GDO, Rumley A, Tunstall-Pedoe H. Fibrinogen as a risk factor for coronary heart disease and mortality in middle aged men and women The Scottish Heart Health Study. Europ Heart J 1998; 19: 55-62.
    CrossrefPubMedSearch in Google Scholar
  • 25 Jay RH, Rampling MW, Betteridge DJ. Abnormalities of blood rheology in familial hypercholesterolaemia: effects of treatment. Atherosclerosis 1990; 85: 249-56.
    CrossrefPubMedSearch in Google Scholar
  • 26 WOSCOPS Group. Influence of pravastatin and plasma lipids on clinical events in WOSCOPS. Circulation 1998; 97: 1440-5.
    CrossrefPubMedSearch in Google Scholar
  • 27 Branchi A, Rovellini A, Sommariva D, Gugliandolo C, Fasoli A. Effect of three fibrate derivatives and two HMG - CoA reductase inhibitors on plasma fibrinogen level in patients with primary hypercholesterolaemia. Thromb Haemost 1993; 70: 241-3.
    Thieme ConnectPubMedSearch in Google Scholar
  • 28 Rosenson RS, Tangrey CC. Anti-atherothrombotic properties of statins. Implications for cardiovascular event reduction. JAMA 1998; 279: 1643-50.
    CrossrefPubMedSearch in Google Scholar
  • 29 Leschke M, Höffken H, Motz W, Blanke H, Schöbel F, Strauer BE. Chronisch-intermittierende Urokinasetherapie bei therapierefraktäner Angina pectoris. Dtsch med Wschr 1992; 117: 81.
    Thieme ConnectPubMedSearch in Google Scholar
  • 30 Lee AJ, Mowbray PI, Lowe GDO, Rumley A, Fowkes FGR, Allan PL. Blood viscosity and elevated carotid intima-media thickness in men and women: the Edinburgh Artery Study. Circulation 1998; 97: 1467-73.
    CrossrefPubMedSearch in Google Scholar
  • 31 Cortellaro M, Cofrancesco E, Boschetti C, Cortellaro F, Mancini M, Mariani M, Paoletti R. Effects of fluvastatin and bezafibrate combination on plasma fibrinogen, t-plasminogen activator inhibitor and C-reactive protein levels in coronary artery disease patients with mixed hyperlipidaemia (FACT Study). Thromb Haemost 2000; 83: 549-54.
    Thieme ConnectPubMedSearch in Google Scholar