Relationships of Plasma Viscosity, Coagulation and Fibrinolysis to Coronary Risk Factors and Angina

Summary

Plasma viscosity, molecular markers of activated coagulation and fibrinolysis (fibrinopeptides A and Bβ_15-42), coagulation factors (fibrinogen and factor VII) and antiplasmins were measured in 529 men aged 35-54 years and related to new angina pectoris (n = 117) and to coronary risk factors in controls without angina (n = 412). Five major risk factors (cigarette-smoking, blood pressure, cholesterol, triglyceride and body mass index) were each associated with increases in plasma viscosity, coagulation factors, and imbalance of coagulation over fibrinolysis (increased ratio of fibrinopeptide A/fibrinopeptide Bβ_15-42). Increased viscosity and fibrinogen in smokers were partly reversed in exsmokers, but the imbalance of coagulation and fibrinolysis persisted. Cholesterol and triglyceride were also associated with increased antiplasmin activity. In men with angina, only fibrinogen was elevated compared to controls. We suggest that increased plasma viscosity and an imbalance of coagulation over fibrinolysis may be mechanisms by which known risk factors promote arterial thrombosis, but are not present in stable angina.

• References

• 1 Meade TW, North WRS, Chakrabarti RR. et al Haemostatic function and cardiovascular death: early results of a prospective study. Lancet 1980; i: 1050-1054
• 2 Meade TW, Mellows S, Brozovig M. et al Haemostatic function and ischaemic heart disease: principal results of the Northwick Park Heart Study. Lancet 1986; ii: 533-537
• 3 Meade TW. The epidemiology of haemostatic and other variables in coronary artery disease. In: Thrombosis and Haemostasis 1987 Verstraete M, Vermylen J, Lijnen R, Arnout J. eds University Press; Leuven: 1987: 37-60
• 4 Lowe GDO. Blood rheology in arterial disease. Clin Sci 1986; 68: 419-425
• 5 Wood DA, Riemersma RA, Butler S. et al Linoleic and eicosapentaenoic acids in adipose tissue and platelets and risk of coronary heart disease. Lancet 1987; i: 177-183
• 6 Astrup T. Fibrinolysis in the organism. Blood 1956; 11: 781-806
• 7 Nossel HL. Relative proteolysis of the fibrinogen B² chain by thrombin and plasmin as a determinant of thrombosis. Nature 1981; 291: 165-167
• 8 Nossel HL. Radioimmunoassay of fibrinopeptides in relation to intravascular coagulation and thrombosis. N Engl J Med 1976; 295: 428-432
• 9 Kudryk B, Robinsoo C, Netre B, Hessel M, Blomback M, Blomback B. Measurement in human blood of fibrinogen/fibrin fragments containing the B²_15-42 sequence. Thromb Res 1982; 25: 277-291
• 10 Miilleftz S. Fibrinolysis General aspects, characteristic features and perspectives. Fibrinolysis 1987; 1: 3-12
• 11 Thkase I, Tirddenham EGD, Chard S, Goodall AH. Monoclonal antibodies to human factor VII: a one step for VII: Ag. J Clin Pathol 1988; 41: 337-341
• 12 Lowe GDO, McArdle BM, Stromberg P, Lorimer AR, Forbes CD, Prentice CRM. Increased blood viscosity and fibrinolytic inhibitor in type II hyperlipoproteinaemia. Lancet 1982; i: 472-475
• 13 Ellis BC, Stransky A. A quick and accurate method for the determination of fibrinogen in plasma. J Lab Clin Med 1961; 58: 477-488
• 14 International Committee for Standardisation in Haematology. Recommendation for a selected method for the measurement of plasma viscosity. J Clin Pathol 1984 37. 1147-1152
• 15 Lowe GDO, Drummond MM, Forbes CD, Barbenel JC. The effects of age and cigarette-smoking on blood and plasma viscosity in men. Scott Med J 1980; 25: 13-17
• 16 Meade TW, Imeson J, Stirling Y. Effects of changes in smoking and other characteristics on clotting factors and the risk of ischaemic heart disease. Lancet 1987; ii: 986-988
• 17 Lowe GDO, Machado SG, Krol WF, Barton BA, Forbes CD. White blood cell count and haematocrit as predictors of coronary recurrence after myocardial infarction. Thromb Haemostas 1985; 54: 700-703
• 18 Letcher RL, Chien S, Pickeing TG, Sealey JE, Laragh JH. Direct relationship between blood pressure and blood viscosity in normal and hypertensive subjects. Am J Med 1981; 70: 1195-1202
• 19 Seplowitz AH, Chien S, Smith FR. Effects of lipoproteins on plasma viscosity. Atherosclerosis 1981; 38: 89-95
• 20 Hamsten A, Wiman B, de Faire U, Blomback M. Increased plasma levels of a rapid inhibitor of tissue plasminogen activator in young survivors of myocardial infarction. N Engl J Med 1985; 313: 1557-1563
• 21 Yague R, Juhan-Vague I, Aillaud MB. et al Correlation between blood fibrinolytic activity, PA-inhibitor level, plasma insulin level and relative body weight in normal and obese subjects. Metabolism 1986; 35: 2504
• 22 Allen RA, Kluft C, Brommer EJP. The acute effect of smoking on fibrinolysis: increase in the activity level of circulating extrinsic (tissue-type) plasminogen activator. Eur J Clin Invest 1984; 14: 354-360
• 23 Lowe GDO, Small M. Stimulation of endogenous fibrinolysis. In: Tissue-type Plasminogen Activator (t-PA): Physiological and Clinical Aspects Kluft C. ed CRC Press; Boca Raton, FL: 1988: 129-169
• 24 MRC Epidemiology Unit. The Caerphilly and Speedwell Collaborative Heart Disease Studies, Progress Report No.6. MRC Epidemiology Unit, Cardiff 1988
• 25 Lowe GDO, Drummond MM, Lorimer AR. et al Relationship between extent of coronary artery disease and blood viscosity. Br Med J 1980; i: 673-674
• 26 Meade TW. Epidemiology of atheroma and thrombosis. In: Haemostasis and Thrombosis Bloom AL, Thomas DP. eds Churchill Livingstone; Edinburgh: 1981: 575-592
• 27 Wood DA. Haemostatic variables and ischaemic heart disease. MSc dissertation University of London; 1981
• 28 Baker IA, Eastham R, Elwood PC, Etherington M, O’Brien JR, Sweetnam PM. Haemostatic factors associated with ischaemic heart disease in men aged 45 to 64 years. The Speedwell Study. Br Heart J 1982; 47: 490-494
• 29 Yarnell JWG, Sweetnam PM, Elwood PC. et al Haemostatic factors and ischaemic heart disease. The Caerphilly Study. Br Heart J 1985; 53: 483-487
• 30 Fuchs J, Weinburger I, Rotenberg Z. et al Plasma viscosity in ischaemic heart disease. Am Heart J 1984; 108: 435-440
• 31 Small M, Lowe GDO, Douglas JT, Hutton I, Lorimer AR, Forbes CD. Thrombin and plasmin activity in coronary artery disease. Br Heart J 1988; 60: 201-203
• 32 Neri Serneri GG, Gensini GR, Abbate R, Laureano R, Parodi O. Is raised fibrinopeptide A a marker of acute coronary insufficiency. Lancet 1980; ii: 982-983
• 33 Lowe GDO, Lowe JM, Drummond MM. et al Blood viscosity in young male diabetics with and without retinopathy. Diabetologia 1980; 18: 359-363
• 34 Small M, Lowe GDO, MacCuish AC, Forbes CD. Thrombin and plasmin activity in diabetes mellitus and their association with glycaemic control. Q J Med (N Ser) 1987; 65: 1025-1031
• 35 Small M, McArdle BM, Lowe GDO, Brodie MJ, Forbes CD. Prentice CRM. Oral stanozolol: effects on plasma and saliva fibrinolysis and plasma viscosity in normal males. Thromb Res 1983 31. 233-237
• 36 Small M, Douglas JI, Lowe GDO, Forbes CD. Increased plasmin activity during stanozolol administration. Lancet 1983; i: ll14