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Liu L, Gracely EJ, Zhao X, Gliebus GP, May NS, Volpe SL, Shi J, DiMaria-Ghalili RA, Eisen HJ. Association of multiple metabolic and cardiovascular markers with the risk of cognitive decline and mortality in adults with Alzheimer's disease and AD-related dementia or cognitive decline: a prospective cohort study. Front Aging Neurosci 2024; 16:1361772. [PMID: 38628973 PMCID: PMC11020085 DOI: 10.3389/fnagi.2024.1361772] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/26/2023] [Accepted: 02/26/2024] [Indexed: 04/19/2024] Open
Abstract
Background and objectives There is a scarcity of data stemming from large-scale epidemiological longitudinal studies focusing on potentially preventable and controllable risk factors for Alzheimer's disease (AD) and AD-related dementia (ADRD). This study aimed to examine the effect of multiple metabolic factors and cardiovascular disorders on the risk of cognitive decline and AD/ADRD. Methods We analyzed a cohort of 6,440 participants aged 45-84 years at baseline. Multiple metabolic and cardiovascular disorder factors included the five components of the metabolic syndrome [waist circumference, high blood pressure (HBP), elevated glucose and triglyceride (TG) concentrations, and reduced high-density lipoprotein cholesterol (HDL-C) concentrations], C-reactive protein (CRP), fibrinogen, interleukin-6 (IL-6), factor VIII, D-dimer, and homocysteine concentrations, carotid intimal-medial thickness (CIMT), and urine albumin-to-creatinine ratio (ACR). Cognitive decline was defined using the Cognitive Abilities Screening Instrument (CASI) score, and AD/ADRD cases were classified using clinical diagnoses. Results Over an average follow-up period of 13 years, HBP and elevated glucose, CRP, homocysteine, IL-6, and ACR concentrations were significantly associated with the risk of mortality in the individuals with incident AD/ADRD or cognitive decline. Elevated D-dimer and homocysteine concentrations, as well as elevated ACR were significantly associated with incident AD/ADRD. Elevated homocysteine and ACR were significantly associated with cognitive decline. A dose-response association was observed, indicating that an increased number of exposures to multiple risk factors corresponded to a higher risk of mortality in individuals with cognitive decline or with AD/ADRD. Conclusion Findings from our study reaffirm the significance of preventable and controllable factors, including HBP, hyperglycemia, elevated CRP, D-dimer, and homocysteine concentrations, as well as, ACR, as potential risk factors for cognitive decline and AD/ADRD.
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Affiliation(s)
- Longjian Liu
- Department of Epidemiology and Biostatistics, Dornsife School of Public Health, Drexel University, Philadelphia, PA, United States
| | - Edward J. Gracely
- Department of Epidemiology and Biostatistics, Dornsife School of Public Health, Drexel University, Philadelphia, PA, United States
- Department of Family, Community & Preventive Medicine, College of Medicine, Drexel University, Philadelphia, PA, United States
| | - Xiaopeng Zhao
- Department of Mechanical, Aerospace, and Biomedical Engineering, University of Tennessee, Knoxville, Knoxville, TN, United States
| | - Gediminas P. Gliebus
- Department of Neurology, College of Medicine, Drexel University Philadelphia, Philadelphia, PA, United States
| | - Nathalie S. May
- Department of Medicine, College of Medicine, Drexel University, Philadelphia, PA, United States
| | - Stella L. Volpe
- Department of Human Nutrition, Foods, and Exercise, Virginia Polytechnic Institute and State University, Blacksburg, VA, United States
| | - Jingyi Shi
- Department of Mathematics and Statistics, Mississippi State University, Starkville, MS, United States
| | - Rose Ann DiMaria-Ghalili
- Doctoral Nursing Department, Nutrition Science Department, College of Nursing and Health Professions, Drexel University, Philadelphia, PA, United States
| | - Howard J. Eisen
- Clinical Research for the Advanced Cardiac and Pulmonary Vascular Disease Program, Thomas Jefferson University Hospital, Philadelphia, PA, United States
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Khalilian S, Mohajer Z, Ghafouri-Fard S. Factor VIII as a Novel Biomarker for Diagnosis, Prognosis, and Therapy Prediction in Human Cancer and Other Disorders. Avicenna J Med Biotechnol 2024; 16:68-80. [PMID: 38618505 PMCID: PMC11007370 DOI: 10.18502/ajmb.v16i2.14857] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/12/2023] [Accepted: 10/28/2023] [Indexed: 04/16/2024] Open
Abstract
Coagulation factor VIII (FVIII) is an essential cofactor in the coagulation cascade, encoded by the F8 gene on the long arm of chromosome X (Xq28). FVIII is normally circulated in complex with Von Willebrand factor (VWF) and has relevant emerging extracoagulative functions. Dysregulation of FVIII is associated with tumor progression, and could be used as a novel biomarker for tumor screening and monitoring. In breast cancer, bladder cancer, colorectal carcinoma, esophageal carcinoma, hepatocellular carcinoma and lung cancer, F8 is regarded as an oncogene. In coronary heart disease, hemophilia A and liver disease, F8 dysregulation has been recognized as a potential biomarker for disease diagnosis and prognosis. However, the basis of these differential expression levels remains to be understood. In this review, which is a mixture of literature review and bioinformatics analysis we described the biological functions and characteristics of FVIII, and also its expression level in non-malignant disorders and various cancers.
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Affiliation(s)
- Sheyda Khalilian
- Student Research Committee, School of Medicine, Shahid Beheshti University of Medical Sciences, Tehran, Iran
- Department of Medical Genetics, School of Medicine, Shahid Beheshti University of Medical Sciences, Tehran, Iran
- USERN Office, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Zahra Mohajer
- Student Research Committee, School of Medicine, Shahid Beheshti University of Medical Sciences, Tehran, Iran
- USERN Office, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Soudeh Ghafouri-Fard
- Department of Medical Genetics, School of Medicine, Shahid Beheshti University of Medical Sciences, Tehran, Iran
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Jaime Garcia D, Chagnot A, Wardlaw JM, Montagne A. A Scoping Review on Biomarkers of Endothelial Dysfunction in Small Vessel Disease: Molecular Insights from Human Studies. Int J Mol Sci 2023; 24:13114. [PMID: 37685924 PMCID: PMC10488088 DOI: 10.3390/ijms241713114] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/23/2023] [Revised: 08/19/2023] [Accepted: 08/21/2023] [Indexed: 09/10/2023] Open
Abstract
Small vessel disease (SVD) is a highly prevalent disorder of the brain's microvessels and a common cause of dementia as well as ischaemic and haemorrhagic strokes. Though much about the underlying pathophysiology of SVD remains poorly understood, a wealth of recently published evidence strongly suggests a key role of microvessel endothelial dysfunction and a compromised blood-brain barrier (BBB) in the development and progression of the disease. Understanding the causes and downstream consequences associated with endothelial dysfunction in this pathological context could aid in the development of effective diagnostic and prognostic tools and provide promising avenues for potential therapeutic interventions. In this scoping review, we aim to summarise the findings from clinical studies examining the role of the molecular mechanisms underlying endothelial dysfunction in SVD, focussing on biochemical markers of endothelial dysfunction detectable in biofluids, including cell adhesion molecules, BBB transporters, cytokines/chemokines, inflammatory markers, coagulation factors, growth factors, and markers involved in the nitric oxide cascade.
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Affiliation(s)
- Daniela Jaime Garcia
- Centre for Clinical Brain Sciences, University of Edinburgh, Edinburgh EH16 4SB, UK; (D.J.G.); (J.M.W.)
- UK Dementia Research Institute, University of Edinburgh, Edinburgh EH16 4SB, UK;
| | - Audrey Chagnot
- UK Dementia Research Institute, University of Edinburgh, Edinburgh EH16 4SB, UK;
| | - Joanna M. Wardlaw
- Centre for Clinical Brain Sciences, University of Edinburgh, Edinburgh EH16 4SB, UK; (D.J.G.); (J.M.W.)
- UK Dementia Research Institute, University of Edinburgh, Edinburgh EH16 4SB, UK;
| | - Axel Montagne
- Centre for Clinical Brain Sciences, University of Edinburgh, Edinburgh EH16 4SB, UK; (D.J.G.); (J.M.W.)
- UK Dementia Research Institute, University of Edinburgh, Edinburgh EH16 4SB, UK;
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Iglesias Morcillo M, Freuer D, Peters A, Heier M, Teupser D, Meisinger C, Linseisen J. Association between fatty liver index and blood coagulation markers: a population-based study. Lipids Health Dis 2023; 22:83. [PMID: 37386502 PMCID: PMC10308678 DOI: 10.1186/s12944-023-01854-8] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/19/2023] [Accepted: 06/19/2023] [Indexed: 07/01/2023] Open
Abstract
BACKGROUND Population-based studies investigating the association between blood coagulation markers and non-alcoholic fatty liver disease (NAFLD) are rare. Thus, we aimed to investigate the relationship between the Fatty Liver Index (FLI) as a measure of hepatic steatosis and plasma concentrations of antithrombin III, D-dimer, fibrinogen D, protein C, protein S, factor VIII, activated partial thromboplastin time (aPTT), quick value and international thromboplastin time (INR) in the general population. METHODS After the exclusion of participants with anticoagulative treatment, 776 participants (420 women and 356 men, aged 54-74 years) of the population-based KORA Fit study with analytic data on hemostatic factors were included in the present analysis. Linear regression models were used to explore the associations between FLI and hemostatic markers, adjusted for sex, age, alcohol consumption, education, smoking status, and physical activity. In a second model, additional adjustments were made for the history of stroke, hypertension, myocardial infarction, serum non-HDL cholesterol levels, and diabetes status. In addition, analyses were stratified by diabetes status. RESULTS In the multivariable models (with or without health conditions), significantly positive associations with FLI were obtained for plasma concentrations of D-dimers, factor VIII, fibrinogen D, protein C, protein S, and quick value, while INR and antithrombin III were inversely associated. These associations were weaker in pre-diabetic subjects and largely disappeared in diabetic patients. CONCLUSION In this population-based study, an increased FLI is clearly related to changes in the blood coagulation system, possibly increasing the risk of thrombotic events. Due to a generally more pro-coagulative profile of hemostatic factors, such an association is not visible in diabetic subjects.
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Affiliation(s)
| | - Dennis Freuer
- Epidemiology, University of Augsburg, University Hospital Augsburg, Stenglinstr. 2, Augsburg, 86156, Germany
| | - Anette Peters
- Institute of Epidemiology, Helmholtz Zentrum München - German Research Center for Environmental Health (GmbH), Neuherberg, 85764, Germany
- Chair of Epidemiology, Institute for Medical Information Processing, Biometry and Epidemiology, Medical Faculty, Ludwig-Maximilians-Universität München, Munich, 81377, Germany
- German Center for Diabetes Research (DZD), Munich-Neuherberg, 85764, Germany
| | - Margit Heier
- Institute of Epidemiology, Helmholtz Zentrum München - German Research Center for Environmental Health (GmbH), Neuherberg, 85764, Germany
- KORA Study Centre, University Hospital Augsburg, Augsburg, 86156, Germany
| | - Daniel Teupser
- Institute of Laboratory Medicine, Medical Faculty, Ludwig-Maximilians-Universität München, Munich, 81377, Germany
| | - Christine Meisinger
- Epidemiology, University of Augsburg, University Hospital Augsburg, Stenglinstr. 2, Augsburg, 86156, Germany
| | - Jakob Linseisen
- Epidemiology, University of Augsburg, University Hospital Augsburg, Stenglinstr. 2, Augsburg, 86156, Germany.
- Institute for Medical Information Processing, Biometry and Epidemiology, Medical Faculty, Ludwig-Maximilians-Universität München, Munich, 81377, Germany.
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Kamstrup P, Sivapalan P, Rønn C, Rastoder E, Modin D, Kristensen AK, Bendstrup E, Sørensen R, Biering-Sørensen T, Ulrik CS, Vestbo J, Jensen JU. Fibrin degradation products and survival in patients with chronic obstructive pulmonary disease: a protocolized prospective observational study. Respir Res 2023; 24:172. [PMID: 37370121 DOI: 10.1186/s12931-023-02472-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/24/2023] [Accepted: 06/08/2023] [Indexed: 06/29/2023] Open
Abstract
BACKGROUND Patients with chronic obstructive pulmonary disease (COPD) have a high incidence of cardiovascular disease including thromboembolisms. Fibrin degradation products, like D-dimer, have been associated with death from all causes in healthy individuals and COPD patients. We aimed to determine the (i) association between D-dimer levels and all-cause mortality and time being alive and out of a hospital, (ii) possible modifying effect of anticoagulant treatment,, and (iii) distribution of D-dimer in patients with moderate to severe COPD. METHODS Results of routinely measured stable phase D-dimer samples from COPD-outpatients at Copenhagen University Hospital - Herlev and Gentofte, COPD-outpatient clinic were collected using the Danish registries. These were used to examine whether COPD-patients with a D-dimer level in the upper quartile, had a higher risk of death from all causes within 365 days. RESULTS In the unadjusted Cox proportional hazards regression we found an association between high D-dimer and all-cause mortality: Hazard ratio (HR): 2.3 (95% Confidence Interval (CI) 1.1-4.7). In the fully adjusted regression, the HR was 1.8 (CI 0.8-3.9). We did not find any interaction between D-dimer and anticoagulant or antiplatelet therapy. For the secondary outcome, proportion of days alive and out of hospital in 365 days (pDAOH), the unadjusted multiple linear regression had an association between high D-dimer level and pDAOH: -2.7% points (pp) (CI -3.9 pp - -1.5 pp), which was attenuated to -1,7pp (-2.9pp - -0.4pp) in the fully adjusted regression. CONCLUSIONS In patients with moderate to severe COPD, patients with a high level of D-dimer were more likely to die; however, the signal was not strong in the adjusted analyses and our results do not support unselected risk stratification with D-dimer in COPD-outpatients.
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Affiliation(s)
- Peter Kamstrup
- Section of Respiratory Medicine, Copenhagen University Hospital Herlev and Gentofte, Hellerup, 2900, Denmark
| | - Pradeesh Sivapalan
- Section of Respiratory Medicine, Copenhagen University Hospital Herlev and Gentofte, Hellerup, 2900, Denmark
| | - Christian Rønn
- Section of Respiratory Medicine, Copenhagen University Hospital Herlev and Gentofte, Hellerup, 2900, Denmark
| | - Ema Rastoder
- Section of Respiratory Medicine, Copenhagen University Hospital Herlev and Gentofte, Hellerup, 2900, Denmark
| | - Daniel Modin
- Department of Cardiology, Copenhagen University Hospital Herlev and Gentofte, Hellerup, 2900, Denmark
| | - Anna Kjaer Kristensen
- Section of Respiratory Medicine, Copenhagen University Hospital Herlev and Gentofte, Hellerup, 2900, Denmark
| | - Elisabeth Bendstrup
- Department Respiratory Disease and Allergy, Aarhus University Hospital, Aarhus, 8000, Denmark
- Department of Clinical Medicine, Aarhus University, Aarhus, 8200, Denmark
| | - Rikke Sørensen
- Department of Cardiology, Copenhagen University Hospital Rigshospitalet, Copenhagen, 2100, Denmark
| | - Tor Biering-Sørensen
- Department of Cardiology, Copenhagen University Hospital Herlev and Gentofte, Hellerup, 2900, Denmark
| | - Charlotte Suppli Ulrik
- Department of Clinical Medicine, University of Copenhagen, Copenhagen, 2200, Denmark
- Department of Respiratory Medicine, Copenhagen University Hospital-Hvidovre, Hvidovre, 2650, Denmark
| | - Jørgen Vestbo
- The North West Lung Centre, Wythenshawe Hospital, Manchester University NHS Foundation Trust, Manchester, M13 9PL, UK
- Division of Infection, Immunity and Respiratory Medicine, School of Biological Sciences, The University of Manchester, Manchester Academic Health Science Centre, Manchester, M13 9PL, UK
| | - Jens-Ulrik Jensen
- Section of Respiratory Medicine, Copenhagen University Hospital Herlev and Gentofte, Hellerup, 2900, Denmark.
- Department of Clinical Medicine, University of Copenhagen, Copenhagen, 2200, Denmark.
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6
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Twine CP, Kakkos SK, Aboyans V, Baumgartner I, Behrendt CA, Bellmunt-Montoya S, Jilma B, Nordanstig J, Saratzis A, Reekers JA, Zlatanovic P, Antoniou GA, de Borst GJ, Bastos Gonçalves F, Chakfé N, Coscas R, Dias NV, Hinchliffe RJ, Kolh P, Lindholt JS, Mees BME, Resch TA, Trimarchi S, Tulamo R, Vermassen FEG, Wanhainen A, Koncar I, Fitridge R, Matsagkas M, Valgimigli M. Editor's Choice - European Society for Vascular Surgery (ESVS) 2023 Clinical Practice Guidelines on Antithrombotic Therapy for Vascular Diseases. Eur J Vasc Endovasc Surg 2023; 65:627-689. [PMID: 37019274 DOI: 10.1016/j.ejvs.2023.03.042] [Citation(s) in RCA: 36] [Impact Index Per Article: 36.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/02/2023] [Accepted: 03/03/2023] [Indexed: 04/05/2023]
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7
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Iglesias Morcillo M, Freuer D, Peters A, Heier M, Meisinger C, Linseisen J. Body Mass Index and Waist Circumference as Determinants of Hemostatic Factors in Participants of a Population-Based Study. MEDICINA (KAUNAS, LITHUANIA) 2023; 59:228. [PMID: 36837430 PMCID: PMC9962601 DOI: 10.3390/medicina59020228] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/24/2022] [Revised: 01/20/2023] [Accepted: 01/23/2023] [Indexed: 01/28/2023]
Abstract
Background: In contrast to studies in patients, an association between obesity and blood coagulation factors has not been established in the population. If confirmed it could become a target for primary prevention. Objective: To investigate the relationship between Body Mass Index (BMI) and waist circumference (WC) with plasma concentrations of antithrombin III, D-dimers, fibrinogen D, protein S, factor VIII, activated partial thromboplastin time (aPTT), quick value, and international normalized ratio (INR) in the general population. Materials and Methods: Participants of the Cooperative Health Research in the Region of Augsburg (KORA) S4 study who took part in the KORA Fit follow-up (2018-2019, aged 54-74 years) examination were eligible. Citrate plasma samples were collected in fasted participants. After the exclusion of participants with anticoagulative treatment, 776 participants (420 women and 356 men) with analytic data on hemostatic factors were included in the present analysis. Linear regression models were used to explore the association between BMI or WC with hemostatic markers, adjusted for sex, age, alcohol consumption, education, smoking status, and physical activity. In a second model, additional adjustments were made for the prevalence of stroke, hypertension, myocardial infarction, serum non-HDL cholesterol, and serum triglycerides. Results: In the multivariable models (with or without health conditions), significant positive associations with BMI were obtained for plasma concentrations of D-dimers, factor VIII, fibrinogen D, protein S, and quick value, while INR and antithrombin III were inversely associated. Similar to BMI, WC was significantly associated with all hemostatic factors, except for aPTT. Conclusion: In this population-based study, both increasing BMI and WC affect the blood coagulation system. Thus, modification of a prothrombotic coagulation profile emerged as a potential target for primary prevention in obese subjects.
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Affiliation(s)
| | - Dennis Freuer
- Chair of Epidemiology, University of Augsburg, 86156 Augsburg, Germany
| | - Annette Peters
- Institute of Epidemiology, Helmholtz Zentrum München, 85764 Neuherberg, Germany
- Chair of Epidemiology, Institute for Medical Information Processing, Biometry and Epidemiology, Medical Faculty, Ludwig-Maximilians-Universität München, 81377 München, Germany
| | - Margit Heier
- Institute of Epidemiology, Helmholtz Zentrum München, 85764 Neuherberg, Germany
- KORA Study Centre, University Hospital Augsburg, 86156 Augsburg, Germany
| | | | - Jakob Linseisen
- Chair of Epidemiology, University of Augsburg, 86156 Augsburg, Germany
- Institute for Medical Information Processing, Biometry and Epidemiology, Ludwig-Maximilians-Universität München, 81377 München, Germany
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Lowe GDO, Peters SAE, Rumley A, Tunstall-Pedoe H, Woodward M. Associations of Hemostatic Variables with Cardiovascular Disease and Total Mortality: The Glasgow MONICA Study. TH OPEN 2022; 6:e107-e113. [DOI: 10.1055/s-0042-1747687] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/13/2021] [Accepted: 02/28/2022] [Indexed: 10/18/2022] Open
Abstract
AbstractThe associations of plasma levels of hemostatic factors, other than fibrinogen, with risks of cardiovascular disease (CVD) and all-cause mortality are not well defined. In two phases of the Glasgow MONICA study, we assayed coagulation factors (VII, VIII, IX, and von Willebrand factor), coagulation inhibitors (antithrombin, protein C, protein S), coagulation activation markers (prothrombin fragment 1 + 2, thrombin–antithrombin complexes, D-dimer), and the fibrinolytic factors, tissue plasminogen activator (t-PA) antigen and plasminogen activator inhibitor type 1. Over 15 to 20 years, we followed up between 382 and 1,123 men and women aged 30 to 74 years, without baseline CVD, for risks of CVD and mortality. Age- and sex-adjusted hazard ratios (HRs) for CVD (top third vs bottom third) were significant only for factor VIII (1.30; 95% confidence interval [CI], 1.06–1.58) and factor IX (1.18; 95% CI, 1.01–1.39); these HRs were attenuated by further adjustment for CVD risk factors: 1.17 (95% CI, 0.94–1.46) and 1.07 (95% CI, 0.92–1.25), respectively. In contrast, factor VIII (HR, 1.63; 95% CI, 1.35–1.96), D-dimer (HR, 2.34; 95% CI, 1.26–4.35), and t-PA (HR, 2.81; 95% CI, 1.43–5.54) were strongly associated with mortality after full risk factor adjustment. Further studies, including meta-analyses, are required to assess the associations of these hemostatic factors with the risks of stroke and heart disease and causes of mortality.
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Affiliation(s)
- Gordon D. O. Lowe
- Institute of Cardiovascular and Medical Sciences, University of Glasgow, Glasgow, United Kingdom
| | - Sanne A. E. Peters
- The George Institute for Global Health, University of New South Wales, Sydney, Australia
- Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht University, Utrecht, The Netherlands
- The George Institute for Global Health, Imperial College London, London, United Kingdom
| | - Ann Rumley
- Institute of Cardiovascular and Medical Sciences, University of Glasgow, Glasgow, United Kingdom
| | - Hugh Tunstall-Pedoe
- Cardiovascular Epidemiology Unit, Institute of Cardiovascular Research, University of Dundee, Dundee, United Kingdom
| | - Mark Woodward
- The George Institute for Global Health, University of New South Wales, Sydney, Australia
- The George Institute for Global Health, Imperial College London, London, United Kingdom
- Cardiovascular Epidemiology Unit, Institute of Cardiovascular Research, University of Dundee, Dundee, United Kingdom
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Lowe G, Peters SA, Rumley A, Tunstall-Pedoe H, Woodward M. ASSOCIATIONS OF HAEMOSTATIC VARIABLES WITH CARDIOVASCULAR DISEASE AND TOTAL MORTALITY - THE GLASGOW MONICA STUDY. TH OPEN 2022. [PMID: 35707625 PMCID: PMC9135477 DOI: 10.1055/a-1789-4896] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022] Open
Abstract
The associations of plasma levels of hemostatic factors, other than fibrinogen, with risks of cardiovascular disease (CVD) and all-cause mortality are not well defined. In two phases of the Glasgow MONICA study, we assayed coagulation factors (VII, VIII, IX, and von Willebrand factor), coagulation inhibitors (antithrombin, protein C, protein S), coagulation activation markers (prothrombin fragment 1 + 2, thrombin–antithrombin complexes, D-dimer), and the fibrinolytic factors, tissue plasminogen activator (t-PA) antigen and plasminogen activator inhibitor type 1. Over 15 to 20 years, we followed up between 382 and 1,123 men and women aged 30 to 74 years, without baseline CVD, for risks of CVD and mortality. Age- and sex-adjusted hazard ratios (HRs) for CVD (top third vs bottom third) were significant only for factor VIII (1.30; 95% confidence interval [CI], 1.06–1.58) and factor IX (1.18; 95% CI, 1.01–1.39); these HRs were attenuated by further adjustment for CVD risk factors: 1.17 (95% CI, 0.94–1.46) and 1.07 (95% CI, 0.92–1.25), respectively. In contrast, factor VIII (HR, 1.63; 95% CI, 1.35–1.96), D-dimer (HR, 2.34; 95% CI, 1.26–4.35), and t-PA (HR, 2.81; 95% CI, 1.43–5.54) were strongly associated with mortality after full risk factor adjustment. Further studies, including meta-analyses, are required to assess the associations of these hemostatic factors with the risks of stroke and heart disease and causes of mortality.
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Affiliation(s)
- Gordon Lowe
- University of Glasgow, Glasgow, United Kingdom of Great Britain and Northern Ireland
| | - Sanne A.E. Peters
- Imperial College London Faculty of Medicine, London, United Kingdom of Great Britain and Northern Ireland
| | - Ann Rumley
- University of Glasgow, Glasgow, United Kingdom of Great Britain and Northern Ireland
| | - Hugh Tunstall-Pedoe
- University of Dundee Division of Medical Sciences, Dundee, United Kingdom of Great Britain and Northern Ireland
| | - Mark Woodward
- George Institute for Global Health, University of New South Wales, Sydney, Australia
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Associations of D-Dimer with Computed Tomographic Lung Abnormalities, Serum Biomarkers of Lung Injury, and Forced Vital Capacity: MESA Lung Study. Ann Am Thorac Soc 2021; 18:1839-1848. [PMID: 33861685 PMCID: PMC8641831 DOI: 10.1513/annalsats.202012-1557oc] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/30/2022] Open
Abstract
Rationale: The coagulation cascade may play a role in the pathogenesis of interstitial lung disease through increased production of thrombin and fibrin deposition. Whether circulating coagulation cascade factors are linked to lung inflammation and scarring among community-dwelling adults is unknown. Objectives: To test the hypothesis that higher baseline D-dimer concentrations are associated with markers of early lung injury and scarring. Methods: Using the MESA (Multi-Ethnic Study of Atherosclerosis) cohort (n = 6,814), we examined associations of baseline D-dimer concentrations with high attenuation areas from examination 1 (2000-2002; n = 6,184) and interstitial lung abnormalities from examination 5 computed tomographic (CT) scans (2010-2012; n = 2,227), and serum MMP-7 (matrix metalloproteinase-7) and SP-A (surfactant protein-A) from examination 1 (n = 1,098). We examined longitudinal change in forced vital capacity (FVC) from examinations 3-6 (2004-2018, n = 3,562). We used linear logistic regression and linear mixed models to examine associations and adjust for potential confounders. Results: The mean (standard deviation) age of the cohort was 62 (10) years, and the D-dimer concentration was 0.35 (0.69) ug/ml. For every 10% increase in D-dimer concentration, there was an increase in high attenuation area percentage of 0.27 (95% confidence interval (CI), 0.08-0.47) after adjustment for covariates. Associations were stronger among those older than 65 years (P values for interaction < 0.001). A 10% increase in D-dimer concentration was associated with an odds ratio of 1.05 for interstitial lung abnormalities (95% CI, 0.99-1.11). Higher D-dimer concentrations were associated with higher serum MMP-7 and a faster decline in FVC. D-dimer was not associated with SP-A. Conclusions: Higher D-dimer concentrations were associated with a greater burden of lung parenchymal abnormalities detected on CT scan, MMP-7, and FVC decline among community-dwelling adults.
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Evensen LH, Folsom AR, Pankow JS, Hansen JB, Allison MA, Cushman M, Lutsey PL. Hemostatic factors, inflammatory markers, and risk of incident venous thromboembolism: The Multi-Ethnic Study of Atherosclerosis. J Thromb Haemost 2021; 19:1718-1728. [PMID: 33773045 PMCID: PMC8606033 DOI: 10.1111/jth.15315] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Revised: 03/18/2021] [Accepted: 03/24/2021] [Indexed: 01/20/2023]
Abstract
BACKGROUND Several hemostatic factors and inflammatory markers are associated with the risk of incident venous thromboembolism (VTE), however, most existing data are from case-control studies in Caucasian populations. OBJECTIVES We aimed to prospectively confirm previous findings and explore less studied biomarkers in relation to VTE risk in a multi-racial/multi-ethnic cohort. METHODS Circulating levels of factor VIII, fibrinogen, D-dimer, plasmin-antiplasmin complex (PAP), C-reactive protein (CRP), and interleukin-6 (IL-6) were measured at baseline (2000-2002) in 6706 participants of the Multi-Ethnic Study of Atherosclerosis. Incident VTE was identified using hospitalization discharge codes from baseline to December 31, 2015. Hazard ratios (HRs) of VTE were estimated in Cox regression models. RESULTS There were 227 events during a median of 14 years of follow-up. Compared with participants in the lowest quartile, the HRs for those above the 95th percentile and p for trend across categories were 3.50 (95% confidence interval [CI] 1.98-6.19; p < .001) for D-dimer, 1.49 (95% CI 0.84-2.63; p = .02) for factor VIII, 1.32 (95% CI 0.76-2.28; p = .99) for fibrinogen, 1.92 (95% CI 1.08-3.42; p = .15) for PAP, 1.68 (95% CI 0.81-3.48; p = .08) for CRP, and 2.55 (95% CI 1.15-5.66; p = .07) for IL-6, after adjustment for demographics and body mass index. For CRP and IL-6, follow-up was restricted to 10 years because of violations of the proportional hazards assumption. No significant interactions by age/ethnicity were observed. CONCLUSIONS We demonstrated a fairly novel association between PAP and risk of incident VTE, and contributed further prospective confirmation regarding the associations of D-dimer, factor VIII, and IL-6 with VTE.
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Affiliation(s)
- Line H. Evensen
- K.G. Jebsen - Thrombosis Research and Expertise Center (TREC), Department of Clinical Medicine, UiT-The Arctic University of Norway, Tromsø, Norway
- Division of Epidemiology and Community Health, School of Public Health, University of Minnesota, Minneapolis, MN, USA
| | - Aaron R. Folsom
- Division of Epidemiology and Community Health, School of Public Health, University of Minnesota, Minneapolis, MN, USA
| | - James S. Pankow
- Division of Epidemiology and Community Health, School of Public Health, University of Minnesota, Minneapolis, MN, USA
| | - John-Bjarne Hansen
- K.G. Jebsen - Thrombosis Research and Expertise Center (TREC), Department of Clinical Medicine, UiT-The Arctic University of Norway, Tromsø, Norway
- Division of Internal Medicine, Tromsø, University Hospital of North Norway, Tromsø, Norway
| | - Matthew A. Allison
- Department of Family Medicine and Public Health, University of California, San Diego, CA, USA
| | - Mary Cushman
- Department of Medicine and Pathology & Laboratory Medicine, University of Vermont, College of Medicine, Burlington, VT, USA
| | - Pamela L. Lutsey
- Division of Epidemiology and Community Health, School of Public Health, University of Minnesota, Minneapolis, MN, USA
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12
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Marchetti M, Falanga A. Hemostatic biomarkers in occult cancer and cancer risk prediction. Thromb Res 2021; 191 Suppl 1:S37-S42. [PMID: 32736777 DOI: 10.1016/s0049-3848(20)30395-9] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/01/2019] [Revised: 01/09/2020] [Accepted: 01/10/2020] [Indexed: 12/20/2022]
Abstract
Cancer patients present with abnormalities of coagulation tests, reflecting a hypercoagulable state, often asso- ciated with a high incidence of thrombotic complications and poor disease prognosis. Different degrees of blood clotting abnormalities are described in diverse cancers, depending on tumor types and stage. The mechanisms of hemostasis that are critically involved in thrombosis are also implicated in tumor progression, angiogenesis, and metastatic spread. In this review, we summarize the results of published studies and focus on ongoing research and future directions of clotting factors and clotting activation bioproducts as biomarkers for cancer disease diagnosis and in cancer risk prediction.
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Affiliation(s)
- Marina Marchetti
- Department of Immunohematology and Transfusion Medicine, Hospital Papa Giovanni XXIII, Bergamo, Italy.
| | - Anna Falanga
- Department of Immunohematology and Transfusion Medicine, Hospital Papa Giovanni XXIII, Bergamo, Italy; University of Milan Bicocca, School of Medicine, Italy
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13
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The plasma D-dimer trends and their value in acute lower limb ischemia patients treated by catheter directed thrombolysis. Sci Rep 2021; 11:10388. [PMID: 34001969 PMCID: PMC8128900 DOI: 10.1038/s41598-021-89905-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/08/2021] [Accepted: 05/04/2021] [Indexed: 11/20/2022] Open
Abstract
To investigate the change trends of plasma D-dimer during catheter-directed thrombolysis (CDT) in acute lower limb ischemia (ALI) patients and their clinical value. A retrospective review of patients with ALI who received CDT was carried out. The repeated measurements of plasma D-dimer were analyzed by generalized estimating equations (GEEs) and the change trends of D-dimer were analyzed by spline regression approach. A total of 150 patients were included. Among them, 3 days of CDT was ineffective in 41 cases, effective in 33 cases and markedly effective in 76 cases. The results of GEEs analysis showed that serum D-dimer changed significantly with time (time effect, P < 0.001). Serum D-dimer levels of patients with different treatment outcomes were different after treatment (group effect, P < 0.001), and serum D-dimer levels in these three groups showed different trends over time (group*time effect, P < 0.001). The different trends in serum D-dimer level with time after treatment in the three groups could be directly seen in the spline regression curve (P < 0.001). The plasma D-dimer changes regularly during CDT for ALI. We can predict the efficacy of CDT and guide adjustments of the therapeutic regimen according to the trend of D-dimer changes during thrombolysis.
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14
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Siddiqui NA, Malik M, Wijeratne Fernando R, Sreekantan Nair A, Illango J, Gor R, Hamid P. D-Dimer: A Potential Solution to Problems of Cancer Screening, Surveillance, and Prognosis Assessment. Cureus 2021; 13:e15064. [PMID: 34141508 PMCID: PMC8205645 DOI: 10.7759/cureus.15064] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/17/2023] Open
Abstract
Research has established a direct link between the plasma level of D-dimer and underlying malignancy. D-dimer has a strong association with the detection and prognosis of several cancers. For these reasons, this literature review aimed to evaluate the usefulness of elevated D-dimer levels in the initial screening of cancer, cancer recurrence surveillance, and for use as a cancer prognostic tool. A search of PubMed up to February 1, 2021, was carried out by reviewers. This literature review includes studies investigating the relationship between pretreatment plasma D-dimer levels and cancer. From the findings, pretreatment D-dimer levels can assist with cancer screening and prognosis assessment. Pretreatment plasma D-dimer levels can function as an effective cancer recurrence control. Elevated pre-treatment plasma D-dimer concentration is valuable in facilitating cancer screening, predicting an augmented risk of cancer recurrence, and anticipating a worse cancer prognosis.
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Affiliation(s)
- Nabeel A Siddiqui
- Research, California Institute of Behavioral Neurosciences & Psychology, Fairfield, USA
| | - Mushrin Malik
- Research, California Institute of Behavioral Neurosciences & Psychology, Fairfield, USA
| | | | | | - Janan Illango
- Research, California Institute of Behavioral Neurosciences & Psychology, Fairfield, USA
| | - Rajvi Gor
- Research, California Institute of Behavioral Neurosciences & Psychology, Fairfield, USA
| | - Pousette Hamid
- Neurology, California Institute of Behavioral Neurosciences & Psychology, Fairfield, USA
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15
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Kietsiriroje N, Ariëns RAS, Ajjan RA. Fibrinolysis in Acute and Chronic Cardiovascular Disease. Semin Thromb Hemost 2021; 47:490-505. [PMID: 33878782 DOI: 10.1055/s-0040-1718923] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
The formation of an obstructive thrombus within an artery remains a major cause of mortality and morbidity worldwide. Despite effective inhibition of platelet function by modern antiplatelet therapies, these agents fail to fully eliminate atherothrombotic risk. This may well be related to extensive vascular disease, beyond the protective abilities of the treatment agents used. However, recent evidence suggests that residual vascular risk in those treated with modern antiplatelet therapies is related, at least in part, to impaired fibrin clot lysis. In this review, we attempt to shed more light on the role of hypofibrinolysis in predisposition to arterial vascular events. We provide a brief overview of the coagulation system followed by addressing the role of impaired fibrin clot lysis in acute and chronic vascular conditions, including coronary artery, cerebrovascular, and peripheral vascular disease. We also discuss the role of combined anticoagulant and antiplatelet therapies to reduce the risk of arterial thrombotic events, addressing both efficacy and safety of such an approach. We conclude that impaired fibrin clot lysis appears to contribute to residual thrombosis risk in individuals with arterial disease on antiplatelet therapy, and targeting proteins in the fibrinolytic system represents a viable strategy to improve outcome in this population. Future work is required to refine the antithrombotic approach by modulating pathological abnormalities in the fibrinolytic system and tailoring therapy according to the need of each individual.
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Affiliation(s)
- Noppadol Kietsiriroje
- Department of Metabolic Medicine, Leeds Institute of Cardiovascular and Metabolic Medicine, Faculty of Medicine and Health, University of Leeds, Leeds, United Kingdom.,Endocrinology and Metabolism Unit, Department of Internal Medicine, Faculty of Medicine, Prince of Songkla University, Hatyai, Songkhla, Thailand
| | - Robert A S Ariëns
- Department of Metabolic Medicine, Leeds Institute of Cardiovascular and Metabolic Medicine, Faculty of Medicine and Health, University of Leeds, Leeds, United Kingdom
| | - Ramzi A Ajjan
- Department of Metabolic Medicine, Leeds Institute of Cardiovascular and Metabolic Medicine, Faculty of Medicine and Health, University of Leeds, Leeds, United Kingdom
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16
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Dietary Supplementation with Selenium and Coenzyme Q 10 Prevents Increase in Plasma D-Dimer While Lowering Cardiovascular Mortality in an Elderly Swedish Population. Nutrients 2021; 13:nu13041344. [PMID: 33920725 PMCID: PMC8073286 DOI: 10.3390/nu13041344] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/26/2021] [Revised: 04/02/2021] [Accepted: 04/13/2021] [Indexed: 12/27/2022] Open
Abstract
A low intake of selenium is associated with increased cardiovascular mortality. This could be reduced by supplementation with selenium and coenzyme Q10. D-dimer, a fragment of fibrin mirroring fibrinolysis, is a biomarker of thromboembolism, increased inflammation, endothelial dysfunction and is associated with cardiovascular mortality in ischemic heart disease. The objective was to examine the impact of selenium and coenzyme Q10 on the level of D-dimer, and its relationship to cardiovascular mortality. D-dimer was measured in 213 individuals at the start and after 48 months of a randomised double-blind placebo-controlled trial with selenium yeast (200 µg/day) and coenzyme Q10 (200 mg/day) (n = 106) or placebo (n = 107). The follow-up time was 4.9 years. All included individuals were low in selenium (mean 67 μg/L, SD 16.8). The differences in D-dimer concentration were evaluated by the use of T-tests, repeated measures of variance and ANCOVA analyses. At the end, a significantly lower D-dimer concentration was observed in the active treatment group in comparison with those on placebo (p = 0.006). Although D-dimer values at baseline were weakly associated with high-sensitive CRP, while being more strongly associated with soluble tumour necrosis factor receptor 1 and sP-selectin, controlling for these in the analysis there was an independent effect on D-dimer. In participants with a D-dimer level above median at baseline, the supplementation resulted in significantly lower cardiovascular mortality compared to those on placebo (p = 0.014). All results were validated with a persisting significant difference between the two groups. Therefore, supplementation with selenium and coenzyme Q10 in a group of elderly low in selenium and coenzyme Q10 prevented an increase in D-dimer and reduced the risk of cardiovascular mortality in comparison with the placebo group. The obtained results also illustrate important associations between inflammation, endothelial function and cardiovascular risk.
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17
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How I treat unexplained arterial thrombosis. Blood 2021; 136:1487-1498. [PMID: 32584955 DOI: 10.1182/blood.2019000820] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/03/2020] [Accepted: 05/22/2020] [Indexed: 12/27/2022] Open
Abstract
Most arterial thrombotic events have a clear atherosclerotic or cardioembolic etiology, but hematologists are frequently asked to assist in the diagnosis and management of a patient with a nonatherosclerotic and noncardioembolic arterial event, referred to here as an unexplained arterial thrombosis. Because there is an assorted list of factors that can precipitate an arterial event, we present a systematic diagnostic approach to ensure consideration of not only primary hypercoagulable disorders, but also pro-thrombotic medications or substances, vascular and anatomic abnormalities, and undiagnosed systemic disorders, such as malignancy and autoimmune diseases. We also review existing literature of the role of hypercoagulable disorders in arterial thrombosis and discuss our approach to thrombophilia workup in patients after an unexplained arterial event. We conclude with 3 representative cases to both illustrate the application of the outlined diagnostic schema and discuss common management considerations, specifically the selection of anticoagulation vs antiplatelet therapy for secondary prevention.
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18
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Krychtiuk KA, Speidl WS, Giannitsis E, Gigante B, Gorog DA, Jaffe AS, Mair J, Möckel M, Mueller C, Storey RF, Vilahur G, Wojta J, Huber K, Halvorsen S, Geisler T, Morais J, Lindahl B, Thygesen K. Biomarkers of coagulation and fibrinolysis in acute myocardial infarction: a joint position paper of the Association for Acute CardioVascular Care and the European Society of Cardiology Working Group on Thrombosis. EUROPEAN HEART JOURNAL-ACUTE CARDIOVASCULAR CARE 2020; 10:343-355. [PMID: 33620437 DOI: 10.1093/ehjacc/zuaa025] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/09/2020] [Accepted: 09/15/2020] [Indexed: 12/19/2022]
Abstract
The formation of a thrombus in an epicardial artery may result in an acute myocardial infarction (AMI). Despite major advances in acute treatment using network approaches to allocate patients to timely reperfusion and optimal antithrombotic treatment, patients remain at high risk for thrombotic complications. Ongoing activation of the coagulation system as well as thrombin-mediated platelet activation may both play a crucial role in this context. Whether measurement of circulating biomarkers of coagulation and fibrinolysis could be useful for risk stratification in secondary prevention is currently not fully understood. In addition, measurement of such biomarkers could be helpful to identify thrombus formation as the leading mechanism for AMI. The introduction of biomarkers of myocardial injury such as high-sensitivity cardiac troponins made rule-out of AMI even more precise. However, elevated markers of myocardial injury cannot provide proof of a type 1 AMI, let alone thrombus formation. The combined measurement of markers of myocardial injury with biomarkers reflecting ongoing thrombus formation might be helpful for the fast and correct diagnosis of an atherothrombotic type 1 AMI. This position paper gives an overview of the current knowledge and possible role of biomarkers of coagulation and fibrinolysis for the diagnosis of AMI, risk stratification, and individualized treatment strategies in patients with AMI.
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Affiliation(s)
- Konstantin A Krychtiuk
- Division of Cardiology, Department of Internal Medicine II, Medical University of Vienna, Waehringer Guertel 18-20, 1090 Vienna, Austria
| | - Walter S Speidl
- Division of Cardiology, Department of Internal Medicine II, Medical University of Vienna, Waehringer Guertel 18-20, 1090 Vienna, Austria
| | - Evangelos Giannitsis
- Department of Internal Medicine III, Cardiology, Angiology, Pulmonology, Medical University of Heidelberg, Im Neuenheimer Feld 672, 69120 Heidelberg, Germany
| | - Bruna Gigante
- Unit of Cardiovascular Medicine, Department of Medicine, Karolinska Institutet, Solnavägen 1, 171 77 Solna, Sweden.,Department of Clinical Science, Danderyds Hospital, Entrévägen 2, 182 57 Danderyd, Sweden
| | - Diana A Gorog
- Department of Medicine, National Heart & Lung Institute, Imperial College, Guy Scadding Building, Dovehouse St, Chelsea, London SW3 6LY, UK.,Postgraduate Medical School, University of Hertfordshire, Hatfield, UK
| | - Allan S Jaffe
- Department of Cardiology, Mayo Clinic, 1216 2nd St SW Rochester, MN 55902, USA.,Department of Laboratory Medicine and Pathology, Mayo Clinic, 1216 2nd St SW Rochester, MN 55902, USA
| | - Johannes Mair
- Department of Internal Medicine III - Cardiology and Angiology, Medical University Innsbruck, Anichstraße 35, 6020 Innsbruck, Austria
| | - Martin Möckel
- Division of Emergency and Acute Medicine and Chest Pain Units, Charite - Universitätsmedizin Berlin, Campus Mitte and Virchow, Augustenburger Pl. 1, 13353 Berlin, Germany
| | - Christian Mueller
- Cardiovascular Research Institute Basel (CRIB), University Hospital Basel, University of Basel, Spitalstrasse 2, 4056 Basel, Switzerland
| | - Robert F Storey
- Cardiovascular Research Unit, Department of Infection Immunity and Cardiovascular Disease, University of Sheffield, Medical School, Beech Hill Rd, Sheffield S10 2RX, UK
| | - Gemma Vilahur
- Cardiovascular Program ICCC - Research Institute Hospital de la Santa Creu i Sant Pau, IIB-Sant Pau, Carrer de Sant Quintí, 89, 08041 Barcelona, Spain.,Centro de Investigación Biomédica en Red Cardiovascular (CIBERCV), Instituto de Salud Carlos III, Calle de Melchor Fernández Almagro, 3, 28029 Madrid, Spain
| | - Johann Wojta
- Division of Cardiology, Department of Internal Medicine II, Medical University of Vienna, Waehringer Guertel 18-20, 1090 Vienna, Austria.,Ludwig Boltzmann Institute for Cardiovascular Research, Waehringer Guertel 18-20, 1090 Vienna, Austria
| | - Kurt Huber
- Ludwig Boltzmann Institute for Cardiovascular Research, Waehringer Guertel 18-20, 1090 Vienna, Austria.,3rd Medical Department of Cardiology and Intensive Care Medicine, Wilhelminenhospital, Montleartstraße 37, 1160 Vienna, Austria
| | - Sigrun Halvorsen
- Department of Cardiology, Oslo University Hospital Ulleval, University of Oslo, Kirkeveien 166, 0450 Oslo, Norway
| | - Tobias Geisler
- University Hospital Tübingen, Hoppe-Seyler-Straße 3, 72076 Tübingen, Germany
| | - Joao Morais
- Division of Cardiology, Santo Andre's Hospital, R. de Santo André, 2410-197 Leiria, Portugal
| | - Bertil Lindahl
- Department of Medical Sciences, Uppsala Clinical Research Center, Dag Hammarskjölds Väg 38, 751 85 Uppsala University, Uppsala, Sweden
| | - Kristian Thygesen
- Department of Cardiology, Aarhus University Hospital, Palle Juul-Jensens Blvd. 161, 8200 Aarhus N, Denmark
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19
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Raffield LM, Lu AT, Szeto MD, Little A, Grinde KE, Shaw J, Auer PL, Cushman M, Horvath S, Irvin MR, Lange EM, Lange LA, Nickerson DA, Thornton TA, Wilson JG, Wheeler MM, Zakai NA, Reiner AP. Coagulation factor VIII: Relationship to cardiovascular disease risk and whole genome sequence and epigenome-wide analysis in African Americans. J Thromb Haemost 2020; 18:1335-1347. [PMID: 31985870 PMCID: PMC7274883 DOI: 10.1111/jth.14741] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/31/2019] [Revised: 01/02/2020] [Accepted: 01/21/2020] [Indexed: 12/12/2022]
Abstract
BACKGROUND Prospective studies have suggested higher factor VIII (FVIII) levels are an independent risk factor for coronary heart disease (CHD) and stroke. However, limited information, including on genetic and epigenetic contributors to FVIII variation, is available specifically among African Americans (AAs), who have higher FVIII levels than Europeans. OBJECTIVES We measured FVIII levels in ~3400 AAs from the community-based Jackson Heart Study and assessed genetic, epigenetic, and epidemiological correlates of FVIII, as well as incident cardiovascular disease (CVD) associations. METHODS We assessed cross-sectional associations of FVIII with CVD risk factors as well as incident CHD, stroke, heart failure, and mortality associations. We additionally assessed associations with TOPMed whole genome sequencing data and an epigenome-wide methylation array. RESULTS Our results confirmed associations between FVIII and risk of incident CHD events and total mortality in AAs; mortality associations were largely independent of traditional risk factors. We also demonstrate an association of FVIII with incident heart failure, independent of B-type natriuretic peptide. Two genomic regions were strongly associated with FVIII (ABO and VWF). The index variant at VWF is specific to individuals of African descent and is distinct from the previously reported European VWF association signal. Epigenome-wide association analysis showed significant FVIII associations with several CpG sites in the ABO region. However, after adjusting for ABO genetic variants, ABO CpG sites were not significant. CONCLUSIONS Larger sample sizes of AAs will be required to discover additional genetic and epigenetic contributors to FVIII phenotypic variation, which may have consequences for CVD health disparities.
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Affiliation(s)
- Laura M Raffield
- Department of Genetics, University of North Carolina, Chapel Hill, North Carolina
| | - Ake T Lu
- Department of Human Genetics, David Geffen School of Medicine, UCLA, Los Angeles, California
| | - Mindy D Szeto
- Division of Biomedical Informatics and Personalized Medicine, School of Medicine, University of Colorado, Anschutz Medical Campus, Aurora, Colorado
| | - Amarise Little
- Department of Biostatistics, University of Washington, Seattle, Washington
| | - Kelsey E Grinde
- Department of Mathematics, Statistics, and Computer Science, Macalester College, St. Paul, Minnesota
| | - Jessica Shaw
- Division of Biomedical Informatics and Personalized Medicine, School of Medicine, University of Colorado, Anschutz Medical Campus, Aurora, Colorado
| | - Paul L Auer
- Joseph J. Zilber School of Public Health, University of Wisconsin-Milwaukee, Milwaukee, Wisconsin
| | - Mary Cushman
- Department of Medicine, Larner College of Medicine at the University of Vermont, Burlington, Vermont
- Department of Pathology & Laboratory Medicine, Larner College of Medicine at the University of Vermont, Burlington, Vermont
| | - Steve Horvath
- Department of Human Genetics, David Geffen School of Medicine, UCLA, Los Angeles, California
- Department of Biostatistics, David Geffen School of Medicine, UCLA, Los Angeles, California
| | - Marguerite R Irvin
- Department of Epidemiology, University of Alabama at Birmingham (UAB) School of Public Health, Birmingham, Alabama
| | - Ethan M Lange
- Division of Biomedical Informatics and Personalized Medicine, School of Medicine, University of Colorado, Anschutz Medical Campus, Aurora, Colorado
| | - Leslie A Lange
- Division of Biomedical Informatics and Personalized Medicine, School of Medicine, University of Colorado, Anschutz Medical Campus, Aurora, Colorado
| | | | - Timothy A Thornton
- Department of Biostatistics, University of Washington, Seattle, Washington
| | - James G Wilson
- Department of Physiology and Biophysics, University of Mississippi Medical Center, Jackson, Mississippi
| | | | - Neil A Zakai
- Department of Medicine, Larner College of Medicine at the University of Vermont, Burlington, Vermont
- Department of Pathology & Laboratory Medicine, Larner College of Medicine at the University of Vermont, Burlington, Vermont
| | - Alex P Reiner
- Department of Epidemiology, University of Washington, Seattle, Washington
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20
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Awotoye J, Fashanu OE, Lutsey PL, Zhao D, O'Neal WT, Michos ED. Resting heart rate and incident venous thromboembolism: the Multi-Ethnic Study of Atherosclerosis. Open Heart 2020; 7:e001080. [PMID: 32153786 PMCID: PMC7046973 DOI: 10.1136/openhrt-2019-001080] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/02/2019] [Revised: 01/07/2020] [Accepted: 01/27/2020] [Indexed: 12/21/2022] Open
Abstract
Objective Venous thromboembolism (VTE) is associated with significant morbidity and mortality. Resting heart rate (RHR), which may be modifiable through lifestyle changes, has been shown to be associated with cardiovascular disease risk and with inflammatory markers that have been predictive of VTE incidence. Methods We examined whether RHR is also associated with VTE incidence independent of these risk factors. We studied 6479 Multi-Ethnic Study of Atherosclerosis participants free from clinical VTE at baseline who had baseline RHR ascertained by 12-lead ECG. VTE events were recorded from hospital records and death certificates using International Classification of Diseases (ICD)-9 and ICD-10 codes. We categorised RHR as <60, 60-69, 70-79 and ≥80 bpm. We used Cox hazard models to determine the association of incident VTE by RHR. Results Participants had mean (SD) age of 62 (10) years and RHR of 63 (10) bpm. RHR was cross-sectionally correlated with multiple inflammatory and coagulation factors. There were 236 VTE cases after a median follow-up of 14 years. Compared with those with RHR<60 bpm, the HR (95% CI) for incident VTE for RHR≥80 bpm was 2.08 (1.31 to 3.30), after adjusting for demographics, physical activity, smoking, diabetes and use of atrioventricular (AV)-nodal blockers, aspirin and anticoagulants, and remained significant after further adjustment for inflammatory markers (2.05 (1.29 to 3.26)). Results were similar after excluding those taking AV-nodal blocker medications. There was no effect modification of these associations by sex or age. Conclusion Elevated RHR was positively associated with VTE incidence after a median of 14 years; this association was independent of several traditional VTE and inflammatory markers.
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Affiliation(s)
- Josephine Awotoye
- Department of Biology, University of Minnesota, Minneapolis, Minnesota, USA
| | - Oluwaseun E Fashanu
- Department of Medicine, Saint Agnes Hospital, Baltimore, Maryland, USA
- The Ciccarone Center for the Prevention of Cardiovascular Disease, Johns Hopkins School of Medicine, Baltimore, Maryland, USA
| | - Pamela L Lutsey
- Division of Epidemiology and Community Health, School of Public Health, University of Minnesota, Minneapolis, Minnesota, USA
| | - Di Zhao
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, USA
| | - Wesley T O'Neal
- Department of Medicine, Division of Cardiology, Emory University School of Medicine, Atlanta, Georgia, USA
| | - Erin D Michos
- The Ciccarone Center for the Prevention of Cardiovascular Disease, Johns Hopkins School of Medicine, Baltimore, Maryland, USA
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, USA
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21
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Giaccherini C, Marchetti M, Masci G, Verzeroli C, Russo L, Celio L, Sarmiento R, Gamba S, Tartari CJ, Diani E, Vignoli A, Malighetti P, Spinelli D, Tondini C, Barni S, Giuliani F, Petrelli F, D'Alessio A, Gasparini G, De Braud F, Santoro A, Labianca R, Falanga A. Thrombotic biomarkers for risk prediction of malignant disease recurrence in patients with early stage breast cancer. Haematologica 2019; 105:1704-1711. [PMID: 31558668 PMCID: PMC7271573 DOI: 10.3324/haematol.2019.228981] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/07/2019] [Accepted: 09/24/2019] [Indexed: 11/09/2022] Open
Abstract
In cancer patients, hypercoagulability is a common finding. It has been associated with an increased risk of venous thromboembolism, but also to tumor proliferation and progression. In this prospective study of a large cohort of breast cancer patients, we aimed to evaluate whether pre-chemotherapy abnormalities in hemostatic biomarkers levels: (i) are associated with breast cancer-specific clinico-pathological features; and (ii) can predict for disease recurrence. D-dimer, fibrinogen, prothrombin fragment 1+2, and FVIIa/antithrombin levels were measured in 701 early-stage resected breast cancer patients candidate to adjuvant chemotherapy and prospectively enrolled in the HYPERCAN study. Significant prognostic parameters for disease recurrence were identified by Cox regression multivariate analysis and used for generating a risk assessment model. Pre-chemotherapy D-dimer, fibrinogen, and pro-thrombin fragment 1+2 levels were significantly associated with tumor size and lymph node metastasis. After 3.4 years of follow up, 71 patients experienced a recurrence. Cox multivariate analysis identified prothrombin fragment 1+2, tumor size, and Luminal B HER2-negative or triple negative molecular subtypes as independent risk factors for disease recurrence. Based on these variables, we generated a risk assessment model that significantly differentiated patients at low- and high-risk of recurrence (cumulative incidence: 6.2 vs. 20.7%; Hazard Ratio=3.5; P<0.001). Our prospective clinical and laboratory data from the HYPERCAN study were crucial for generating a scoring model for assessing risk of disease recurrence in resected breast cancer patients, candidate to systemic chemotherapy. This finding stimulates future investigations addressing the role of plasma prothrombin fragment 1+2 in the management of breast cancer patients to provide the rationale for new therapeutic strategies. (The HYPERCAN study is registered at clinicaltrials.gov identifier 02622815.)
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Affiliation(s)
- Cinzia Giaccherini
- Immunohematology and Transfusion Medicine, Hospital Papa Giovanni XXIII, Bergamo
| | - Marina Marchetti
- Immunohematology and Transfusion Medicine, Hospital Papa Giovanni XXIII, Bergamo
| | | | - Cristina Verzeroli
- Immunohematology and Transfusion Medicine, Hospital Papa Giovanni XXIII, Bergamo
| | - Laura Russo
- Immunohematology and Transfusion Medicine, Hospital Papa Giovanni XXIII, Bergamo
| | - Luigi Celio
- Oncology Unit, IRCCS National Cancer Institute, Milan
| | | | - Sara Gamba
- Immunohematology and Transfusion Medicine, Hospital Papa Giovanni XXIII, Bergamo
| | - Carmen J Tartari
- Immunohematology and Transfusion Medicine, Hospital Papa Giovanni XXIII, Bergamo
| | - Erika Diani
- Immunohematology and Transfusion Medicine, Hospital Papa Giovanni XXIII, Bergamo
| | - Alfonso Vignoli
- Immunohematology and Transfusion Medicine, Hospital Papa Giovanni XXIII, Bergamo
| | - Paolo Malighetti
- Department of Management, Information and Production Engineering, University of Bergamo, Bergamo
| | - Daniele Spinelli
- Department of Management, Information and Production Engineering, University of Bergamo, Bergamo
| | - Carlo Tondini
- Oncology Unit, Hospital Papa Giovanni XXIII, Bergamo
| | - Sandro Barni
- Oncology Unit, Hospital Treviglio-Caravaggio, Treviglio
| | | | | | - Andrea D'Alessio
- Medical Oncology and Internal Medicine, Policlinico San Marco, Zingonia-Bergamo
| | | | | | | | - Roberto Labianca
- Department Oncology Bergamo Province, Hospital Papa Giovanni XXIII, Bergamo
| | - Anna Falanga
- Immunohematology and Transfusion Medicine, Hospital Papa Giovanni XXIII, Bergamo .,University of Milan Bicocca, School of Medicine and Surgery, Milan, Italy
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Simes J, Robledo KP, White HD, Espinoza D, Stewart RA, Sullivan DR, Zeller T, Hague W, Nestel PJ, Glasziou PP, Keech AC, Elliott J, Blankenberg S, Tonkin AM. D-Dimer Predicts Long-Term Cause-Specific Mortality, Cardiovascular Events, and Cancer in Patients With Stable Coronary Heart Disease: LIPID Study. Circulation 2019; 138:712-723. [PMID: 29367425 DOI: 10.1161/circulationaha.117.029901] [Citation(s) in RCA: 82] [Impact Index Per Article: 16.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
Abstract
BACKGROUND D-dimer, a degradation product of cross-linked fibrin, is a marker for hypercoagulability and thrombotic events. Moderately elevated levels of D-dimer are associated with the risk of venous and arterial events in patients with vascular disease. We assessed the role of D-dimer levels in predicting long-term vascular outcomes, cause-specific mortality, and new cancers in the LIPID trial (Long-Term Intervention with Pravastatin in Ischaemic Disease) in the context of other risk factors. METHODS LIPID randomized patients to placebo or pravastatin 40 mg/d 5 to 38 months after myocardial infarction or unstable angina. D-dimer levels were measured at baseline and at 1 year. Median follow-up was 6.0 years during the trial and 16 years in total. RESULTS Baseline D-dimer levels for 7863 patients were grouped by quartile (≤112, 112-173, 173-273, >273 ng/mL). Higher levels were associated with older age, female sex, history of hypertension, poor renal function, and elevated levels of B-natriuretic peptide, high-sensitivity C-reactive protein, and sensitive troponin I (each P<0.001). During the first 6 years, after adjustment for up to 30 additional risk factors, higher D-dimer was associated with a significantly increased risk of a major coronary event (quartile 4 versus 1: hazard ratio [HR], 1.45; 95% confidence interval, 1.21-1.74), major cardiovascular disease (CVD) event (HR, 1.45; 95% confidence interval, 1.23-1.71) and venous thromboembolism (HR, 4.03; 95% confidence interval, 2.31-7.03; each P<0.001). During the 16 years overall, higher D-dimer was an independent predictor of all-cause mortality (HR, 1.59), CVD mortality (HR, 1.61), cancer mortality (HR, 1.54), and non-CVD noncancer mortality (HR, 1.57; each P<0.001), remaining significant for deaths resulting from each cause occurring beyond 10 years of follow-up (each P≤0.01). Higher D-dimer also independently predicted an increase in cancer incidence (HR, 1.16; P=0.02).The D-dimer level increased the net reclassification index for all-cause mortality by 4.0 and venous thromboembolism by 13.6. CONCLUSIONS D-dimer levels predict long-term risk of arterial and venous events, CVD mortality, and non-CVD noncancer mortality independent of other risk factors. D-dimer is also a significant predictor of cancer incidence and mortality. These results support an association of D-dimer with fatal events across multiple diseases and demonstrate that this link extends beyond 10 years' follow-up.
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Affiliation(s)
- John Simes
- National Health and Medical Research Council Clinical Trials Centre, University of Sydney, Australia (J.S., K.P.R., D.E., W.H., A.C.K.)
| | - Kristy P Robledo
- National Health and Medical Research Council Clinical Trials Centre, University of Sydney, Australia (J.S., K.P.R., D.E., W.H., A.C.K.)
| | - Harvey D White
- Green Lane Cardiovascular Service, Auckland City Hospital, New Zealand (H.D.W., R.A.S.)
| | - David Espinoza
- National Health and Medical Research Council Clinical Trials Centre, University of Sydney, Australia (J.S., K.P.R., D.E., W.H., A.C.K.)
| | - Ralph A Stewart
- Green Lane Cardiovascular Service, Auckland City Hospital, New Zealand (H.D.W., R.A.S.)
| | | | - Tanja Zeller
- University Heart Centre Hamburg, Germany (T.Z., S.B.)
| | - Wendy Hague
- National Health and Medical Research Council Clinical Trials Centre, University of Sydney, Australia (J.S., K.P.R., D.E., W.H., A.C.K.)
| | - Paul J Nestel
- Baker Heart and Diabetes Institute, Melbourne, Australia (P.J.N.)
| | - Paul P Glasziou
- Faculty of Health Sciences and Medicine, Bond University, Gold Coast, Queensland, Australia (P.P.G.)
| | - Anthony C Keech
- National Health and Medical Research Council Clinical Trials Centre, University of Sydney, Australia (J.S., K.P.R., D.E., W.H., A.C.K.)
| | - John Elliott
- Department of Medicine, University of Otago, Christchurch, New Zealand (J.E.)
| | | | - Andrew M Tonkin
- Department of Epidemiology and Preventive Medicine, Monash University, Melbourne, Australia (A.M.T.)
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23
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Belkina AC, Starchenko A, Drake KA, Proctor EA, Pihl RMF, Olson A, Lauffenburger DA, Lin N, Snyder-Cappione JE. Multivariate Computational Analysis of Gamma Delta T Cell Inhibitory Receptor Signatures Reveals the Divergence of Healthy and ART-Suppressed HIV+ Aging. Front Immunol 2018; 9:2783. [PMID: 30568654 PMCID: PMC6290897 DOI: 10.3389/fimmu.2018.02783] [Citation(s) in RCA: 29] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/07/2018] [Accepted: 11/12/2018] [Indexed: 12/15/2022] Open
Abstract
Even with effective viral control, HIV-infected individuals are at a higher risk for morbidities associated with older age than the general population, and these serious non-AIDS events (SNAEs) track with plasma inflammatory and coagulation markers. The cell subsets driving inflammation in aviremic HIV infection are not yet elucidated. Also, whether ART-suppressed HIV infection causes premature induction of the inflammatory events found in uninfected elderly or if a novel inflammatory network ensues when HIV and older age co-exist is unclear. In this study we measured combinational expression of five inhibitory receptors (IRs) on seven immune cell subsets and 16 plasma markers from peripheral blood mononuclear cells (PBMC) and plasma samples, respectively, from a HIV and Aging cohort comprised of ART-suppressed HIV-infected and uninfected controls stratified by age (≤35 or ≥50 years old). For data analysis, multiple multivariate computational algorithms [cluster identification, characterization, and regression (CITRUS), partial least squares regression (PLSR), and partial least squares-discriminant analysis (PLS-DA)] were used to determine if immune parameter disparities can distinguish the subject groups and to investigate if there is a cross-impact of aviremic HIV and age on immune signatures. IR expression on gamma delta (γδ) T cells exclusively separated HIV+ subjects from controls in CITRUS analyses and secretion of inflammatory cytokines and cytotoxic mediators from γδ T cells tracked with TIGIT expression among HIV+ subjects. Also, plasma markers predicted the percentages of TIGIT+ γδ T cells in subjects with and without HIV in PSLR models, and a PLS-DA model of γδ T cell IR signatures and plasma markers significantly stratified all four of the subject groups (uninfected younger, uninfected older, HIV+ younger, and HIV+ older). These data implicate γδ T cells as an inflammatory driver in ART-suppressed HIV infection and provide evidence of distinct “inflamm-aging” processes with and without ART-suppressed HIV infection.
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Affiliation(s)
- Anna C Belkina
- Flow Cytometry Core Facility, Boston University School of Medicine, Boston, MA, United States.,Department of Pathology and Laboratory Medicine, Boston University School of Medicine, Boston, MA, United States
| | - Alina Starchenko
- Department of Biological Engineering, Massachusetts Institute of Technology, Cambridge, MA, United States
| | | | - Elizabeth A Proctor
- Department of Biological Engineering, Massachusetts Institute of Technology, Cambridge, MA, United States
| | - Riley M F Pihl
- Flow Cytometry Core Facility, Boston University School of Medicine, Boston, MA, United States
| | - Alex Olson
- Department of Medicine, Boston University School of Medicine, Boston, MA, United States
| | - Douglas A Lauffenburger
- Department of Biological Engineering, Massachusetts Institute of Technology, Cambridge, MA, United States
| | - Nina Lin
- Department of Medicine, Boston University School of Medicine, Boston, MA, United States
| | - Jennifer E Snyder-Cappione
- Flow Cytometry Core Facility, Boston University School of Medicine, Boston, MA, United States.,Department of Microbiology, Boston University School of Medicine, Boston, MA, United States
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Zakai NA, Judd SE, Kissela B, Howard G, Safford MM, Cushman M. Factor VIII, Protein C and Cardiovascular Disease Risk: The REasons for Geographic and Racial Differences in Stroke Study (REGARDS). Thromb Haemost 2018; 118:1305-1315. [PMID: 29890521 PMCID: PMC6028294 DOI: 10.1055/s-0038-1655766] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/02/2023]
Abstract
BACKGROUND Haemostatic balance represented by low protein C (PC) and elevated factor VIII (FVIII) has been inconsistently associated with stroke and coronary heart disease (CHD) risk. OBJECTIVE This article assesses whether an elevated FVIII and a low PC would increase cardiovascular risk more than either individually. PATIENTS AND METHODS REGARDS recruited 30,239 black and white U.S. participants aged ≥ 45 years between 2003 and 2007. FVIII and PC were measured in a case-cohort sample of 646 stroke, 654 CHD, and a 1,104-person random sample with follow-up for approximately 4.5 years. Hazard ratios (HRs) were estimated using Cox models adjusted for demographic and cardiovascular risk factors. RESULTS Elevated FVIII (per standard deviation [SD] increase) was associated with increased risk of both stroke (HR, 1.26; 95% confidence interval [CI], 1.08, 1.46) and CHD (HR, 1.52; 95% CI, 1.29, 1.79), while there was no association of PC per SD decrease. For PC, there was a trend towards increased cardiovascular disease risk in the lowest values (bottom 5%). For stroke, there was no interaction between FVIII and low PC (pinteraction = 0.55). For CHD, the adjusted HR of FVIII per SD increase was significantly greater with PC in the bottom 5% (HR, 3.59; 95% CI, 1.39, 8.29) than PC in the upper 95% (HR, 1.45; 95% CI, 1.23, 1.71; pinteraction = 0.07). CONCLUSION Higher FVIII was associated with both CHD and stroke risk and the risk potentiated by low PC for CHD. Findings demonstrate that risks for cardiovascular diseases conferred by adverse levels of haemostasis biomarkers may be augmented by levels of other biomarkers.
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Affiliation(s)
- Neil A. Zakai
- Larner College of Medicine at the University of Vermont College, Burlington, VT
| | | | | | | | | | - Mary Cushman
- Larner College of Medicine at the University of Vermont College, Burlington, VT
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25
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Inflammation-Related Morbidity and Mortality Among HIV-Positive Adults: How Extensive Is It? J Acquir Immune Defic Syndr 2017; 77:1-7. [PMID: 28991883 DOI: 10.1097/qai.0000000000001554] [Citation(s) in RCA: 36] [Impact Index Per Article: 5.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/14/2023]
Abstract
OBJECTIVE To determine the rate of grade 4, potentially life-threatening events not attributable to AIDS, cardiovascular disease (CVD), or non-AIDS cancer among participants on antiretroviral therapy and to describe associations of these events with interleukin-6 (IL-6) and D-dimer. DESIGN Cohort study. METHODS HIV-infected participants on antiretroviral therapy (N = 3568) with an HIV-RNA level ≤ 500 copies/mL were followed for grade 4, AIDS, CVD, non-AIDS cancer, and all-cause mortality events. Grade 4 events were further classified masked to biomarker levels as reflecting chronic inflammation-related disease (ChrIRD) or not (non-ChrIRD). Associations of baseline IL-6 and D-dimer with events were studied using Cox models. RESULTS Over a median follow-up of 4.3 years, 339 participants developed a grade 4 event (22.9 per 1000 person-years); 165 participants developed a ChrIRD grade 4 event (10.7 per 1000 person-years). Grade 4 events were more common than AIDS (54 participants), CVD (132), and non-AIDS cancer (80) events, any of which developed in 252 participants (17.1 per 1000 person-years). Grade 4 and AIDS events were associated with similar risks of death. Higher IL-6 [hazard ratio (HR) = 1.19 per doubling of biomarker; P = 0.003] and D-dimer (HR = 1.23; P < 0.001) levels were associated with an increased risk of grade 4 events. IL-6 associations were stronger for ChrIRD (HR = 1.38; P < 0.001) than non-ChrIRD grade 4 events (HR = 1.11; P = 0.21). CONCLUSIONS Morbidity and mortality associated with activation of inflammatory and coagulation pathways include conditions other than AIDS, CVD, and non-AIDS cancer events. Effective inflammation-dampening interventions could greatly affect the health of people with HIV.
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26
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Castelnuovo AD, Agnoli C, Curtis AD, Giurdanella MC, Sieri S, Mattiello A, Matullo G, Panico S, Sacerdote C, Tumino R, Vineis P, Gaetano GD, Donati MB, Iacoviello L. Elevated levels of D-dimers increase the risk of ischaemic and haemorrhagic stroke. Thromb Haemost 2017; 112:941-6. [DOI: 10.1160/th14-04-0297] [Citation(s) in RCA: 29] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/03/2014] [Accepted: 05/30/2014] [Indexed: 02/02/2023]
Abstract
SummaryElevated D-dimer levels are reportedly associated with coronary artery disease. It was the study objective to investigate the association of baseline D-dimer levels with strokes that occurred in the European Prospective Investigation into Cancer and Nutrition-Italy cohort. Using a nested case-cohort design, a centre-–stratified sample of 832 subjects (66 % women, age 35–71) was selected as subcohort and compared with 289 strokes in a mean follow-up of nine years. D-dimers were measured by an automated latex-enhanced immunoassay (HemosIL-IL). The multivariable hazard ratios were estimated by a Cox regression model using Prentice method. Individuals with elevated D-dimer levels had significantly higher risk of incident stroke. It was evident from the second quartile (D-dimers > 100 ng/ml) and persisted almost unchanged for higher D-dimers (hazard ratio [HR] 2.10, 95 % confidence interval [CI]: 1.28–3.47; 2.42, 95 %CI: 1.44–4.09 and 2.10, 95 %CI: 1.27–3.48 for the second, third or fourth quartile compared with the lowest quartile, respectively). The association was independent of several confounders, including triglycerides and C-reactive protein. No differences were observed in men and women (P for interaction= 0.46), in hypertensive or non-hypertensive subjects (P for interaction= 0.88) or in subjects with low (< 1 mg/l) or elevated (≥ 1 mg/l) C-reactive protein (P for interaction=0.35). After stratification for stroke type, the hazard ratio for every standard deviation increase was statistically significant both for ischaemic (1.21; 95 %CI: 1.01 to 1.45) and haemorrhagic (1.24; 95 %CI: 1.00 to 1.65) strokes. In conclusion, our data provide clear evidence that elevated levels of D-dimers are potential risk factors not only for ischaemic but also for haemorrhagic strokes.
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27
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Raffield LM, Zakai NA, Duan Q, Laurie C, Smith JD, Irvin MR, Doyle MF, Naik RP, Song C, Manichaikul AW, Liu Y, Durda P, Rotter JI, Jenny NS, Rich SS, Wilson JG, Johnson AD, Correa A, Li Y, Nickerson DA, Rice K, Lange EM, Cushman M, Lange LA, Reiner AP. D-Dimer in African Americans: Whole Genome Sequence Analysis and Relationship to Cardiovascular Disease Risk in the Jackson Heart Study. Arterioscler Thromb Vasc Biol 2017; 37:2220-2227. [PMID: 28912365 DOI: 10.1161/atvbaha.117.310073] [Citation(s) in RCA: 26] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/15/2017] [Accepted: 08/29/2017] [Indexed: 12/18/2022]
Abstract
OBJECTIVE Plasma levels of the fibrinogen degradation product D-dimer are higher among African Americans (AAs) compared with those of European ancestry and higher among women compared with men. Among AAs, little is known of the genetic architecture of D-dimer or the relationship of D-dimer to incident cardiovascular disease. APPROACH AND RESULTS We measured baseline D-dimer in 4163 AAs aged 21 to 93 years from the prospective JHS (Jackson Heart Study) cohort and assessed association with incident cardiovascular disease events. In participants with whole genome sequencing data (n=2980), we evaluated common and rare genetic variants for association with D-dimer. Each standard deviation higher baseline D-dimer was associated with a 20% to 30% increased hazard for incident coronary heart disease, stroke, and all-cause mortality. Genetic variation near F3 was associated with higher D-dimer (rs2022030, β=0.284, P=3.24×10-11). The rs2022030 effect size was nearly 3× larger among women (β=0.373, P=9.06×10-13) than among men (β=0.135, P=0.06; P interaction =0.009). The sex by rs2022030 interaction was replicated in an independent sample of 10 808 multiethnic men and women (P interaction =0.001). Finally, the African ancestral sickle cell variant (HBB rs334) was significantly associated with higher D-dimer in JHS (β=0.507, P=1.41×10-14), and this association was successfully replicated in 1933 AAs (P=2.3×10-5). CONCLUSIONS These results highlight D-dimer as an important predictor of cardiovascular disease risk in AAs and suggest that sex-specific and African ancestral genetic effects of the F3 and HBB loci contribute to the higher levels of D-dimer among women and AAs.
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Affiliation(s)
- Laura M Raffield
- From the Department of Genetics (L.M.R., Q.D., Y. Li), Department of Biostatistics (Y. Li), and Department of Computer Science (Y. Li), University of North Carolina, Chapel Hill; Department of Pathology & Laboratory Medicine (N.A.Z., M.F.D., P.D., N.S.J., M.C.), and Department of Medicine (N.A.Z., M.C.), Hematology/Oncology Division, Larner College of Medicine at the University of Vermont, Burlington; Department of Biostatistics (C.L., K.R.), Department of Genome Sciences (J.D.S., D.A.N.), and Department of Epidemiology (A.P.R.), University of Washington, Seattle; Department of Epidemiology, University of Alabama, Birmingham (M.R.I.); Hematology, Department of Medicine, Johns Hopkins University, Baltimore, MD (R.P.N.); National Heart, Lung, and Blood Institute, Division of Intramural Research, Population Sciences Branch, Bethesda, MD (C.S., A.D.J.); Center for Public Health Genomics, University of Virginia, Charlottesville (A.W.M., S.S.R.); Epidemiology & Prevention, Public Health Sciences, Wake Forest School of Medicine, Winston-Salem, NC (Y. Liu); Institute for Translational Genomics and Population Sciences, Los Angeles Biomedical Research Institute and Departments of Pediatrics and Medicine, Harbor-UCLA Medical Center, Torrance, CA, and the David Geffen School of Medicine at UCLA (J.I.R.); Department of Physiology and Biophysics (J.G.W.), and Department of Medicine (A.C.), University of Mississippi Medical Center, Jackson; and Department of Medicine, University of Colorado Denver, Anschutz Medical Campus, Aurora (E.M.L., L.A.L.).
| | - Neil A Zakai
- From the Department of Genetics (L.M.R., Q.D., Y. Li), Department of Biostatistics (Y. Li), and Department of Computer Science (Y. Li), University of North Carolina, Chapel Hill; Department of Pathology & Laboratory Medicine (N.A.Z., M.F.D., P.D., N.S.J., M.C.), and Department of Medicine (N.A.Z., M.C.), Hematology/Oncology Division, Larner College of Medicine at the University of Vermont, Burlington; Department of Biostatistics (C.L., K.R.), Department of Genome Sciences (J.D.S., D.A.N.), and Department of Epidemiology (A.P.R.), University of Washington, Seattle; Department of Epidemiology, University of Alabama, Birmingham (M.R.I.); Hematology, Department of Medicine, Johns Hopkins University, Baltimore, MD (R.P.N.); National Heart, Lung, and Blood Institute, Division of Intramural Research, Population Sciences Branch, Bethesda, MD (C.S., A.D.J.); Center for Public Health Genomics, University of Virginia, Charlottesville (A.W.M., S.S.R.); Epidemiology & Prevention, Public Health Sciences, Wake Forest School of Medicine, Winston-Salem, NC (Y. Liu); Institute for Translational Genomics and Population Sciences, Los Angeles Biomedical Research Institute and Departments of Pediatrics and Medicine, Harbor-UCLA Medical Center, Torrance, CA, and the David Geffen School of Medicine at UCLA (J.I.R.); Department of Physiology and Biophysics (J.G.W.), and Department of Medicine (A.C.), University of Mississippi Medical Center, Jackson; and Department of Medicine, University of Colorado Denver, Anschutz Medical Campus, Aurora (E.M.L., L.A.L.)
| | - Qing Duan
- From the Department of Genetics (L.M.R., Q.D., Y. Li), Department of Biostatistics (Y. Li), and Department of Computer Science (Y. Li), University of North Carolina, Chapel Hill; Department of Pathology & Laboratory Medicine (N.A.Z., M.F.D., P.D., N.S.J., M.C.), and Department of Medicine (N.A.Z., M.C.), Hematology/Oncology Division, Larner College of Medicine at the University of Vermont, Burlington; Department of Biostatistics (C.L., K.R.), Department of Genome Sciences (J.D.S., D.A.N.), and Department of Epidemiology (A.P.R.), University of Washington, Seattle; Department of Epidemiology, University of Alabama, Birmingham (M.R.I.); Hematology, Department of Medicine, Johns Hopkins University, Baltimore, MD (R.P.N.); National Heart, Lung, and Blood Institute, Division of Intramural Research, Population Sciences Branch, Bethesda, MD (C.S., A.D.J.); Center for Public Health Genomics, University of Virginia, Charlottesville (A.W.M., S.S.R.); Epidemiology & Prevention, Public Health Sciences, Wake Forest School of Medicine, Winston-Salem, NC (Y. Liu); Institute for Translational Genomics and Population Sciences, Los Angeles Biomedical Research Institute and Departments of Pediatrics and Medicine, Harbor-UCLA Medical Center, Torrance, CA, and the David Geffen School of Medicine at UCLA (J.I.R.); Department of Physiology and Biophysics (J.G.W.), and Department of Medicine (A.C.), University of Mississippi Medical Center, Jackson; and Department of Medicine, University of Colorado Denver, Anschutz Medical Campus, Aurora (E.M.L., L.A.L.)
| | - Cecelia Laurie
- From the Department of Genetics (L.M.R., Q.D., Y. Li), Department of Biostatistics (Y. Li), and Department of Computer Science (Y. Li), University of North Carolina, Chapel Hill; Department of Pathology & Laboratory Medicine (N.A.Z., M.F.D., P.D., N.S.J., M.C.), and Department of Medicine (N.A.Z., M.C.), Hematology/Oncology Division, Larner College of Medicine at the University of Vermont, Burlington; Department of Biostatistics (C.L., K.R.), Department of Genome Sciences (J.D.S., D.A.N.), and Department of Epidemiology (A.P.R.), University of Washington, Seattle; Department of Epidemiology, University of Alabama, Birmingham (M.R.I.); Hematology, Department of Medicine, Johns Hopkins University, Baltimore, MD (R.P.N.); National Heart, Lung, and Blood Institute, Division of Intramural Research, Population Sciences Branch, Bethesda, MD (C.S., A.D.J.); Center for Public Health Genomics, University of Virginia, Charlottesville (A.W.M., S.S.R.); Epidemiology & Prevention, Public Health Sciences, Wake Forest School of Medicine, Winston-Salem, NC (Y. Liu); Institute for Translational Genomics and Population Sciences, Los Angeles Biomedical Research Institute and Departments of Pediatrics and Medicine, Harbor-UCLA Medical Center, Torrance, CA, and the David Geffen School of Medicine at UCLA (J.I.R.); Department of Physiology and Biophysics (J.G.W.), and Department of Medicine (A.C.), University of Mississippi Medical Center, Jackson; and Department of Medicine, University of Colorado Denver, Anschutz Medical Campus, Aurora (E.M.L., L.A.L.)
| | - Joshua D Smith
- From the Department of Genetics (L.M.R., Q.D., Y. Li), Department of Biostatistics (Y. Li), and Department of Computer Science (Y. Li), University of North Carolina, Chapel Hill; Department of Pathology & Laboratory Medicine (N.A.Z., M.F.D., P.D., N.S.J., M.C.), and Department of Medicine (N.A.Z., M.C.), Hematology/Oncology Division, Larner College of Medicine at the University of Vermont, Burlington; Department of Biostatistics (C.L., K.R.), Department of Genome Sciences (J.D.S., D.A.N.), and Department of Epidemiology (A.P.R.), University of Washington, Seattle; Department of Epidemiology, University of Alabama, Birmingham (M.R.I.); Hematology, Department of Medicine, Johns Hopkins University, Baltimore, MD (R.P.N.); National Heart, Lung, and Blood Institute, Division of Intramural Research, Population Sciences Branch, Bethesda, MD (C.S., A.D.J.); Center for Public Health Genomics, University of Virginia, Charlottesville (A.W.M., S.S.R.); Epidemiology & Prevention, Public Health Sciences, Wake Forest School of Medicine, Winston-Salem, NC (Y. Liu); Institute for Translational Genomics and Population Sciences, Los Angeles Biomedical Research Institute and Departments of Pediatrics and Medicine, Harbor-UCLA Medical Center, Torrance, CA, and the David Geffen School of Medicine at UCLA (J.I.R.); Department of Physiology and Biophysics (J.G.W.), and Department of Medicine (A.C.), University of Mississippi Medical Center, Jackson; and Department of Medicine, University of Colorado Denver, Anschutz Medical Campus, Aurora (E.M.L., L.A.L.)
| | - Marguerite R Irvin
- From the Department of Genetics (L.M.R., Q.D., Y. Li), Department of Biostatistics (Y. Li), and Department of Computer Science (Y. Li), University of North Carolina, Chapel Hill; Department of Pathology & Laboratory Medicine (N.A.Z., M.F.D., P.D., N.S.J., M.C.), and Department of Medicine (N.A.Z., M.C.), Hematology/Oncology Division, Larner College of Medicine at the University of Vermont, Burlington; Department of Biostatistics (C.L., K.R.), Department of Genome Sciences (J.D.S., D.A.N.), and Department of Epidemiology (A.P.R.), University of Washington, Seattle; Department of Epidemiology, University of Alabama, Birmingham (M.R.I.); Hematology, Department of Medicine, Johns Hopkins University, Baltimore, MD (R.P.N.); National Heart, Lung, and Blood Institute, Division of Intramural Research, Population Sciences Branch, Bethesda, MD (C.S., A.D.J.); Center for Public Health Genomics, University of Virginia, Charlottesville (A.W.M., S.S.R.); Epidemiology & Prevention, Public Health Sciences, Wake Forest School of Medicine, Winston-Salem, NC (Y. Liu); Institute for Translational Genomics and Population Sciences, Los Angeles Biomedical Research Institute and Departments of Pediatrics and Medicine, Harbor-UCLA Medical Center, Torrance, CA, and the David Geffen School of Medicine at UCLA (J.I.R.); Department of Physiology and Biophysics (J.G.W.), and Department of Medicine (A.C.), University of Mississippi Medical Center, Jackson; and Department of Medicine, University of Colorado Denver, Anschutz Medical Campus, Aurora (E.M.L., L.A.L.)
| | - Margaret F Doyle
- From the Department of Genetics (L.M.R., Q.D., Y. Li), Department of Biostatistics (Y. Li), and Department of Computer Science (Y. Li), University of North Carolina, Chapel Hill; Department of Pathology & Laboratory Medicine (N.A.Z., M.F.D., P.D., N.S.J., M.C.), and Department of Medicine (N.A.Z., M.C.), Hematology/Oncology Division, Larner College of Medicine at the University of Vermont, Burlington; Department of Biostatistics (C.L., K.R.), Department of Genome Sciences (J.D.S., D.A.N.), and Department of Epidemiology (A.P.R.), University of Washington, Seattle; Department of Epidemiology, University of Alabama, Birmingham (M.R.I.); Hematology, Department of Medicine, Johns Hopkins University, Baltimore, MD (R.P.N.); National Heart, Lung, and Blood Institute, Division of Intramural Research, Population Sciences Branch, Bethesda, MD (C.S., A.D.J.); Center for Public Health Genomics, University of Virginia, Charlottesville (A.W.M., S.S.R.); Epidemiology & Prevention, Public Health Sciences, Wake Forest School of Medicine, Winston-Salem, NC (Y. Liu); Institute for Translational Genomics and Population Sciences, Los Angeles Biomedical Research Institute and Departments of Pediatrics and Medicine, Harbor-UCLA Medical Center, Torrance, CA, and the David Geffen School of Medicine at UCLA (J.I.R.); Department of Physiology and Biophysics (J.G.W.), and Department of Medicine (A.C.), University of Mississippi Medical Center, Jackson; and Department of Medicine, University of Colorado Denver, Anschutz Medical Campus, Aurora (E.M.L., L.A.L.)
| | - Rakhi P Naik
- From the Department of Genetics (L.M.R., Q.D., Y. Li), Department of Biostatistics (Y. Li), and Department of Computer Science (Y. Li), University of North Carolina, Chapel Hill; Department of Pathology & Laboratory Medicine (N.A.Z., M.F.D., P.D., N.S.J., M.C.), and Department of Medicine (N.A.Z., M.C.), Hematology/Oncology Division, Larner College of Medicine at the University of Vermont, Burlington; Department of Biostatistics (C.L., K.R.), Department of Genome Sciences (J.D.S., D.A.N.), and Department of Epidemiology (A.P.R.), University of Washington, Seattle; Department of Epidemiology, University of Alabama, Birmingham (M.R.I.); Hematology, Department of Medicine, Johns Hopkins University, Baltimore, MD (R.P.N.); National Heart, Lung, and Blood Institute, Division of Intramural Research, Population Sciences Branch, Bethesda, MD (C.S., A.D.J.); Center for Public Health Genomics, University of Virginia, Charlottesville (A.W.M., S.S.R.); Epidemiology & Prevention, Public Health Sciences, Wake Forest School of Medicine, Winston-Salem, NC (Y. Liu); Institute for Translational Genomics and Population Sciences, Los Angeles Biomedical Research Institute and Departments of Pediatrics and Medicine, Harbor-UCLA Medical Center, Torrance, CA, and the David Geffen School of Medicine at UCLA (J.I.R.); Department of Physiology and Biophysics (J.G.W.), and Department of Medicine (A.C.), University of Mississippi Medical Center, Jackson; and Department of Medicine, University of Colorado Denver, Anschutz Medical Campus, Aurora (E.M.L., L.A.L.)
| | - Ci Song
- From the Department of Genetics (L.M.R., Q.D., Y. Li), Department of Biostatistics (Y. Li), and Department of Computer Science (Y. Li), University of North Carolina, Chapel Hill; Department of Pathology & Laboratory Medicine (N.A.Z., M.F.D., P.D., N.S.J., M.C.), and Department of Medicine (N.A.Z., M.C.), Hematology/Oncology Division, Larner College of Medicine at the University of Vermont, Burlington; Department of Biostatistics (C.L., K.R.), Department of Genome Sciences (J.D.S., D.A.N.), and Department of Epidemiology (A.P.R.), University of Washington, Seattle; Department of Epidemiology, University of Alabama, Birmingham (M.R.I.); Hematology, Department of Medicine, Johns Hopkins University, Baltimore, MD (R.P.N.); National Heart, Lung, and Blood Institute, Division of Intramural Research, Population Sciences Branch, Bethesda, MD (C.S., A.D.J.); Center for Public Health Genomics, University of Virginia, Charlottesville (A.W.M., S.S.R.); Epidemiology & Prevention, Public Health Sciences, Wake Forest School of Medicine, Winston-Salem, NC (Y. Liu); Institute for Translational Genomics and Population Sciences, Los Angeles Biomedical Research Institute and Departments of Pediatrics and Medicine, Harbor-UCLA Medical Center, Torrance, CA, and the David Geffen School of Medicine at UCLA (J.I.R.); Department of Physiology and Biophysics (J.G.W.), and Department of Medicine (A.C.), University of Mississippi Medical Center, Jackson; and Department of Medicine, University of Colorado Denver, Anschutz Medical Campus, Aurora (E.M.L., L.A.L.)
| | - Ani W Manichaikul
- From the Department of Genetics (L.M.R., Q.D., Y. Li), Department of Biostatistics (Y. Li), and Department of Computer Science (Y. Li), University of North Carolina, Chapel Hill; Department of Pathology & Laboratory Medicine (N.A.Z., M.F.D., P.D., N.S.J., M.C.), and Department of Medicine (N.A.Z., M.C.), Hematology/Oncology Division, Larner College of Medicine at the University of Vermont, Burlington; Department of Biostatistics (C.L., K.R.), Department of Genome Sciences (J.D.S., D.A.N.), and Department of Epidemiology (A.P.R.), University of Washington, Seattle; Department of Epidemiology, University of Alabama, Birmingham (M.R.I.); Hematology, Department of Medicine, Johns Hopkins University, Baltimore, MD (R.P.N.); National Heart, Lung, and Blood Institute, Division of Intramural Research, Population Sciences Branch, Bethesda, MD (C.S., A.D.J.); Center for Public Health Genomics, University of Virginia, Charlottesville (A.W.M., S.S.R.); Epidemiology & Prevention, Public Health Sciences, Wake Forest School of Medicine, Winston-Salem, NC (Y. Liu); Institute for Translational Genomics and Population Sciences, Los Angeles Biomedical Research Institute and Departments of Pediatrics and Medicine, Harbor-UCLA Medical Center, Torrance, CA, and the David Geffen School of Medicine at UCLA (J.I.R.); Department of Physiology and Biophysics (J.G.W.), and Department of Medicine (A.C.), University of Mississippi Medical Center, Jackson; and Department of Medicine, University of Colorado Denver, Anschutz Medical Campus, Aurora (E.M.L., L.A.L.)
| | - Yongmei Liu
- From the Department of Genetics (L.M.R., Q.D., Y. Li), Department of Biostatistics (Y. Li), and Department of Computer Science (Y. Li), University of North Carolina, Chapel Hill; Department of Pathology & Laboratory Medicine (N.A.Z., M.F.D., P.D., N.S.J., M.C.), and Department of Medicine (N.A.Z., M.C.), Hematology/Oncology Division, Larner College of Medicine at the University of Vermont, Burlington; Department of Biostatistics (C.L., K.R.), Department of Genome Sciences (J.D.S., D.A.N.), and Department of Epidemiology (A.P.R.), University of Washington, Seattle; Department of Epidemiology, University of Alabama, Birmingham (M.R.I.); Hematology, Department of Medicine, Johns Hopkins University, Baltimore, MD (R.P.N.); National Heart, Lung, and Blood Institute, Division of Intramural Research, Population Sciences Branch, Bethesda, MD (C.S., A.D.J.); Center for Public Health Genomics, University of Virginia, Charlottesville (A.W.M., S.S.R.); Epidemiology & Prevention, Public Health Sciences, Wake Forest School of Medicine, Winston-Salem, NC (Y. Liu); Institute for Translational Genomics and Population Sciences, Los Angeles Biomedical Research Institute and Departments of Pediatrics and Medicine, Harbor-UCLA Medical Center, Torrance, CA, and the David Geffen School of Medicine at UCLA (J.I.R.); Department of Physiology and Biophysics (J.G.W.), and Department of Medicine (A.C.), University of Mississippi Medical Center, Jackson; and Department of Medicine, University of Colorado Denver, Anschutz Medical Campus, Aurora (E.M.L., L.A.L.)
| | - Peter Durda
- From the Department of Genetics (L.M.R., Q.D., Y. Li), Department of Biostatistics (Y. Li), and Department of Computer Science (Y. Li), University of North Carolina, Chapel Hill; Department of Pathology & Laboratory Medicine (N.A.Z., M.F.D., P.D., N.S.J., M.C.), and Department of Medicine (N.A.Z., M.C.), Hematology/Oncology Division, Larner College of Medicine at the University of Vermont, Burlington; Department of Biostatistics (C.L., K.R.), Department of Genome Sciences (J.D.S., D.A.N.), and Department of Epidemiology (A.P.R.), University of Washington, Seattle; Department of Epidemiology, University of Alabama, Birmingham (M.R.I.); Hematology, Department of Medicine, Johns Hopkins University, Baltimore, MD (R.P.N.); National Heart, Lung, and Blood Institute, Division of Intramural Research, Population Sciences Branch, Bethesda, MD (C.S., A.D.J.); Center for Public Health Genomics, University of Virginia, Charlottesville (A.W.M., S.S.R.); Epidemiology & Prevention, Public Health Sciences, Wake Forest School of Medicine, Winston-Salem, NC (Y. Liu); Institute for Translational Genomics and Population Sciences, Los Angeles Biomedical Research Institute and Departments of Pediatrics and Medicine, Harbor-UCLA Medical Center, Torrance, CA, and the David Geffen School of Medicine at UCLA (J.I.R.); Department of Physiology and Biophysics (J.G.W.), and Department of Medicine (A.C.), University of Mississippi Medical Center, Jackson; and Department of Medicine, University of Colorado Denver, Anschutz Medical Campus, Aurora (E.M.L., L.A.L.)
| | - Jerome I Rotter
- From the Department of Genetics (L.M.R., Q.D., Y. Li), Department of Biostatistics (Y. Li), and Department of Computer Science (Y. Li), University of North Carolina, Chapel Hill; Department of Pathology & Laboratory Medicine (N.A.Z., M.F.D., P.D., N.S.J., M.C.), and Department of Medicine (N.A.Z., M.C.), Hematology/Oncology Division, Larner College of Medicine at the University of Vermont, Burlington; Department of Biostatistics (C.L., K.R.), Department of Genome Sciences (J.D.S., D.A.N.), and Department of Epidemiology (A.P.R.), University of Washington, Seattle; Department of Epidemiology, University of Alabama, Birmingham (M.R.I.); Hematology, Department of Medicine, Johns Hopkins University, Baltimore, MD (R.P.N.); National Heart, Lung, and Blood Institute, Division of Intramural Research, Population Sciences Branch, Bethesda, MD (C.S., A.D.J.); Center for Public Health Genomics, University of Virginia, Charlottesville (A.W.M., S.S.R.); Epidemiology & Prevention, Public Health Sciences, Wake Forest School of Medicine, Winston-Salem, NC (Y. Liu); Institute for Translational Genomics and Population Sciences, Los Angeles Biomedical Research Institute and Departments of Pediatrics and Medicine, Harbor-UCLA Medical Center, Torrance, CA, and the David Geffen School of Medicine at UCLA (J.I.R.); Department of Physiology and Biophysics (J.G.W.), and Department of Medicine (A.C.), University of Mississippi Medical Center, Jackson; and Department of Medicine, University of Colorado Denver, Anschutz Medical Campus, Aurora (E.M.L., L.A.L.)
| | - Nancy S Jenny
- From the Department of Genetics (L.M.R., Q.D., Y. Li), Department of Biostatistics (Y. Li), and Department of Computer Science (Y. Li), University of North Carolina, Chapel Hill; Department of Pathology & Laboratory Medicine (N.A.Z., M.F.D., P.D., N.S.J., M.C.), and Department of Medicine (N.A.Z., M.C.), Hematology/Oncology Division, Larner College of Medicine at the University of Vermont, Burlington; Department of Biostatistics (C.L., K.R.), Department of Genome Sciences (J.D.S., D.A.N.), and Department of Epidemiology (A.P.R.), University of Washington, Seattle; Department of Epidemiology, University of Alabama, Birmingham (M.R.I.); Hematology, Department of Medicine, Johns Hopkins University, Baltimore, MD (R.P.N.); National Heart, Lung, and Blood Institute, Division of Intramural Research, Population Sciences Branch, Bethesda, MD (C.S., A.D.J.); Center for Public Health Genomics, University of Virginia, Charlottesville (A.W.M., S.S.R.); Epidemiology & Prevention, Public Health Sciences, Wake Forest School of Medicine, Winston-Salem, NC (Y. Liu); Institute for Translational Genomics and Population Sciences, Los Angeles Biomedical Research Institute and Departments of Pediatrics and Medicine, Harbor-UCLA Medical Center, Torrance, CA, and the David Geffen School of Medicine at UCLA (J.I.R.); Department of Physiology and Biophysics (J.G.W.), and Department of Medicine (A.C.), University of Mississippi Medical Center, Jackson; and Department of Medicine, University of Colorado Denver, Anschutz Medical Campus, Aurora (E.M.L., L.A.L.)
| | - Stephen S Rich
- From the Department of Genetics (L.M.R., Q.D., Y. Li), Department of Biostatistics (Y. Li), and Department of Computer Science (Y. Li), University of North Carolina, Chapel Hill; Department of Pathology & Laboratory Medicine (N.A.Z., M.F.D., P.D., N.S.J., M.C.), and Department of Medicine (N.A.Z., M.C.), Hematology/Oncology Division, Larner College of Medicine at the University of Vermont, Burlington; Department of Biostatistics (C.L., K.R.), Department of Genome Sciences (J.D.S., D.A.N.), and Department of Epidemiology (A.P.R.), University of Washington, Seattle; Department of Epidemiology, University of Alabama, Birmingham (M.R.I.); Hematology, Department of Medicine, Johns Hopkins University, Baltimore, MD (R.P.N.); National Heart, Lung, and Blood Institute, Division of Intramural Research, Population Sciences Branch, Bethesda, MD (C.S., A.D.J.); Center for Public Health Genomics, University of Virginia, Charlottesville (A.W.M., S.S.R.); Epidemiology & Prevention, Public Health Sciences, Wake Forest School of Medicine, Winston-Salem, NC (Y. Liu); Institute for Translational Genomics and Population Sciences, Los Angeles Biomedical Research Institute and Departments of Pediatrics and Medicine, Harbor-UCLA Medical Center, Torrance, CA, and the David Geffen School of Medicine at UCLA (J.I.R.); Department of Physiology and Biophysics (J.G.W.), and Department of Medicine (A.C.), University of Mississippi Medical Center, Jackson; and Department of Medicine, University of Colorado Denver, Anschutz Medical Campus, Aurora (E.M.L., L.A.L.)
| | - James G Wilson
- From the Department of Genetics (L.M.R., Q.D., Y. Li), Department of Biostatistics (Y. Li), and Department of Computer Science (Y. Li), University of North Carolina, Chapel Hill; Department of Pathology & Laboratory Medicine (N.A.Z., M.F.D., P.D., N.S.J., M.C.), and Department of Medicine (N.A.Z., M.C.), Hematology/Oncology Division, Larner College of Medicine at the University of Vermont, Burlington; Department of Biostatistics (C.L., K.R.), Department of Genome Sciences (J.D.S., D.A.N.), and Department of Epidemiology (A.P.R.), University of Washington, Seattle; Department of Epidemiology, University of Alabama, Birmingham (M.R.I.); Hematology, Department of Medicine, Johns Hopkins University, Baltimore, MD (R.P.N.); National Heart, Lung, and Blood Institute, Division of Intramural Research, Population Sciences Branch, Bethesda, MD (C.S., A.D.J.); Center for Public Health Genomics, University of Virginia, Charlottesville (A.W.M., S.S.R.); Epidemiology & Prevention, Public Health Sciences, Wake Forest School of Medicine, Winston-Salem, NC (Y. Liu); Institute for Translational Genomics and Population Sciences, Los Angeles Biomedical Research Institute and Departments of Pediatrics and Medicine, Harbor-UCLA Medical Center, Torrance, CA, and the David Geffen School of Medicine at UCLA (J.I.R.); Department of Physiology and Biophysics (J.G.W.), and Department of Medicine (A.C.), University of Mississippi Medical Center, Jackson; and Department of Medicine, University of Colorado Denver, Anschutz Medical Campus, Aurora (E.M.L., L.A.L.)
| | - Andrew D Johnson
- From the Department of Genetics (L.M.R., Q.D., Y. Li), Department of Biostatistics (Y. Li), and Department of Computer Science (Y. Li), University of North Carolina, Chapel Hill; Department of Pathology & Laboratory Medicine (N.A.Z., M.F.D., P.D., N.S.J., M.C.), and Department of Medicine (N.A.Z., M.C.), Hematology/Oncology Division, Larner College of Medicine at the University of Vermont, Burlington; Department of Biostatistics (C.L., K.R.), Department of Genome Sciences (J.D.S., D.A.N.), and Department of Epidemiology (A.P.R.), University of Washington, Seattle; Department of Epidemiology, University of Alabama, Birmingham (M.R.I.); Hematology, Department of Medicine, Johns Hopkins University, Baltimore, MD (R.P.N.); National Heart, Lung, and Blood Institute, Division of Intramural Research, Population Sciences Branch, Bethesda, MD (C.S., A.D.J.); Center for Public Health Genomics, University of Virginia, Charlottesville (A.W.M., S.S.R.); Epidemiology & Prevention, Public Health Sciences, Wake Forest School of Medicine, Winston-Salem, NC (Y. Liu); Institute for Translational Genomics and Population Sciences, Los Angeles Biomedical Research Institute and Departments of Pediatrics and Medicine, Harbor-UCLA Medical Center, Torrance, CA, and the David Geffen School of Medicine at UCLA (J.I.R.); Department of Physiology and Biophysics (J.G.W.), and Department of Medicine (A.C.), University of Mississippi Medical Center, Jackson; and Department of Medicine, University of Colorado Denver, Anschutz Medical Campus, Aurora (E.M.L., L.A.L.)
| | - Adolfo Correa
- From the Department of Genetics (L.M.R., Q.D., Y. Li), Department of Biostatistics (Y. Li), and Department of Computer Science (Y. Li), University of North Carolina, Chapel Hill; Department of Pathology & Laboratory Medicine (N.A.Z., M.F.D., P.D., N.S.J., M.C.), and Department of Medicine (N.A.Z., M.C.), Hematology/Oncology Division, Larner College of Medicine at the University of Vermont, Burlington; Department of Biostatistics (C.L., K.R.), Department of Genome Sciences (J.D.S., D.A.N.), and Department of Epidemiology (A.P.R.), University of Washington, Seattle; Department of Epidemiology, University of Alabama, Birmingham (M.R.I.); Hematology, Department of Medicine, Johns Hopkins University, Baltimore, MD (R.P.N.); National Heart, Lung, and Blood Institute, Division of Intramural Research, Population Sciences Branch, Bethesda, MD (C.S., A.D.J.); Center for Public Health Genomics, University of Virginia, Charlottesville (A.W.M., S.S.R.); Epidemiology & Prevention, Public Health Sciences, Wake Forest School of Medicine, Winston-Salem, NC (Y. Liu); Institute for Translational Genomics and Population Sciences, Los Angeles Biomedical Research Institute and Departments of Pediatrics and Medicine, Harbor-UCLA Medical Center, Torrance, CA, and the David Geffen School of Medicine at UCLA (J.I.R.); Department of Physiology and Biophysics (J.G.W.), and Department of Medicine (A.C.), University of Mississippi Medical Center, Jackson; and Department of Medicine, University of Colorado Denver, Anschutz Medical Campus, Aurora (E.M.L., L.A.L.)
| | - Yun Li
- From the Department of Genetics (L.M.R., Q.D., Y. Li), Department of Biostatistics (Y. Li), and Department of Computer Science (Y. Li), University of North Carolina, Chapel Hill; Department of Pathology & Laboratory Medicine (N.A.Z., M.F.D., P.D., N.S.J., M.C.), and Department of Medicine (N.A.Z., M.C.), Hematology/Oncology Division, Larner College of Medicine at the University of Vermont, Burlington; Department of Biostatistics (C.L., K.R.), Department of Genome Sciences (J.D.S., D.A.N.), and Department of Epidemiology (A.P.R.), University of Washington, Seattle; Department of Epidemiology, University of Alabama, Birmingham (M.R.I.); Hematology, Department of Medicine, Johns Hopkins University, Baltimore, MD (R.P.N.); National Heart, Lung, and Blood Institute, Division of Intramural Research, Population Sciences Branch, Bethesda, MD (C.S., A.D.J.); Center for Public Health Genomics, University of Virginia, Charlottesville (A.W.M., S.S.R.); Epidemiology & Prevention, Public Health Sciences, Wake Forest School of Medicine, Winston-Salem, NC (Y. Liu); Institute for Translational Genomics and Population Sciences, Los Angeles Biomedical Research Institute and Departments of Pediatrics and Medicine, Harbor-UCLA Medical Center, Torrance, CA, and the David Geffen School of Medicine at UCLA (J.I.R.); Department of Physiology and Biophysics (J.G.W.), and Department of Medicine (A.C.), University of Mississippi Medical Center, Jackson; and Department of Medicine, University of Colorado Denver, Anschutz Medical Campus, Aurora (E.M.L., L.A.L.)
| | - Deborah A Nickerson
- From the Department of Genetics (L.M.R., Q.D., Y. Li), Department of Biostatistics (Y. Li), and Department of Computer Science (Y. Li), University of North Carolina, Chapel Hill; Department of Pathology & Laboratory Medicine (N.A.Z., M.F.D., P.D., N.S.J., M.C.), and Department of Medicine (N.A.Z., M.C.), Hematology/Oncology Division, Larner College of Medicine at the University of Vermont, Burlington; Department of Biostatistics (C.L., K.R.), Department of Genome Sciences (J.D.S., D.A.N.), and Department of Epidemiology (A.P.R.), University of Washington, Seattle; Department of Epidemiology, University of Alabama, Birmingham (M.R.I.); Hematology, Department of Medicine, Johns Hopkins University, Baltimore, MD (R.P.N.); National Heart, Lung, and Blood Institute, Division of Intramural Research, Population Sciences Branch, Bethesda, MD (C.S., A.D.J.); Center for Public Health Genomics, University of Virginia, Charlottesville (A.W.M., S.S.R.); Epidemiology & Prevention, Public Health Sciences, Wake Forest School of Medicine, Winston-Salem, NC (Y. Liu); Institute for Translational Genomics and Population Sciences, Los Angeles Biomedical Research Institute and Departments of Pediatrics and Medicine, Harbor-UCLA Medical Center, Torrance, CA, and the David Geffen School of Medicine at UCLA (J.I.R.); Department of Physiology and Biophysics (J.G.W.), and Department of Medicine (A.C.), University of Mississippi Medical Center, Jackson; and Department of Medicine, University of Colorado Denver, Anschutz Medical Campus, Aurora (E.M.L., L.A.L.)
| | - Kenneth Rice
- From the Department of Genetics (L.M.R., Q.D., Y. Li), Department of Biostatistics (Y. Li), and Department of Computer Science (Y. Li), University of North Carolina, Chapel Hill; Department of Pathology & Laboratory Medicine (N.A.Z., M.F.D., P.D., N.S.J., M.C.), and Department of Medicine (N.A.Z., M.C.), Hematology/Oncology Division, Larner College of Medicine at the University of Vermont, Burlington; Department of Biostatistics (C.L., K.R.), Department of Genome Sciences (J.D.S., D.A.N.), and Department of Epidemiology (A.P.R.), University of Washington, Seattle; Department of Epidemiology, University of Alabama, Birmingham (M.R.I.); Hematology, Department of Medicine, Johns Hopkins University, Baltimore, MD (R.P.N.); National Heart, Lung, and Blood Institute, Division of Intramural Research, Population Sciences Branch, Bethesda, MD (C.S., A.D.J.); Center for Public Health Genomics, University of Virginia, Charlottesville (A.W.M., S.S.R.); Epidemiology & Prevention, Public Health Sciences, Wake Forest School of Medicine, Winston-Salem, NC (Y. Liu); Institute for Translational Genomics and Population Sciences, Los Angeles Biomedical Research Institute and Departments of Pediatrics and Medicine, Harbor-UCLA Medical Center, Torrance, CA, and the David Geffen School of Medicine at UCLA (J.I.R.); Department of Physiology and Biophysics (J.G.W.), and Department of Medicine (A.C.), University of Mississippi Medical Center, Jackson; and Department of Medicine, University of Colorado Denver, Anschutz Medical Campus, Aurora (E.M.L., L.A.L.)
| | - Ethan M Lange
- From the Department of Genetics (L.M.R., Q.D., Y. Li), Department of Biostatistics (Y. Li), and Department of Computer Science (Y. Li), University of North Carolina, Chapel Hill; Department of Pathology & Laboratory Medicine (N.A.Z., M.F.D., P.D., N.S.J., M.C.), and Department of Medicine (N.A.Z., M.C.), Hematology/Oncology Division, Larner College of Medicine at the University of Vermont, Burlington; Department of Biostatistics (C.L., K.R.), Department of Genome Sciences (J.D.S., D.A.N.), and Department of Epidemiology (A.P.R.), University of Washington, Seattle; Department of Epidemiology, University of Alabama, Birmingham (M.R.I.); Hematology, Department of Medicine, Johns Hopkins University, Baltimore, MD (R.P.N.); National Heart, Lung, and Blood Institute, Division of Intramural Research, Population Sciences Branch, Bethesda, MD (C.S., A.D.J.); Center for Public Health Genomics, University of Virginia, Charlottesville (A.W.M., S.S.R.); Epidemiology & Prevention, Public Health Sciences, Wake Forest School of Medicine, Winston-Salem, NC (Y. Liu); Institute for Translational Genomics and Population Sciences, Los Angeles Biomedical Research Institute and Departments of Pediatrics and Medicine, Harbor-UCLA Medical Center, Torrance, CA, and the David Geffen School of Medicine at UCLA (J.I.R.); Department of Physiology and Biophysics (J.G.W.), and Department of Medicine (A.C.), University of Mississippi Medical Center, Jackson; and Department of Medicine, University of Colorado Denver, Anschutz Medical Campus, Aurora (E.M.L., L.A.L.)
| | - Mary Cushman
- From the Department of Genetics (L.M.R., Q.D., Y. Li), Department of Biostatistics (Y. Li), and Department of Computer Science (Y. Li), University of North Carolina, Chapel Hill; Department of Pathology & Laboratory Medicine (N.A.Z., M.F.D., P.D., N.S.J., M.C.), and Department of Medicine (N.A.Z., M.C.), Hematology/Oncology Division, Larner College of Medicine at the University of Vermont, Burlington; Department of Biostatistics (C.L., K.R.), Department of Genome Sciences (J.D.S., D.A.N.), and Department of Epidemiology (A.P.R.), University of Washington, Seattle; Department of Epidemiology, University of Alabama, Birmingham (M.R.I.); Hematology, Department of Medicine, Johns Hopkins University, Baltimore, MD (R.P.N.); National Heart, Lung, and Blood Institute, Division of Intramural Research, Population Sciences Branch, Bethesda, MD (C.S., A.D.J.); Center for Public Health Genomics, University of Virginia, Charlottesville (A.W.M., S.S.R.); Epidemiology & Prevention, Public Health Sciences, Wake Forest School of Medicine, Winston-Salem, NC (Y. Liu); Institute for Translational Genomics and Population Sciences, Los Angeles Biomedical Research Institute and Departments of Pediatrics and Medicine, Harbor-UCLA Medical Center, Torrance, CA, and the David Geffen School of Medicine at UCLA (J.I.R.); Department of Physiology and Biophysics (J.G.W.), and Department of Medicine (A.C.), University of Mississippi Medical Center, Jackson; and Department of Medicine, University of Colorado Denver, Anschutz Medical Campus, Aurora (E.M.L., L.A.L.)
| | - Leslie A Lange
- From the Department of Genetics (L.M.R., Q.D., Y. Li), Department of Biostatistics (Y. Li), and Department of Computer Science (Y. Li), University of North Carolina, Chapel Hill; Department of Pathology & Laboratory Medicine (N.A.Z., M.F.D., P.D., N.S.J., M.C.), and Department of Medicine (N.A.Z., M.C.), Hematology/Oncology Division, Larner College of Medicine at the University of Vermont, Burlington; Department of Biostatistics (C.L., K.R.), Department of Genome Sciences (J.D.S., D.A.N.), and Department of Epidemiology (A.P.R.), University of Washington, Seattle; Department of Epidemiology, University of Alabama, Birmingham (M.R.I.); Hematology, Department of Medicine, Johns Hopkins University, Baltimore, MD (R.P.N.); National Heart, Lung, and Blood Institute, Division of Intramural Research, Population Sciences Branch, Bethesda, MD (C.S., A.D.J.); Center for Public Health Genomics, University of Virginia, Charlottesville (A.W.M., S.S.R.); Epidemiology & Prevention, Public Health Sciences, Wake Forest School of Medicine, Winston-Salem, NC (Y. Liu); Institute for Translational Genomics and Population Sciences, Los Angeles Biomedical Research Institute and Departments of Pediatrics and Medicine, Harbor-UCLA Medical Center, Torrance, CA, and the David Geffen School of Medicine at UCLA (J.I.R.); Department of Physiology and Biophysics (J.G.W.), and Department of Medicine (A.C.), University of Mississippi Medical Center, Jackson; and Department of Medicine, University of Colorado Denver, Anschutz Medical Campus, Aurora (E.M.L., L.A.L.)
| | - Alex P Reiner
- From the Department of Genetics (L.M.R., Q.D., Y. Li), Department of Biostatistics (Y. Li), and Department of Computer Science (Y. Li), University of North Carolina, Chapel Hill; Department of Pathology & Laboratory Medicine (N.A.Z., M.F.D., P.D., N.S.J., M.C.), and Department of Medicine (N.A.Z., M.C.), Hematology/Oncology Division, Larner College of Medicine at the University of Vermont, Burlington; Department of Biostatistics (C.L., K.R.), Department of Genome Sciences (J.D.S., D.A.N.), and Department of Epidemiology (A.P.R.), University of Washington, Seattle; Department of Epidemiology, University of Alabama, Birmingham (M.R.I.); Hematology, Department of Medicine, Johns Hopkins University, Baltimore, MD (R.P.N.); National Heart, Lung, and Blood Institute, Division of Intramural Research, Population Sciences Branch, Bethesda, MD (C.S., A.D.J.); Center for Public Health Genomics, University of Virginia, Charlottesville (A.W.M., S.S.R.); Epidemiology & Prevention, Public Health Sciences, Wake Forest School of Medicine, Winston-Salem, NC (Y. Liu); Institute for Translational Genomics and Population Sciences, Los Angeles Biomedical Research Institute and Departments of Pediatrics and Medicine, Harbor-UCLA Medical Center, Torrance, CA, and the David Geffen School of Medicine at UCLA (J.I.R.); Department of Physiology and Biophysics (J.G.W.), and Department of Medicine (A.C.), University of Mississippi Medical Center, Jackson; and Department of Medicine, University of Colorado Denver, Anschutz Medical Campus, Aurora (E.M.L., L.A.L.)
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Ng GJ, Quek AM, Cheung C, Arumugam TV, Seet RC. Stroke biomarkers in clinical practice: A critical appraisal. Neurochem Int 2017; 107:11-22. [DOI: 10.1016/j.neuint.2017.01.005] [Citation(s) in RCA: 40] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/21/2016] [Revised: 01/05/2017] [Accepted: 01/08/2017] [Indexed: 02/04/2023]
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Huang MJ, Wei RB, Wang Y, Su TY, Di P, Li QP, Yang X, Li P, Chen XM. Blood coagulation system in patients with chronic kidney disease: a prospective observational study. BMJ Open 2017; 7:e014294. [PMID: 28576889 PMCID: PMC5541338 DOI: 10.1136/bmjopen-2016-014294] [Citation(s) in RCA: 75] [Impact Index Per Article: 10.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/28/2023] Open
Abstract
OBJECTIVES Thromboembolic events are the major factor affecting the prognosis of patients with chronic kidney disease (CKD). Haemostatic alterations are possible causes of these complications, but their roles remain poorly characterised. In the prospective observational study, we investigated the entire coagulation process in patients with CKD to elucidate the mechanisms of their high thromboembolic risk. METHODS A total of 95 patients with CKD and 20 healthy controls who met the inclusion criteria were consecutively recruited from September 2015 to March 2016. The platelet count, platelet aggregation, von Willebrand factor antigen (vWF:Ag), vWF ristocetin cofactor activity (vWF:RCo), fibrinogen, factor V (FV), FVII, FVIII, antithrombin III, protein C, protein S, D-dimer, standard coagulation tests and thromboelastography were measured in patients with CKD and controls. Associations between the estimated glomerular filtration rate (eGFR) and haemostatic biomarkers were tested using multivariable linear regression. RESULTS The adjusted and unadjusted levels of vWF:Ag, vWF:RCo, fibrinogen, FVII, FVIII and D-dimer were significantly higher in patients with CKD than that in the healthy controls, and were elevated with CKD progression. However, after adjustment for baseline differences, platelet aggregation and thromboelastography parameters showed no significant differences between patients with CKD and healthy controls. In the correlation analysis, vWF:Ag, vWF:RCo and FVIII were inversely associated with eGFR (r=-0.359, p<0.001; r=-0.391, p<0.001; r=-0.327, p<0.001, respectively). During the 1-year of follow-up, one cardiovascular event occurred in patients with CKD 5 stage, whereas no thromboembolic event occurred in the CKD 3 and 4 and control groups. CONCLUSIONS Patients with CKD are characterised by endothelial dysfunction and increased coagulation, especially FVIII activity. The abnormal haemostatic profiles may contribute to the elevated risk of thrombotic events but further longer-term study with large samples is still required to more precisely determine the relationship between the elevation of procoagulant factors and clinical outcomes.
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Affiliation(s)
- Meng-Jie Huang
- Department of Nephrology, Chinese PLA General Hospital, Chinese PLA Institute of Nephrology, State Key Laboratory of Kidney Diseases, National Clinical Research Center for Kidney Diseases, Beijing Key Laboratory of Kidney Disease Research, Beijing, China
| | - Ri-bao Wei
- Department of Nephrology, Chinese PLA General Hospital, Chinese PLA Institute of Nephrology, State Key Laboratory of Kidney Diseases, National Clinical Research Center for Kidney Diseases, Beijing Key Laboratory of Kidney Disease Research, Beijing, China
| | - Yang Wang
- Department of Nephrology, Chinese PLA General Hospital, Chinese PLA Institute of Nephrology, State Key Laboratory of Kidney Diseases, National Clinical Research Center for Kidney Diseases, Beijing Key Laboratory of Kidney Disease Research, Beijing, China
| | - Ting-yu Su
- Department of Nephrology, Chinese PLA General Hospital, Chinese PLA Institute of Nephrology, State Key Laboratory of Kidney Diseases, National Clinical Research Center for Kidney Diseases, Beijing Key Laboratory of Kidney Disease Research, Beijing, China
| | - Ping Di
- Department of Clinical Laboratory, Chinese PLA General Hospital, Beijing, China
| | - Qing-ping Li
- Department of Nephrology, Chinese PLA General Hospital, Chinese PLA Institute of Nephrology, State Key Laboratory of Kidney Diseases, National Clinical Research Center for Kidney Diseases, Beijing Key Laboratory of Kidney Disease Research, Beijing, China
| | - Xi Yang
- Department of Nephrology, Chinese PLA General Hospital, Chinese PLA Institute of Nephrology, State Key Laboratory of Kidney Diseases, National Clinical Research Center for Kidney Diseases, Beijing Key Laboratory of Kidney Disease Research, Beijing, China
| | - Ping Li
- Department of Nephrology, Chinese PLA General Hospital, Chinese PLA Institute of Nephrology, State Key Laboratory of Kidney Diseases, National Clinical Research Center for Kidney Diseases, Beijing Key Laboratory of Kidney Disease Research, Beijing, China
| | - Xiang-mei Chen
- Department of Nephrology, Chinese PLA General Hospital, Chinese PLA Institute of Nephrology, State Key Laboratory of Kidney Diseases, National Clinical Research Center for Kidney Diseases, Beijing Key Laboratory of Kidney Disease Research, Beijing, China
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Tosi F, Micaglio R, Sandri M, Castagna A, Minguzzi D, Stefanoni F, Chiariello C, Franzese I, Luciani GB, Faggian G, Girelli D, Olivieri O, Martinelli N. Increased plasma thrombin potential is associated with stable coronary artery disease: An angiographically-controlled study. Thromb Res 2017; 155:16-22. [PMID: 28477533 DOI: 10.1016/j.thromres.2017.04.021] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/31/2016] [Revised: 03/25/2017] [Accepted: 04/21/2017] [Indexed: 10/19/2022]
Abstract
INTRODUCTION Coagulation plays a crucial role in coronary artery disease (CAD) contributing to both atherosclerotic plaque development and acute thrombotic complications, like myocardial infarction (MI). Coagulation biomarkers have been linked with ischemic heart disease, but results are still controversial. MATERIALS AND METHODS D-dimer and thrombin generation, two "overall" coagulation assays, were evaluated in 775 subjects with or without angiographically-proven CAD (170 CAD-free and 605 CAD, 355 of whom with history of previous MI). Subjects taking anticoagulant drugs or with any acute illness were excluded. D-dimer plasma concentration was determined by an immuno-turbidimetric assay. Thrombin generation was assessed as the ability of plasma to generate thrombin triggered by the addition of tissue factor ex-vivo by means of a chromogenic method. RESULTS Both D-dimer and thrombin generation parameters were associated with several traditional cardiovascular risk factors. Lag-time, time-to-peak, peak height, and Endogenous Thrombin Potential (ETP), as well as D-dimer levels, were higher in CAD patients than in CAD-free subjects. After adjustment for all the traditional risk factors, only ETP levels remained significantly associated with CAD (the highest versus the lowest tertile: OR 2.61 with 95%CI 1.14-5.99), but without improvement of C-statistic. The association of D-dimer vanished after adjustment for inflammatory markers. No difference of either D-dimer or thrombin generation parameters was found between CAD patients with or without previous MI history. CONCLUSIONS Our results suggest that an increased plasma thrombin potential is characteristic in patients with clinically stable CAD, irrespective of previous MI history and independent of traditional cardiovascular risk factors.
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Affiliation(s)
- Federica Tosi
- Department of Medicine, University of Verona, Verona, Italy
| | | | - Marco Sandri
- Department of Medicine, University of Verona, Verona, Italy
| | | | - Diego Minguzzi
- Department of Medicine, University of Verona, Verona, Italy
| | | | | | - Ilaria Franzese
- Department of Surgical Sciences, Dentistry, Gynecology and Pediatrics - Division of Cardiac Surgery, University of Verona, Italy
| | - Giovanni Battista Luciani
- Department of Surgical Sciences, Dentistry, Gynecology and Pediatrics - Division of Cardiac Surgery, University of Verona, Italy
| | - Giuseppe Faggian
- Department of Surgical Sciences, Dentistry, Gynecology and Pediatrics - Division of Cardiac Surgery, University of Verona, Italy
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Falanga A, Santoro A, Labianca R, De Braud F, Gasparini G, D'Alessio A, Barni S, Iacoviello L. Hypercoagulation screening as an innovative tool for risk assessment, early diagnosis and prognosis in cancer: the HYPERCAN study. Thromb Res 2017; 140 Suppl 1:S55-9. [PMID: 27067979 DOI: 10.1016/s0049-3848(16)30099-8] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
The HYPERCAN is a prospective observational Italian multicentre study started in 2012, structured in two main projects (i.e. Projects A and B) that involve both healthy subjects and cancer patients. The HYPERCAN study aims to assess whether the occurrence of a hypercoagulable state may be predictive of cancer diagnosis in healthy individuals, or may be predictive of disease recurrence, clinical progression and thrombosis in cancer patients. Project A involves two different large cohorts of subjects: The first cohort (Project A-1) consists of 10,000 healthy volunteer blood donors to be enrolled and prospectively follow-up for cancer occurrence, while the second cohort (Project A-2) consists of 25,000 people already enrolled in the framework of the general population-based Moli-Sani study. Project B involves 4,000 adult patients with a confirmed diagnosis of four different cancer types (both limited/resected or metastatic diseases), i.e. non-small cell-lung, gastric, colorectal, and breast cancer, to be enrolled and followed up for 5years or death. Blood samples from all enrolled subjects are collected at baseline and then at different time intervals according to specific time schedules set up for either normal subjects, or patients with limited cancers, or patients with metastatic cancers. Samples will be analysed for a panel of hemostatic proteins, clotting activation biomarkers, thrombin generation, procoagulant microparticles, and thrombophilic polymorphisms. As of November 2015, 6,189 healthy blood donors have been enrolled in project A-1 and 2,532 cancer patients in project B. Clinical follow-up and biological assays are ongoing. The HYPERCAN study wants to explore in different subset of individuals, affected and non-affected by malignant disease, the relationship between coagulation and cancer. The prospective design and the involvement of a large number of individuals will definitively clarify whether alterations in circulating thrombotic markers may be predictive of cancer diagnosis in an otherwise healthy subject and/or may be prognostic of cancer outcome, or of disease progression/relapse in cancer-affected individuals. Finally, the proposed screening with relatively simple and non-high-cost laboratory tests and the use of easy-obtainable peripheral blood samples add a very relevant translational value to this study.
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Affiliation(s)
- Anna Falanga
- Division of Immunohematology and Transfusion Medicine & Thrombosis and Hemostasis Center, Hospital Papa Giovanni XXIII, Bergamo Italy.
| | - Armando Santoro
- Division of Medical Oncology IRCCS Humanitas Institute, Rozzano, Italy
| | - Roberto Labianca
- Dipartimento Interaziendale Provinciale Oncologico (DIPO), Hospital Papa Giovanni XXIII, Bergamo, Italy
| | | | - Giampietro Gasparini
- Division of Medical Oncology, Hospital San Filippo Neri, Rome, Italy and IRCCS National Cancer Institute, Bari, Italy
| | | | | | - Licia Iacoviello
- IRCCS Istituto Neurologico Mediterraneo NEUROMED, Pozzilli, Italy
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Zakai NA, McClure LA, Judd SE, Kissela B, Howard G, Safford M, Cushman M. D-dimer and the Risk of Stroke and Coronary Heart Disease. The REasons for Geographic and Racial Differences in Stroke (REGARDS) Study. Thromb Haemost 2016; 117:618-624. [PMID: 28004063 DOI: 10.1160/th16-07-0519] [Citation(s) in RCA: 28] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/08/2016] [Accepted: 12/05/2016] [Indexed: 11/05/2022]
Abstract
D-dimer, a biomarker of coagulation, is higher in blacks than in whites and has been associated with stroke and coronary heart disease (CHD). It was our objective to assess the association of higher D-dimer with stroke and CHD in blacks and whites. REGARDS recruited 30,239 black and white participants across the contiguous US and measured baseline D-dimer in stroke (n=646) and CHD (n=654) cases and a cohort random sample (n=1,104). Cox models adjusting for cardiovascular risk factors determined the hazard ratio (HR) for increasing D-dimer for cardiovascular disease with bootstrapping to assess the difference in HR for CHD versus stroke by race. D-dimer was higher with increasing age, female sex, diabetes, hypertension, pre-baseline cardiovascular disease and higher C-reactive protein (CRP). Accounting for cardiovascular risk factors, each doubling of D-dimer was associated with increased stroke (hazard ratio [HR] 1.15; 95 % confidence interval [CI] 1.01, 1.31) and CHD (HR 1.27; 95 % CI 1.11, 1.45) risk. The difference in the HR between CHD and stroke was 0.20 (95 % CI >0.00, 0.58) for blacks and 0.02 (95 % CI -0.30, 0.27) for whites. CRP mediated 22 % (95 % CI 5 %, 41 %) of the association between D-dimer and CHD and none of the association with stroke. Higher D-dimer increased the risk of stroke and CHD independent of cardiovascular risk factors and CRP, with perhaps a stronger association for CHD versus stroke in blacks than whites. These findings highlight potential different pathophysiology of vascular disease by disease site and race suggesting potential further studies targeting haemostasis in primary prevention of vascular disease.
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Affiliation(s)
- Neil A Zakai
- Neil A. Zakai, MD MSc, University of Vermont Larner College of Medicine, 360 South Park Drive, Colchester, VT 05446, USA, Tel.: +1 802 6563154, Fax: +1 802 656 8965, E-mail:
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Swier N, Versteeg HH. Reciprocal links between venous thromboembolism, coagulation factors and ovarian cancer progression. Thromb Res 2016; 150:8-18. [PMID: 27988375 DOI: 10.1016/j.thromres.2016.12.002] [Citation(s) in RCA: 48] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/29/2016] [Revised: 11/23/2016] [Accepted: 12/03/2016] [Indexed: 02/06/2023]
Abstract
Ovarian cancer is the most lethal gynecological malignancy, which is due to late presentation. Treating advanced stage ovarian cancer is difficult, and tumor recurrence and chemoresistance frequently occur. In addition, early detection remains a major challenge as there are no early warning signs and no appropriate biomarkers. To reduce mortality rates of ovarian cancer patients, novel drug targets and biomarkers are needed. We postulate that hemostatic keyplayers are of importance when combatting ovarian cancer. The majority of ovarian cancer patients have abnormal hemostatic blood serum marker levels, which indicate an activated coagulation system. This makes patients more prone to experiencing venous thromboembolism (VTE), and the occurrence of VTE in ovarian cancer patients adversely affects survival. Coagulation activation also promotes tumor progression as it influences tumor biology at several stages and the decreased survival rates associated with ovarian cancer-associated thrombosis are more likely due to cancer metastasis rather than to fatal thromboembolic events. In this review, we will discuss; (1) Population studies that address the bidirectional relationship between VTE and ovarian cancer, and the most important risk factors involved; (2) The mechanisms of coagulation factors and platelets that are critically involved in the development of VTE, and the progression of ovarian cancer; (3) Roles and future directions of coagulation factors in ovarian cancer therapy, and in diagnosis and prognosis of ovarian cancer as biomarkers.
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Affiliation(s)
- Nathalie Swier
- Department of Internal Medicine, Thrombosis and Hemostasis Division, Leiden University Medical Center, Albinusdreef 2, 2333, ZA, Leiden, The Netherlands
| | - Henri H Versteeg
- Department of Internal Medicine, Thrombosis and Hemostasis Division, Leiden University Medical Center, Albinusdreef 2, 2333, ZA, Leiden, The Netherlands.
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Emmer BT, Ginsburg D, Desch KC. Von Willebrand Factor and ADAMTS13: Too Much or Too Little of a Good Thing? Arterioscler Thromb Vasc Biol 2016; 36:2281-2282. [PMID: 27879275 DOI: 10.1161/atvbaha.116.308531] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/07/2023]
Affiliation(s)
- Brian T Emmer
- From the Department of Internal Medicine (B.T.E., D.G.), Life Sciences Institute, Department of Human Genetics, Howard Hughes Medical Institute (D.G.), and Department of Pediatrics and Communicable Disease (D.G., K.C.D.), University of Michigan, Ann Arbor
| | - David Ginsburg
- From the Department of Internal Medicine (B.T.E., D.G.), Life Sciences Institute, Department of Human Genetics, Howard Hughes Medical Institute (D.G.), and Department of Pediatrics and Communicable Disease (D.G., K.C.D.), University of Michigan, Ann Arbor
| | - Karl C Desch
- From the Department of Internal Medicine (B.T.E., D.G.), Life Sciences Institute, Department of Human Genetics, Howard Hughes Medical Institute (D.G.), and Department of Pediatrics and Communicable Disease (D.G., K.C.D.), University of Michigan, Ann Arbor.
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Grund B, Baker JV, Deeks SG, Wolfson J, Wentworth D, Cozzi-Lepri A, Cohen CJ, Phillips A, Lundgren JD, Neaton JD. Relevance of Interleukin-6 and D-Dimer for Serious Non-AIDS Morbidity and Death among HIV-Positive Adults on Suppressive Antiretroviral Therapy. PLoS One 2016; 11:e0155100. [PMID: 27171281 PMCID: PMC4865234 DOI: 10.1371/journal.pone.0155100] [Citation(s) in RCA: 141] [Impact Index Per Article: 17.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/21/2015] [Accepted: 04/25/2016] [Indexed: 01/09/2023] Open
Abstract
Background Despite effective antiretroviral treatment (ART), HIV-positive individuals are at increased risk of serious non-AIDS conditions (cardiovascular, liver and renal disease, and cancers), perhaps due in part to ongoing inflammation and/or coagulation. To estimate the potential risk reduction in serious non-AIDS conditions or death from any cause that might be achieved with treatments that reduce inflammation and/or coagulation, we examined associations of interleukin-6 (IL-6), D-dimer, and high-sensitivity C-reactive protein (hsCRP) levels with serious non-AIDS conditions or death in 3 large cohorts. Methods In HIV-positive adults on suppressive ART, associations of IL-6, D-dimer, and hsCRP levels at study entry with serious non-AIDS conditions or death were studied using Cox regression. Hazard ratios (HR) adjusted for age, gender, study, and regression dilution bias (due to within-person biomarker variability) were used to predict risk reductions in serious non-AIDS conditions or death associated with lower “usual” levels of IL-6 and D-dimer. Results Over 4.9 years of mean follow-up, 260 of the 3766 participants experienced serious non-AIDS conditions or death. IL-6, D-dimer and hsCRP were each individually associated with risk of serious non-AIDS conditions or death, HR = 1.45 (95% CI: 1.30 to 1.63), 1.28 (95% CI: 1.14 to 1.44), and 1.17 (95% CI: 1.09 to 1.26) per 2x higher biomarker levels, respectively. In joint models, IL-6 and D-dimer were independently associated with serious non-AIDS conditions or death, with consistent results across the 3 cohorts and across serious non-AIDS event types. The association of IL-6 and D-dimer with serious non-AIDS conditions or death was graded and persisted throughout follow-up. For 25% lower “usual” IL-6 and D-dimer levels, the joint biomarker model estimates a 37% reduction (95% CI: 28 to 46%) in the risk of serious non-AIDS conditions or death if the relationship is causal. Conclusions Both IL-6 and D-dimer are independently associated with serious non-AIDS conditions or death among HIV-positive adults with suppressed virus. This suggests that treatments that reduce IL-6 and D-dimer levels might substantially decrease morbidity and mortality in patients on suppressive ART. Clinical trials are needed to test this hypothesis.
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Affiliation(s)
- Birgit Grund
- School of Statistics, University of Minnesota, Minneapolis, MN, United States of America
- * E-mail:
| | - Jason V Baker
- Hennepin County Medical Center, Minneapolis, MN, United States of America
- Department of Medicine, University of Minnesota, Minneapolis, MN, United States of America
| | - Steven G. Deeks
- University of California San Francisco, San Francisco, CA, United States of America
- San Francisco General Hospital, San Francisco, CA, United States of America
| | - Julian Wolfson
- Division of Biostatistics, School of Public Health, University of Minnesota, Minneapolis, MN, United States of America
| | - Deborah Wentworth
- Division of Biostatistics, School of Public Health, University of Minnesota, Minneapolis, MN, United States of America
| | | | - Calvin J. Cohen
- Medical Affairs Department, Gilead Sciences, Foster City, CA, United States of America
| | | | - Jens D. Lundgren
- Department of Infectious Diseases, Rigshospitalet, University of Copenhagen, Copenhagen, Denmark
| | - James D. Neaton
- Division of Biostatistics, School of Public Health, University of Minnesota, Minneapolis, MN, United States of America
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Borges ÁH, O'Connor JL, Phillips AN, Neaton JD, Grund B, Neuhaus J, Vjecha MJ, Calmy A, Koelsch KK, Lundgren JD. Interleukin 6 Is a Stronger Predictor of Clinical Events Than High-Sensitivity C-Reactive Protein or D-Dimer During HIV Infection. J Infect Dis 2016; 214:408-16. [PMID: 27132283 DOI: 10.1093/infdis/jiw173] [Citation(s) in RCA: 86] [Impact Index Per Article: 10.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/03/2016] [Accepted: 04/25/2016] [Indexed: 01/06/2023] Open
Abstract
BACKGROUND Interleukin 6 (IL-6), high-sensitivity C-reactive protein (hsCRP), and D-dimer levels are linked to adverse outcomes in human immunodeficiency virus (HIV) infection, but the strength of their associations with different clinical end points warrants investigation. METHODS Participants receiving standard of care in 2 HIV trials with measured biomarker levels were followed to ascertain all-cause death, non-AIDS-related death, AIDS, cardiovascular disease (CVD), and non-AIDS-defining malignancies. Hazard ratios (HRs) and 95% confidence intervals (CIs) of each end point for quartiles and log2-transformed IL-6, hsCRP, and D-dimer levels were calculated using Cox models. Marginal models modelling multiple events tested for equal effects of biomarker levels on different end points. RESULTS Among 4304 participants, there were 157 all-cause deaths, 117 non-AIDS-related deaths, 101 AIDS cases, 121 CVD cases, and 99 non-AIDS-defining malignancies. IL-6 was more strongly associated with most end points, compared with hsCRP. IL-6 appeared to be a stronger predictor than D-dimer for CVD and non-AIDS-defining malignancies, but 95% CIs overlapped. Independent associations of IL-6 were stronger for non-AIDS-related death (HR, 1.71; 95% CI, 1.43-2.04) and all-cause death (HR, 1.56; 95% CI, 1.33-1.84) and similar for CVD (HR, 1.35; 95% CI, 1.12-1.62) and non-AIDS-defining malignancies (HR, 1.30; 95% CI, 1.06-1.61). There was heterogeneity of IL-6 (P < .001) but not hsCRP (P = .15) or D-dimer (P = .20) as a predictor for different end points. CONCLUSIONS IL-6 is a stronger predictor of fatal events than of CVD and non-AIDS-defining malignancies. Adjuvant antiinflammatory and antithrombotic therapies should be tested in HIV-infected individuals.
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Affiliation(s)
- Álvaro H Borges
- Centre for Health and Infectious Diseases Research (CHIP), Department of Infectious Diseases, Rigshospitalet-University of Copenhagen, Denmark
| | - Jemma L O'Connor
- Research Department of Infection and Population Health, University College London, United Kingdom
| | - Andrew N Phillips
- Research Department of Infection and Population Health, University College London, United Kingdom
| | | | - Birgit Grund
- School of Statistics, University of Minnesota, Minneapolis
| | | | - Michael J Vjecha
- Institute for Clinical Research Veterans Affairs Medical Center, Washington D.C
| | - Alexandra Calmy
- HIV Unit, Division of Infectious Diseases, Geneva University Hospitals, Switzerland
| | - Kersten K Koelsch
- The Kirby Institute for Infection and Immunity in Society, University of New South Wales, and St. Vincent's Hospital, Sydney, Australia
| | - Jens D Lundgren
- Centre for Health and Infectious Diseases Research (CHIP), Department of Infectious Diseases, Rigshospitalet-University of Copenhagen, Denmark
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Folsom AR, Gottesman RF, Appiah D, Shahar E, Mosley TH. Plasma d-Dimer and Incident Ischemic Stroke and Coronary Heart Disease: The Atherosclerosis Risk in Communities Study. Stroke 2015; 47:18-23. [PMID: 26556822 DOI: 10.1161/strokeaha.115.011035] [Citation(s) in RCA: 47] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/30/2015] [Accepted: 10/15/2015] [Indexed: 11/16/2022]
Abstract
BACKGROUND AND PURPOSE Epidemiological studies have documented that plasma d-dimer, a fibrin degradation product, is a risk marker for coronary heart disease, but there is limited prospective evidence for stroke. Given that thrombosis is a key mechanism for many strokes, we studied whether d-dimer is a risk marker for ischemic stroke incidence in the Atherosclerosis Risk in Communities (ARIC) Study. METHODS We measured d-dimer in 11 415 ARIC participants free of stroke and coronary heart disease in 1992 to 1995. We followed them for stroke, stroke subtype, and coronary heart disease events through 2012. RESULTS Over a median of 18 years of follow-up, 719 participants had incident strokes (628 ischemic and 91 hemorrhagic). d-dimer was associated positively with risk of total, ischemic, and cardioembolic strokes, with risk elevated primarily for the highest quintile of d-dimer. After adjustment for other cardiovascular risk factors, the hazard ratio for the highest versus lowest quintile of d-dimer was 1.30 (95% confidence interval, 1.02-1.67) for total stroke, 1.33 (95% confidence interval, 1.02-1.73) for ischemic stroke, and 1.79 (95% confidence interval, 1.08-2.95) for cardioembolic stroke. There was no association with hemorrhagic, lacunar, or nonlacunar stroke categories. d-dimer was positively but weakly associated with coronary heart disease incidence. CONCLUSIONS A higher basal plasma d-dimer concentration in the general population is a risk marker for ischemic stroke, especially cardioembolic stroke.
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Affiliation(s)
- Aaron R Folsom
- From the Division of Epidemiology and Community Health, School of Public Health, University of Minnesota, Minneapolis (A.R.F., D.A.); Department of Neurology, Johns Hopkins University School of Medicine, Baltimore, MD (R.F.G.); Department of Epidemiology and Biostatistics, Mel & Enid Zuckerman College of Public Health, University of Arizona, Tucson (E.S.); and Department of Neurology and Geriatrics/Gerontology, University of Mississippi Medical Center, Jackson (T.H.M.).
| | - Rebecca F Gottesman
- From the Division of Epidemiology and Community Health, School of Public Health, University of Minnesota, Minneapolis (A.R.F., D.A.); Department of Neurology, Johns Hopkins University School of Medicine, Baltimore, MD (R.F.G.); Department of Epidemiology and Biostatistics, Mel & Enid Zuckerman College of Public Health, University of Arizona, Tucson (E.S.); and Department of Neurology and Geriatrics/Gerontology, University of Mississippi Medical Center, Jackson (T.H.M.)
| | - Duke Appiah
- From the Division of Epidemiology and Community Health, School of Public Health, University of Minnesota, Minneapolis (A.R.F., D.A.); Department of Neurology, Johns Hopkins University School of Medicine, Baltimore, MD (R.F.G.); Department of Epidemiology and Biostatistics, Mel & Enid Zuckerman College of Public Health, University of Arizona, Tucson (E.S.); and Department of Neurology and Geriatrics/Gerontology, University of Mississippi Medical Center, Jackson (T.H.M.)
| | - Eyal Shahar
- From the Division of Epidemiology and Community Health, School of Public Health, University of Minnesota, Minneapolis (A.R.F., D.A.); Department of Neurology, Johns Hopkins University School of Medicine, Baltimore, MD (R.F.G.); Department of Epidemiology and Biostatistics, Mel & Enid Zuckerman College of Public Health, University of Arizona, Tucson (E.S.); and Department of Neurology and Geriatrics/Gerontology, University of Mississippi Medical Center, Jackson (T.H.M.)
| | - Thomas H Mosley
- From the Division of Epidemiology and Community Health, School of Public Health, University of Minnesota, Minneapolis (A.R.F., D.A.); Department of Neurology, Johns Hopkins University School of Medicine, Baltimore, MD (R.F.G.); Department of Epidemiology and Biostatistics, Mel & Enid Zuckerman College of Public Health, University of Arizona, Tucson (E.S.); and Department of Neurology and Geriatrics/Gerontology, University of Mississippi Medical Center, Jackson (T.H.M.)
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Jacobson TA, Maki KC, Orringer CE, Jones PH, Kris-Etherton P, Sikand G, La Forge R, Daniels SR, Wilson DP, Morris PB, Wild RA, Grundy SM, Daviglus M, Ferdinand KC, Vijayaraghavan K, Deedwania PC, Aberg JA, Liao KP, McKenney JM, Ross JL, Braun LT, Ito MK, Bays HE, Brown WV. National Lipid Association Recommendations for Patient-Centered Management of Dyslipidemia: Part 2. J Clin Lipidol 2015; 9:S1-122.e1. [DOI: 10.1016/j.jacl.2015.09.002] [Citation(s) in RCA: 315] [Impact Index Per Article: 35.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
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Yap ES, Timp JF, Flinterman LE, van Hylckama Vlieg A, Rosendaal FR, Cannegieter SC, Lijfering WM. Elevated levels of factor VIII and subsequent risk of all-cause mortality: results from the MEGA follow-up study. J Thromb Haemost 2015; 13:1833-42. [PMID: 26264493 DOI: 10.1111/jth.13071] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/21/2015] [Indexed: 12/21/2022]
Abstract
BACKGROUND Factor VIII (FVIII) levels are increased in individuals with a non-O blood group and play a role in the etiology of thrombosis. High FVIII levels have also been associated with increased all-cause mortality. OBJECTIVE We explored whether elevated FVIII levels are associated with an increased risk of death in patients who had venous thrombosis and in individuals from the general population, and to what extent this association is causal. METHODS We followed 2178 patients with previous venous thrombosis and 2827 age and sex-matched community controls for on average 5.5 years and measured their FVIII levels and ABO blood group. RESULTS All-cause mortality increased in a dose-response fashion with increasing percentiles of FVIII levels. In the thrombosis patients the risk was highest above the 97.5th percentile (FVIII > 199 IU dL(-1) ) with an adjusted hazard ratio (HR) of 3.1 (95% confidence interval [CI], 0.9-10.8) as compared with patients in the 25th percentile category (FVIII ≤ 85 IU dL(-1) ). The adjusted HR was 4.5 (95% CI, 1.4-14.3) in controls. Using non-O blood group as a measure of genetically elevated FVIII levels to determine a causal relationship between FVIII and death showed observed HRs of 0.99 (95% CI, 0.72-1.36) in patients and 1.25 (95% CI, 0.82-1.90) in controls. CONCLUSIONS We showed a dose-response relationship between high FVIII levels and risk of death in venous thrombosis patients and in individuals from the general population. However, environmental factors, such as chronic comorbidities and chronic inflammation, are at least in part responsible for the association between factor VIII and mortality.
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Affiliation(s)
- E S Yap
- Department of Clinical Epidemiology, Leiden University Medical Center, Leiden, the Netherlands
- Department of Haematology-Oncology, National University Cancer Institute, Singapore, Singapore
| | - J F Timp
- Department of Clinical Epidemiology, Leiden University Medical Center, Leiden, the Netherlands
| | - L E Flinterman
- Department of Clinical Epidemiology, Leiden University Medical Center, Leiden, the Netherlands
| | - A van Hylckama Vlieg
- Department of Clinical Epidemiology, Leiden University Medical Center, Leiden, the Netherlands
| | - F R Rosendaal
- Department of Clinical Epidemiology, Leiden University Medical Center, Leiden, the Netherlands
- Einthoven Laboratory for Experimental Vascular Medicine, Leiden University Medical Center, Leiden, the Netherlands
- Department of Thrombosis and Haemostasis, Leiden University Medical Center, Leiden, the Netherlands
| | - S C Cannegieter
- Department of Clinical Epidemiology, Leiden University Medical Center, Leiden, the Netherlands
- Einthoven Laboratory for Experimental Vascular Medicine, Leiden University Medical Center, Leiden, the Netherlands
| | - W M Lijfering
- Department of Clinical Epidemiology, Leiden University Medical Center, Leiden, the Netherlands
- Einthoven Laboratory for Experimental Vascular Medicine, Leiden University Medical Center, Leiden, the Netherlands
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Ong KL, Ding J, McClelland RL, Cheung BMY, Criqui MH, Barter PJ, Rye KA, Allison MA. Relationship of pericardial fat with biomarkers of inflammation and hemostasis, and cardiovascular disease: the Multi-Ethnic Study of Atherosclerosis. Atherosclerosis 2015; 239:386-92. [PMID: 25682037 PMCID: PMC4361311 DOI: 10.1016/j.atherosclerosis.2015.01.033] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/14/2014] [Revised: 01/28/2015] [Accepted: 01/28/2015] [Indexed: 12/19/2022]
Abstract
OBJECTIVE Pericardial fat may increase the risk of cardiovascular disease (CVD) by increasing circulating levels of inflammation and hemostasis biomarkers. We investigated the associations of pericardial fat with inflammation and hemostasis biomarkers, as well as incident CVD events, and whether there are any ethnic differences in these associations. METHODS We analyzed results from 6415 participants from the Multi-Ethnic Study of Atherosclerosis who had measurements of pericardial fat volume and circulating levels of C-reactive protein (CRP), fibrinogen, interleukin (IL)-6, factor VIII, D-dimer and plasmin-antiplasmin complex (PAP), and had a mean follow-up period of 9.5 years. Incident CVD event was defined as any adjudicated CVD event. RESULTS After adjusting for confounding factors, pericardial fat volume was positively associated with natural log (ln) of IL-6 levels, but inversely associated with ln D-dimer and ln PAP levels (β = 0.067, -0.032, and -0.105 respectively, all P < 0.05). Although a larger pericardial fat volume was associated with a higher risk of incident CVD, the association was attenuated to borderline significance after adjusting for traditional cardiovascular risk factors (P = 0.050). There was a borderline significant ethnicity interaction (P = 0.080), whereby the association between pericardial fat volume and incident CVD was significant in Hispanic Americans, even after further adjusting for biomarkers of inflammation and hemostasis (hazard ratio = 1.31 per SD increase, 95% confidence interval 1.09-1.57, P = 0.004). CONCLUSION Pericardial fat was associated with several inflammation and hemostasis biomarkers. The association of pericardial fat with incident CVD events was independent of these biomarkers only among Hispanic Americans.
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Affiliation(s)
- Kwok-Leung Ong
- Centre for Vascular Research, University of New South Wales, Sydney, NSW, Australia; Faculty of Medicine, University of Sydney, Sydney, NSW, Australia.
| | - Jingzhong Ding
- Sticht Center on Aging, Wake Forest University School of Medicine, Winston-Salem, NC, United States
| | - Robyn L McClelland
- Department of Biostatistics, University of Washington, Seattle, WA, United States
| | | | - Michael H Criqui
- Department of Family and Preventive Medicine, University of California San Diego, La Jolla, CA, United States
| | - Philip J Barter
- Centre for Vascular Research, University of New South Wales, Sydney, NSW, Australia; Faculty of Medicine, University of Sydney, Sydney, NSW, Australia
| | - Kerry-Anne Rye
- Centre for Vascular Research, University of New South Wales, Sydney, NSW, Australia; Faculty of Medicine, University of Sydney, Sydney, NSW, Australia
| | - Matthew A Allison
- Department of Family and Preventive Medicine, University of California San Diego, La Jolla, CA, United States
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Hermanns MI, Grossmann V, Spronk HMH, Schulz A, Jünger C, Laubert-Reh D, Mazur J, Gori T, Zeller T, Pfeiffer N, Beutel M, Blankenberg S, Münzel T, Lackner KJ, Ten Cate-Hoek AJ, Ten Cate H, Wild PS. Distribution, genetic and cardiovascular determinants of FVIII:c - Data from the population-based Gutenberg Health Study. Int J Cardiol 2015; 187:166-74. [PMID: 25828346 DOI: 10.1016/j.ijcard.2015.03.330] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/24/2014] [Revised: 02/18/2015] [Accepted: 03/20/2015] [Indexed: 11/20/2022]
Abstract
BACKGROUND Elevated levels of FVIII c are associated with risk for both venous and arterial thromboembolism. However, no population-based study on the sex-specific distribution and reference ranges of plasma FVIII c and its cardiovascular determinants is available. METHODS FVIII c was analyzed in a randomly selected sample of 2533 males and 2440 females from the Gutenberg Health Study in Germany. Multivariable regression analyses for FVIII c were performed under adjustment for genetic determinants, cardiovascular risk factors and cardiovascular disease. RESULTS AND CONCLUSIONS Females (126.6% (95% CI: 125.2/128)) showed higher FVIII c levels than males (121.2% (119.8/122.7)). FVIII c levels increased with age in both sexes (ß per decade: 5.67% (4.22/7.13) male, 6.15% (4.72/7.57) female; p<0.001). Sex-specific reference limits and categories indicating the grade of deviation from the reference were calculated, and nomograms for FVIII c were created. FVIII c was approximately 25% higher in individuals with non-O blood type. Adjusted for sex and age, ABO-blood group accounted for 18.3% of FVIII c variation. In multivariable analysis, FVIII c was notably positively associated with diabetes mellitus, obesity, hypertension and dyslipidemia and negatively with current smoking. In a fully adjusted multivariable model, the strongest associations observed were of elevated FVIII c with diabetes and peripheral artery disease in both sexes and with obesity in males. Effects of SNPs in the vWF, STAB2 and SCARA5 gene were stronger in females than in males. The use of nomograms for valuation of FVIII c might be useful to identify high-risk cohorts for thromboembolism. Additionally, the prospective evaluation of FVIII c as a risk predictor becomes feasible.
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Affiliation(s)
- M Iris Hermanns
- Center for Thrombosis and Hemostasis (CTH), University Medical Center of the Johannes Gutenberg-University Mainz, Germany.
| | - Vera Grossmann
- Center for Thrombosis and Hemostasis (CTH), University Medical Center of the Johannes Gutenberg-University Mainz, Germany
| | - Henri M H Spronk
- Laboratory for Clinical Thrombosis and Hemostasis, Dept. of Internal Medicine, Cardiovascular Research Institute Maastricht (CARIM), Maastricht University Medical Center, Maastricht, The Netherlands
| | - Andreas Schulz
- Preventive Cardiology and Preventive Medicine, Dept. of Medicine 2, University Medical Center of the Johannes Gutenberg-University Mainz, Germany
| | - Claus Jünger
- Preventive Cardiology and Preventive Medicine, Dept. of Medicine 2, University Medical Center of the Johannes Gutenberg-University Mainz, Germany
| | - Dagmar Laubert-Reh
- Preventive Cardiology and Preventive Medicine, Dept. of Medicine 2, University Medical Center of the Johannes Gutenberg-University Mainz, Germany
| | - Johanna Mazur
- Institute for Medical Biostatistics, Epidemiology and Informatics, University Medical Center of the Johannes Gutenberg-University Mainz, Germany
| | - Tommaso Gori
- Dept. of Medicine 2, University Medical Center of the Johannes Gutenberg-University Mainz, Germany
| | - Tanja Zeller
- Clinic for General and Interventional Cardiology, University Heart Center Hamburg, Germany; DZHK (German Center for Cardiovascular Research), Partner Site Hamburg/Kiel/Lübeck, Hamburg, Germany
| | - Norbert Pfeiffer
- Department of Ophthalmology, University Medical Center of the Johannes Gutenberg-University Mainz, Germany
| | - Manfred Beutel
- Department of Psychosomatic Medicine and Psychotherapy, University Medical Center of the Johannes Gutenberg-University Mainz, Germany
| | - Stefan Blankenberg
- Clinic for General and Interventional Cardiology, University Heart Center Hamburg, Germany; DZHK (German Center for Cardiovascular Research), Partner Site Hamburg/Kiel/Lübeck, Hamburg, Germany
| | - Thomas Münzel
- Dept. of Medicine 2, University Medical Center of the Johannes Gutenberg-University Mainz, Germany; DZHK (German Center for Cardiovascular Research), Partner Site Rhine-Main, Mainz, Germany
| | - Karl J Lackner
- Institute for Clinical Chemistry and Laboratory Medicine, University Medical Center of the Johannes Gutenberg-University Mainz, Germany
| | - Arina J Ten Cate-Hoek
- Laboratory for Clinical Thrombosis and Hemostasis, Dept. of Internal Medicine, Cardiovascular Research Institute Maastricht (CARIM), Maastricht University Medical Center, Maastricht, The Netherlands
| | - Hugo Ten Cate
- Laboratory for Clinical Thrombosis and Hemostasis, Dept. of Internal Medicine, Cardiovascular Research Institute Maastricht (CARIM), Maastricht University Medical Center, Maastricht, The Netherlands
| | - Philipp S Wild
- Center for Thrombosis and Hemostasis (CTH), University Medical Center of the Johannes Gutenberg-University Mainz, Germany; Preventive Cardiology and Preventive Medicine, Dept. of Medicine 2, University Medical Center of the Johannes Gutenberg-University Mainz, Germany; DZHK (German Center for Cardiovascular Research), Partner Site Rhine-Main, Mainz, Germany
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Wannamethee SG, Whincup PH, Lennon L, Papacosta O, Lowe GD. Associations between fibrin D-dimer, markers of inflammation, incident self-reported mobility limitation, and all-cause mortality in older men. J Am Geriatr Soc 2015; 62:2357-62. [PMID: 25516032 PMCID: PMC4293158 DOI: 10.1111/jgs.13133] [Citation(s) in RCA: 36] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/13/2023]
Abstract
OBJECTIVES To examine the independent relationships between fibrin D-dimer, interleukin 6 (IL-6), C-reactive protein (CRP), and fibrinogen and incident mobility limitation and mortality. DESIGN Prospective. SETTING General practice in 24 British towns. PARTICIPANTS Men aged 60 to 79 without prevalent heart failure followed up for an average of 11.5 years (N = 3,925). MEASUREMENTS All-cause mortality (n = 1,286) and self-reported mobility disability obtained at examination in 1998 to 2000 and in a postal questionnaire 3 to 5 years later in 2003. RESULTS High D-dimer (top vs lowest tertile: adjusted odds ratio (aOR) = 1.46, 95% confidence interval = 1.02-2.05) and IL-6 (aOR = 1.43, 95% CI = 1.01-2.02) levels (but not CRP or fibrinogen) were associated with greater incident mobility limitation after adjustment for confounders and prevalent disease status. IL-6, CRP, fibrinogen, and D-dimer were significantly associated with total mortality after adjustment for confounders. Only D-dimer and IL-6 predicted total mortality independent of each other and the other biomarkers. The adjusted hazard ratio (aHR) was 1.16 (95% CI = 1.10-1.22) for a standard deviation increase in log D-dimer and 1.10 (95% CI = 1.04-1.18) for a standard deviation increase in log IL-6. D-dimer was independently related to vascular and nonvascular mortality, and IL-6 was independently related to vascular mortality. Risks of mobility limitation and mortality were greatest in those with a combination of high D-dimer and IL-6 levels. CONCLUSION D-dimer and IL-6 are associated with risk of mobility limitation and mortality in older men without heart failure. The findings suggest that coagulation leads to functional decline and mortality s that inflammation does not explain.
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Affiliation(s)
- S Goya Wannamethee
- Department of Primary Care and Population Health, University College London, London, UK
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Abstract
: In HIV negatives, markers of hemostasis, including D-dimer, factor VIII, plasminogen activator inhibitor-1 antigen (PAI-1), and total protein S are associated with all-cause and cardiovascular disease mortality. In HIV positives, studies of D-dimer and factor VIII with death were limited to short follow-up; associations of PAI-1 and total protein S with death have not been examined. In 674 HIV-infected women from the Women's Interagency HIV Study, markers from the first visit after enrollment were exposures of interest in multivariate analyses of death (AIDS and non-AIDS) in separate models at 5 and 16 years. There were 87 AIDS and 44 non-AIDS deaths at 5 years, and 159 AIDS and 113 non-AIDS deaths at 16 years. An inverse association of total protein S quartiles with non-AIDS deaths was observed at 5 (P trend = 0.002) and 16 years (P trend = 0.02); there was no association with AIDS deaths. The third quartile of PAI-1 was associated with AIDS deaths at 5 [hazard ratio (HR) = 4.0; 95% confidence interval (CI): 1.9 to 8.4] and 16 years (HR = 3.4; 95% CI: 1.9 to 5.9); and with non-AIDS deaths at 5 years (HR = 4.8; 95% CI: 1.6 to 13.9). D-dimer and factor VIII were not associated with AIDS or non-AIDS death at 5 or 16 years. Lower total Protein S was a consistent marker of non-AIDS death. We found no association between D-dimer with AIDS or non-AIDS death, in contrast to previous studies showing increased short-term (<5 years) mortality, which may represent sex differences or population heterogeneity. Given longer survival on highly active antiretroviral therapy, further studies of these markers are needed to determine their prognostic value.
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Motavaf E, Sunesen KG, Stender MT, Thorlacius-Ussing O. Prognostic value of preoperative D-dimer and carcinoembryonic antigen levels in patients undergoing intended curative resection for colorectal cancer: a prospective cohort study. Int J Colorectal Dis 2014; 29:1427-32. [PMID: 25147006 DOI: 10.1007/s00384-014-2000-1] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 08/17/2014] [Indexed: 02/04/2023]
Abstract
PURPOSE Carcinoembryonic antigen (CEA) has limited value as an isolated predictor for survival among colorectal cancer (CRC) patients. D-dimer (DD) is a strong predictor of survival among metastatic CRC patients, but the prognostic value in non-metastatic CRC patients remains controversial. We examined the prognostic value of preoperative DD levels in relation to CEA levels in non-metastatic, resectable CRC patients. METHODS Between October 2003 and November 2005, 166 patients were included. We used the Kaplan-Meier method to compute 5-year mortality rates, stratified by preoperative DD and CEA levels. Adjusted Cox regression analysis was used to compute mortality rate ratios (MRRs) during postoperative years 0-1 and 1-5 based on the preoperative CEA and DD levels. RESULTS The cumulative 5-year mortality rate was 15 % (95 % confidence interval [CI], 9-25 %) in patients with normal DD and CEA levels, 30 % (CI, 16-53 %) in patients with isolated elevated CEA levels, 37 % (CI, 25-53 %) in patients with isolated elevated DD levels, and 60 % (CI, 37-83 %) in patients with elevated CEA and DD levels. Elevated CEA was associated with an approximately ten-fold increase in mortality within the first postoperative year (adjusted MRR 9.8, CI 2.5-38.3); this association was lost during postoperative years 1-5 (adjusted MRR 1.1, CI 0.5-2.7). Elevated DD was associated with a greater than two-fold increase in mortality during postoperative years 0-1 (adjusted MRR 2.8, CI 0.7-11.0) and 1-5 (adjusted MRR 2.2, CI 1.1-4.8). CONCLUSION DD is a strong predictor of survival among non-metastatic curatively resected CRC patients, particularly in combination with CEA.
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Affiliation(s)
- Ehsan Motavaf
- Department of Gastrointestinal Surgery, Aalborg University Hospital, Hobrovej 18-22, 9000, Aalborg, Denmark,
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Shea MK, Cushman M, Booth SL, Burke GL, Chen H, Kritchevsky SB. Associations between vitamin K status and haemostatic and inflammatory biomarkers in community-dwelling adults. The Multi-Ethnic Study of Atherosclerosis. Thromb Haemost 2014; 112:438-44. [PMID: 24849546 DOI: 10.1160/th13-12-1003] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/10/2013] [Accepted: 03/22/2014] [Indexed: 01/10/2023]
Abstract
Vitamin K is integral to haemostatic function, and in vitro and animal experiments suggest that vitamin K can suppress production of inflammatory cytokines. To test the hypothesis that higher vitamin K status is associated with lower haemostatic activation and inflammation in community-dwelling adults, we analysed the cross-sectional association between serum phylloquinone (vitamin K1) with haemostatic and inflammatory biomarkers in 662 participants in the Multi-Ethnic Study of Atherosclerosis (MESA) [mean (SD) age=62 (10) years; 46% female; 37% Caucasian, 25% African-American, 25% Hispanic, 13% Chinese-American]. Following adjustment for demographic and lifestyle characteristics, medication use, triglycerides and body mass index, those in the highest quartile of serum phylloquinone had significantly lower circulating interleukin-6 [adjusted mean (SEM) pmol/l: quartile 4 (Q4)=1.22 (0.07), quartile 1 (Q1)=1.45 (0.07); p-trend<0.01], C-reactive protein [adjusted mean (SEM) mg/dl: Q4=1.57 (0.11), Q1=2.08 (0.18); p-trend=0.02], soluble intercellular adhesion molecule-1 [adjusted mean (SEM) ng/ml: Q4=247 (11), Q1=288 (11); p-trend=0.02], and plasmin-antiplasmin complex [adjusted mean (SEM) nmol/l: Q4=4.02 (0.1), Q1=4.31 (0.1), p-trend=0.04]. We detected an interaction between age and serum phylloquinone with respect to factor VIII and D-dimer (interaction p-values=0.03 and 0.09, respectively). Among participants ≥70 years, serum phylloquinone was inversely associated with factor VIII activity (p-trend=0.06) and positively associated with D-dimer (p-trend=0.01), but was not associated with either marker among participants <70 years (both p≥0.38). In contrast, dietary phylloquinone intake was not associated with any inflammatory or haemostatic biomarker evaluated (all p-trend>0.11). These findings are consistent with laboratory-based studies that suggest a possible anti-inflammatory role for vitamin K. Whether or not these associations predict clinical outcomes linked to elevated inflammation or haemostatic activation remains to be determined.
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Affiliation(s)
- M K Shea
- Kyla Shea, PhD, USDA Human Nutrition Research Center on Aging, Tufts University, Boston, MA, USA, E-mail:
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Lind M, Boman K, Johansson L, Nilsson TK, Järvholm LS, Jansson JH. d-dimer predicts major bleeding, cardiovascular events and all-cause mortality during warfarin treatment. Clin Biochem 2014; 47:570-3. [DOI: 10.1016/j.clinbiochem.2014.03.003] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/15/2013] [Revised: 02/03/2014] [Accepted: 03/09/2014] [Indexed: 11/26/2022]
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Borges ÁH, O’Connor JL, Phillips AN, Baker JV, Vjecha MJ, Losso MH, Klinker H, Lopardo G, Williams I, Lundgren JD. Factors associated with D-dimer levels in HIV-infected individuals. PLoS One 2014; 9:e90978. [PMID: 24626096 PMCID: PMC3953205 DOI: 10.1371/journal.pone.0090978] [Citation(s) in RCA: 53] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/21/2013] [Accepted: 02/05/2014] [Indexed: 12/27/2022] Open
Abstract
Background Higher plasma D-dimer levels are strong predictors of mortality in HIV+ individuals. The factors associated with D-dimer levels during HIV infection, however, remain poorly understood. Methods In this cross-sectional study, participants in three randomized controlled trials with measured D-dimer levels were included (N = 9,848). Factors associated with D-dimer were identified by linear regression. Covariates investigated were: age, gender, race, body mass index, nadir and baseline CD4+ count, plasma HIV RNA levels, markers of inflammation (C-reactive protein [CRP], interleukin-6 [IL-6]), antiretroviral therapy (ART) use, ART regimens, co-morbidities (hepatitis B/C, diabetes mellitus, prior cardiovascular disease), smoking, renal function (estimated glomerular filtration rate [eGFR] and cystatin C) and cholesterol. Results Women from all age groups had higher D-dimer levels than men, though a steeper increase of D-dimer with age occurred in men. Hepatitis B/C co-infection was the only co-morbidity associated with higher D-dimer levels. In this subgroup, the degree of hepatic fibrosis, as demonstrated by higher hyaluronic acid levels, but not viral load of hepatitis viruses, was positively correlated with D-dimer. Other factors independently associated with higher D-dimer levels were black race, higher plasma HIV RNA levels, being off ART at baseline, and increased levels of CRP, IL-6 and cystatin C. In contrast, higher baseline CD4+ counts and higher high-density lipoprotein cholesterol were negatively correlated with D-dimer levels. Conclusions D-dimer levels increase with age in HIV+ men, but are already elevated in women at an early age due to reasons other than a higher burden of concomitant diseases. In hepatitis B/C co-infected individuals, hepatic fibrosis, but not hepatitis viral load, was associated with higher D-dimer levels.
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Affiliation(s)
- Álvaro H. Borges
- Centre for Health & Infectious Diseases Research (CHIP), Department of Infectious Diseases, Rigshospitalet, University of Copenhagen, Copenhagen, Denmark
- * E-mail:
| | - Jemma L. O’Connor
- Research Department of Infection and Population Health, University College London, London, United Kingdom
| | - Andrew N. Phillips
- Research Department of Infection and Population Health, University College London, London, United Kingdom
| | - Jason V. Baker
- Hennepin County Medical Center, Minneapolis, Minnesota, United States of America
- Department of Medicine, University of Minnesota, Minneapolis, Minnesota, United States of America
| | - Michael J. Vjecha
- Veterans Affairs Medical Center, Washington, D. C., United States of America
| | | | | | - Gustavo Lopardo
- Fundación Centro de Estudios Infectológicos, Buenos Aires, Argentina
| | - Ian Williams
- Centre for Sexual Health & HIV Research, University College London, London, United Kingdom
| | - Jens D. Lundgren
- Centre for Health & Infectious Diseases Research (CHIP), Department of Infectious Diseases, Rigshospitalet, University of Copenhagen, Copenhagen, Denmark
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Krishnan S, Wilson EMP, Sheikh V, Rupert A, Mendoza D, Yang J, Lempicki R, Migueles SA, Sereti I. Evidence for innate immune system activation in HIV type 1-infected elite controllers. J Infect Dis 2014; 209:931-9. [PMID: 24185941 PMCID: PMC3935475 DOI: 10.1093/infdis/jit581] [Citation(s) in RCA: 113] [Impact Index Per Article: 11.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/03/2013] [Accepted: 09/10/2013] [Indexed: 02/07/2023] Open
Abstract
BACKGROUND Elite controllers maintain high CD4(+) T-cell counts and suppress plasma human immunodeficiency virus (HIV) viremia in the absence of antiretroviral therapy (ART). It is unclear whether levels of biomarkers associated with coagulation, monocyte activation, and inflammation, which are linked to HIV-associated mortality, differ among elite controllers, ART recipients with suppressed viremia (plasma HIV type 1 RNA load, <50 copies/mL), and HIV-negative controls. METHODS A total of 68 elite controllers, 68 ART recipients with suppressed viremia, and 35 HIV-negative participants were evaluated. Levels of biomarkers in cryopreserved plasma were measured by enzyme-linked immunosorbent assay and electrochemiluminescence-based assay. Cryopreserved peripheral blood mononuclear cells were used to assess monocyte phenotype and function and interferon-inducible gene expression (IFIG). Nonparametric testing was used to compare median values among groups. RESULTS CD4(+) T-cell counts were similar between elite controllers and HIV-negative controls but significantly lower in ART recipients with suppressed viremia. Levels of C-reactive protein and interleukin 6 were higher and IFIG upregulated in both HIV-positive groups, compared with HIV-negative controls. D-dimer and soluble tissue factor levels were significantly elevated in elite controllers, compared with those in ART recipients with suppressed viremia and HIV-negative controls (P < .01). Monocytes from elite controllers (and ART recipients with suppressed viremia) expressed lower CCR2 and higher CX3CR1 levels than monocytes from HIV-negative controls. In addition, elite controllers had a significantly higher proportion of CD14(++)CD16(+) monocytes, compared with HIV-negative controls. CONCLUSION Elite controllers maintain control of plasma HIV viremia and have evidence of an activated innate immune response.
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Affiliation(s)
- Sonya Krishnan
- Clinical Research Directorate/Clinical Monitoring Research Program
| | - Eleanor M. P. Wilson
- National Institute of Allergy and Infectious Diseases, National Institutes of Health, Bethesda, Maryland
| | - Virginia Sheikh
- National Institute of Allergy and Infectious Diseases, National Institutes of Health, Bethesda, Maryland
| | | | - Daniel Mendoza
- National Institute of Allergy and Infectious Diseases, National Institutes of Health, Bethesda, Maryland
| | - Jun Yang
- Applied and Developmental Research Directorate, Science Application International Corporation (SAIC)–Frederick,National Cancer Institute (NCI)–Frederick, Frederick
| | - Richard Lempicki
- Applied and Developmental Research Directorate, Science Application International Corporation (SAIC)–Frederick,National Cancer Institute (NCI)–Frederick, Frederick
| | - Stephen A. Migueles
- National Institute of Allergy and Infectious Diseases, National Institutes of Health, Bethesda, Maryland
| | - Irini Sereti
- National Institute of Allergy and Infectious Diseases, National Institutes of Health, Bethesda, Maryland
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Circulating levels of tissue factor microparticle procoagulant activity are reduced with antiretroviral therapy and are associated with persistent inflammation and coagulation activation among HIV-positive patients. J Acquir Immune Defic Syndr 2013; 63:367-71. [PMID: 23507662 DOI: 10.1097/qai.0b013e3182910121] [Citation(s) in RCA: 34] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/20/2023]
Abstract
Activation of coagulation pathways may contribute to risk for non-AIDS-related conditions among HIV-positive patients. Tissue factor (TF)-dependent procoagulant activity on circulating microparticles (MP-TF) in the plasma of 163 HIV-positive participants, both untreated and treated, with viral suppression was measured. MP-TF activity was 39% lower among treated versus untreated participants (P < 0.001), which persisted in adjusted models (-36%, P = 0.03). Among treated participants, MP-TF activity correlated modestly with D-dimer (r = 0.24, P = 0.01), von Willebrand factor (r = 0.36, P < 0.001), and interleukin-6 (r = 0.20, P = 0.04) levels. Future research should focus on mechanisms driving residual functional TF activity and whether these alterations have clinical consequences for non-AIDS-defining complications.
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Baker JV. Chronic HIV disease and activation of the coagulation system. Thromb Res 2013; 132:495-9. [PMID: 24034985 DOI: 10.1016/j.thromres.2013.08.016] [Citation(s) in RCA: 34] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/26/2013] [Revised: 07/26/2013] [Accepted: 08/21/2013] [Indexed: 12/15/2022]
Abstract
With current effective antiretroviral treatment, the spectrum of morbidity and mortality during chronic HIV disease has shifted away from AIDS defining clinical events. Persistent abnormalities in coagulation appear to contribute to excess risk for a broad spectrum of non-AIDS defining complications, including, but not limited to, venous and arterial thrombotic disease. Mechanisms specific to HIV disease, antiretroviral therapy, and lifestyle or behavioral factors contribute to a pro-coagulant state, in part, through increased tissue factor activity coupled with a paradoxical decline in the anti-coagulant response. Alterations in coagulation biology in the context of HIV disease appear to be largely a consequence of persistent systemic immune activation, micro- and macro-vascular disease, and, potentially, impaired hepatic synthesis of coagulation factors. The clinical consequences of HIV-related changes in coagulation biology, the degree to which they are unique to HIV disease, and whether they can be mitigated through adjunct treatments, remains a focus of current research.
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Affiliation(s)
- Jason V Baker
- University of Minnesota, Hennepin County Medical Center, 701 Park Avenue, Mail Code G5, Minneapolis, MN 55415, United States.
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