Predictive Value of Tests of Haemostatic Function in Ischaemic Heart Disease

The Northwick Park Heart Study (NPHS) has recruited 5,500 participants since it began in 1973. Follow-up examinations began in 1978. The chief objective is to obtain prospective data on the association of results of tests of haemostatic function with the subsequent incidence of clinically manifest ischaemic heart disease (IHD). Levels of factors V, VII and VIII, fibrinogen, anti-thrombin III, and fibrinolytic activity, platelet adhesiveness and platelet count have been measured routinely on all participants. Prospective data are also being obtained from plasma aliquote stored in liquid nitrogen at recruit-pent, but only analysed, on a case-comparison basis, as new events of IHD occur; ristocetin co-factor is one variable being assayed in this way. In addition, the follow-up round of examinations is being used to carry out full dose-response related platelet aggregation to ADP and adrenaline in about half the participants, and to investigate the feasibility of measuring relevant prostaglandin derivatives, particularly thromboxane, on large numhers. Assays of factors II and X have also been introduced. However, nrospective findings on adequate numbers of different types of new IHD events (i.e. “sudden death”, infarction, angina) are still some years away. Meanwhile, analyses of data from those who had already had IHD at the time of recruitment, and of the general epidemiology nf the variables concerned are providing evidence of the haemostatic system’s involvement in the pathogenesis of IHD.

 

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