Assessment of coronary heart disease risk by combined analysis of coagulation factors

Nena Aleksic, Yao Wei W Wang, Chul Ahn, Harinder S. Juneja, Aaron R. Folsom, Kenneth K. Wu

Research output: Contribution to journalArticlepeer-review

14 Scopus citations


Objective: Prospective studies have reported a positive association of coagulation factors with risk of coronary heart disease (CHD). It is unclear whether these coagulation factors interact. Methods and results: Using a prospective case-cohort design, we analyzed by Cox proportional hazard regression interactions between soluble thrombomodulin (sTM) and fibrinogen, factor VIII (FVIII), FVII, or plasminogen activator inhibitor-1 (PAI-1) in 410 CHD cases and 721 non-cases from the Atherosclerosis Risk in Communities (ARIC). There was a significant interaction between sTM and fibrinogen (p = 0.027). We next assessed risk ratios (RR) by combined tertile analysis. Combined analysis revealed that being in the upper sTM tertile counteracted the CHD risk imposed by higher fibrinogen whereas being in the lower sTM tertile amplified the CHD risk of higher fibrinogen. sTM and fibrinogen mutually influenced CHD incidence in a concentration-dependent manner. When analyzed as single factors by tertiles, FVIII, FVII and PAI-1 were not associated with CHD. However, when analyzed together with sTM, FVIII and PAI-1 were both positively associated with CHD for those in the lower sTM tertile. Conclusion: There is a complex interaction between sTM and prothrombotic coagulation factors. Combined analysis improves CHD risk assessment.

Original languageEnglish (US)
Pages (from-to)294-300
Number of pages7
Issue number2
StatePublished - Jun 2008

Bibliographical note

Funding Information:
The Atherosclerosis Risk in Communities Study is carried out as a collaborative study supported by National Heart, Lung, and Blood Institute contracts N01-HC-55015, N01-HC-55016, N01-HC-55018, N01-HC-55019, N01-HC-55020, N01-HC-55021 and N01-HC-55022. The authors thank the staff and participants of the ARIC study for their important contributions. We thank Ms. Susan Mitterling for preparing this manuscript and editorial assistance.


  • Coronary heart disease
  • Factor VIII
  • Fibrinogen
  • PAI-1
  • Soluble thrombomodulin


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