fibrinopeptide-a and Carotid-Stenosis

Increased levels of markers of hemostasis may assist in the determination of the extent of carotid occlusive disease and the identification of neurologically intact individuals at increased risk of ischemic events.. We conducted a prospective study of 304 subjects, including 82 with a recent (< or =7 days) transient ischemic attack (TIA), 157 asymptomatic individuals with a cervical bruit, and 65 control subjects. Baseline evaluation included a neurological assessment, ECG, cervical ultrasonography, and cerebral CT and/or MRI. Levels of markers of coagulation and fibrinolytic activity were also determined. Results were analyzed in relation to the degree of carotid disease and the subsequent occurrence of cerebral and cardiac ischemic events.. Over a mean follow-up period of 2.8 years (SD, 1.3 years), 114 ischemic events occurred. Survival analyses showed that prothrombin fragment 1.2 (F(1.2)) was a predictor of time to cerebral and cardiac ischemic events in the combined TIA and asymptomatic bruit group (relative risk [RR], 1.46; 95% CI, 1.18 to 1.81) as well as in the asymptomatic bruit group separately (RR, 1.70; 95% CI, 1.14 to 2.53). In the TIA group, both F(1.2) (RR, 2.36; 95% CI, 1.19 to 4.68) and severe (> or =80%) carotid stenosis (RR, 3.53; 95% CI, 1.19 to 10.51) were predictive of time to ischemic stroke, myocardial infarction, or vascular death.. In patients with TIAs and in asymptomatic individuals with cervical bruits, F(1.2) levels were found to be independent predictors of subsequent cerebral and cardiac ischemic events. Our results are consistent with an active role of the coagulation system through upregulation of thrombin in carotid disease progression and in the pathogenesis of ischemic events in patients at risk.

Topics: Aged; alpha-2-Antiplasmin; Antifibrinolytic Agents; Antithrombin III; Biomarkers; Carotid Stenosis; Enzyme-Linked Immunosorbent Assay; Female; Fibrinolysin; Fibrinopeptide A; Hemostasis; Humans; Incidence; Ischemic Attack, Transient; Male; Middle Aged; Myocardial Infarction; Peptide Fragments; Peptide Hydrolases; Plasminogen Activator Inhibitor 1; Prognosis; Proportional Hazards Models; Prospective Studies; Prothrombin; Quebec; Risk Factors; Survival Rate

The association between apolipoprotein(a) [apo(a)], fibrinogen, fibrinopeptide A (FPA) and carotid intima-media thickness (IMT) was analyzed in Eastern Finnish men aged 50 to 60 years. Apo(a) correlated directly with carotid bifurcation (r = 0.26, p = 0.001), but not with common carotid IMT. Men in the lowest quartile of apo(a) had thinner (p = 0.013) IMT in bifurcation [1.59 mm (95% CI 1.49; 1.68)] compared to the men in the highest [1.91 mm (95% CI 1.73; 2.09)] apo(a) quartile. The difference remained (p = 0.038) after adjusting for confounders. Plasma fibrinogen was not related to carotid IMT, whereas FPA correlated with common carotid (r = 0.21, p = 0.016) and carotid bifurcation (r = 0.21, p = 0.018) IMT. These associations abolished after adjusting for the confounders. The data suggest that apo(a) associate with carotid atherosclerosis independent of other risk factors for ischemic cardiovascular diseases.

Topics: Anthropometry; Apolipoproteins; Apoprotein(a); Arteriosclerosis; Blood Pressure; Carotid Arteries; Carotid Artery Diseases; Carotid Artery, Common; Carotid Stenosis; Cohort Studies; Diet; Fibrinopeptide A; Finland; Humans; Lipids; Lipoprotein(a); Male; Middle Aged; Muscle, Smooth, Vascular; Risk Factors; Smoking