High Plasminogen Activator Inhibitor and Tissue Plasminogen Activator Levels in Plasma Precede a First Acute Myocardial Infarction in Both Men and Women Evidence for the Fibrinolytic System as an Independent Primary Risk Factor

• Published in: Circulation (New York, N.Y.) Vol. 98; no. 21; pp. 2241 - 2247
• Main Authors: Thögersen, Anna M., Jansson, Jan-Håkan, Boman, Kurt, Nilsson, Torbjörn K., Weinehall, Lars, Huhtasaari, Fritz, Hallmans, Göran
• Format: Journal Article
• Language: English
• Published: Hagerstown, MD Lippincott Williams & Wilkins 24.11.1998
• Subjects: Adult; Age Factors; Biological and medical sciences; Biomarkers - blood; Cardiology. Vascular system; Case-Control Studies; Coronary heart disease; Dehydroepiandrosterone Sulfate - blood; Female; Fibrinolysis; Heart; Humans; Incidence; Medical sciences; Middle Aged; Myocardial Infarction - blood; Myocardial Infarction - epidemiology; Plasminogen Inactivators - blood; Predictive Value of Tests; Prospective Studies; Risk Factors; Sex Factors; Sweden; Tissue Plasminogen Activator - blood; Sweden; Human; Serine endopeptidases; Infarct; Enzyme; Acute; Cardiovascular disease; Coronary heart disease; Myocardial disease; t-Plasminogen activator; Blood plasma; Peptidases; Plasminogen activator inhibitor 1; Risk factor; Myocardium; Hydrolases; Willebrand factor
• ISSN: 0009-7322; 1524-4539; 1524-4539
• DOI: 10.1161/01.CIR.98.21.2241

Background —In patients with established ischemic heart disease, prospective cohort studies have indicated that plasminogen activator inhibitor (PAI-1), the inhibitor of the fibrinolytic system, may predict cardiovascular events. So far, there have been no primary prospective studies of PAI-1. Methods and Results —The aim of the present study was to test whether plasma levels of PAI-1, tissue-type plasminogen activator (tPA), von Willebrand factor (vWF), and thrombomodulin (TM) could predict the occurrence of a first acute myocardial infarction (AMI) in a population with high prevalence of coronary heart disease by use of a prospective nested case-control design. Mass concentrations of PAI-1 and tPA were significantly higher for the 78 subjects who developed a first AMI compared with the 156 references matched for age, sex, and sampling time; for tPA, this increase was independent of smoking habits, body mass index, hypertension, diabetes, cholesterol, and apolipoprotein A-I. The ratio of quartile 4 to 1 for tPA was 5.9 for a patient to develop a first AMI. The association between tPA and AMI was seen in both men and women. Increased levels of vWF were associated with AMI in a univariate analysis. High levels of TM were associated with AMI in women but not in men. Conclusions —The plasma levels of PAI-1, tPA, and vWF are associated with subsequent development of a first AMI; for PAI-1 and tPA, this relation was found in both men and women. For tPA but not for PAI-1 and vWF, this association is independent of established risk factors.