D-Dimer Predicts Long-Term Cause-Specific Mortality, Cardiovascular Events, and Cancer in Patients With Stable Coronary Heart Disease: LIPID Study

Autor: David Espinoza, Wendy Hague, John Elliott, Andrew Tonkin, Anthony C Keech, Ralph A.H. Stewart, Kristy P. Robledo, Lipid Study Investigators, Paul Glasziou, Harvey D. White, David R. Sullivan, Paul J. Nestel, Stefan Blankenberg, John Simes, Tanja Zeller
Rok vydání: 2018
Předmět:
Adult
Male
medicine.medical_specialty
Time Factors
Coronary Disease
030204 cardiovascular system & hematology
Risk Assessment
Fibrin
Fibrin Fibrinogen Degradation Products
03 medical and health sciences
chemistry.chemical_compound
0302 clinical medicine
Predictive Value of Tests
Risk Factors
Physiology (medical)
Internal medicine
Neoplasms
D-dimer
medicine
Humans
In patient
030212 general & internal medicine
Aged
Pravastatin
Randomized Controlled Trials as Topic
biology
Cholesterol
business.industry
Cancer
Cause specific mortality
Venous Thromboembolism
Middle Aged
medicine.disease
Coronary heart disease
Up-Regulation
Treatment Outcome
chemistry
Cardiology
biology.protein
Female
Hydroxymethylglutaryl-CoA Reductase Inhibitors
Cardiology and Cardiovascular Medicine
Risk assessment
business
Biomarkers
Zdroj: Circulation. 138(7)
ISSN: 1524-4539
Popis: Background: D-dimer, a degradation product of cross-linked fibrin, is a marker for hypercoagulability and thrombotic events. Moderately elevated levels of D-dimer are associated with the risk of venous and arterial events in patients with vascular disease. We assessed the role of D-dimer levels in predicting long-term vascular outcomes, cause-specific mortality, and new cancers in the LIPID trial (Long-Term Intervention with Pravastatin in Ischaemic Disease) in the context of other risk factors. Methods: LIPID randomized patients to placebo or pravastatin 40 mg/d 5 to 38 months after myocardial infarction or unstable angina. D-dimer levels were measured at baseline and at 1 year. Median follow-up was 6.0 years during the trial and 16 years in total. Results: Baseline D-dimer levels for 7863 patients were grouped by quartile (≤112, 112–173, 173–273, >273 ng/mL). Higher levels were associated with older age, female sex, history of hypertension, poor renal function, and elevated levels of B-natriuretic peptide, high-sensitivity C-reactive protein, and sensitive troponin I (each P P P P ≤0.01). Higher D-dimer also independently predicted an increase in cancer incidence (HR, 1.16; P =0.02).The D-dimer level increased the net reclassification index for all-cause mortality by 4.0 and venous thromboembolism by 13.6. Conclusions: D-dimer levels predict long-term risk of arterial and venous events, CVD mortality, and non-CVD noncancer mortality independent of other risk factors. D-dimer is also a significant predictor of cancer incidence and mortality. These results support an association of D-dimer with fatal events across multiple diseases and demonstrate that this link extends beyond 10 years’ follow-up.
Databáze: OpenAIRE
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