Associations of factor VIII_c, D-dimer, and plasmin-antiplasmin with incident cardiovascular disease and all-cause mortality

To examine the associations of three understudied hemostatic factors - D-dimer, factor VIII_c, and plasmin-antiplasmin (PAP) complex - with incident cardiovascular disease (CVD) and all cause mortality in the Multiethnic Study of Atherosclerosis cohort. Hemostatic factors were measured at baseline in 45-84-year-old patients (n = 6,391) who were free of clinically recognized CVD. Over 4.6 years of follow-up, we identified 307 CVD events, 207 hard coronary heart disease events, and 210 deaths. D-dimer, factor VIII_c, and PAP were not associated with CVD incidence after adjustment for other risk factors. In contrast, each factor was associated positively with total mortality, and D-dimer and factor VIII_c were associated positively with cancer mortality. When modeled as ordinal variables and adjusted for risk factors, total mortality was greater by 33% (95% CI 15-54) for each quartile increment of D-dimer, 26% (11-44) for factor VIII_c, and 20% (4-38) for PAP. This prospective cohort study did not find D-dimer, factor VIII _c, or PAP to be risk factors for CVD. Instead, elevated levels of these three hemostatic factors were associated independently with increased risk of death. Elevated D-dimer and factor VIII_c were associated with increased cancer death.