68. Recent progress in epidemiology of hemostatic parameters

Association of hemostatic parameters with symptomatic atherothrombotic arterial diseases and subclinical atherosclerosis has been reported in population-based studies such as ARIC. There is a good agreement among the reported results regarding the independent association of fibrinogen with subclinical and symptomatic arterial diseases. Association of other coagulation factors, fibrinolytic and platelet parameters is not as well established. In the ARIC study, we have evaluated the relationship of several coagulation factors with incident coronary heart disease (CHD) over 4 years 1987-91. Age and race-adjusted relative risks (RR) of CHD (n=223) were statistically elevated (P<0.05) for the highest versus lowest tertile of fibrinogen, factor VIIIc (women only), von Willebrand factor and white cell count. There was no statistically significant association of CHD with factor VIIc, protein C, antithrombin III or platelet count. We have also determined the association of coagulation, fibrinolytic and platelet factors with subclinical carotid atherosclerosis measured by B-model ultrasonography. Fibrinogen and β-thromboglobulin are independently associated with increased carotid arterial wall thickness. There is no statistically significant association of carotid atherosclerosis with factor VIIc, VIIIc, vWF, protein C, or AT-III. These results indicate that the haemostatic risk factor for subclinical atherosclerosis and symptomatic CHD overlap but are not identical. Factor VIIIc and vWF are associated with incident CHD but not with asymptomatic atherosclerosis.