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Risk Factors That Predict Recurrent MI.

WASHINGTON -- Consider adding measures of D-dimer, apolipoprotein B, and apolipoprotein A-1 to the list of traditional factors used to predict a patient's risk of recurrent myocardial infarction.

High levels of D-dimer and apolipoprotein B (apo B) and low levels of apo A-1 increase the risk of a recurrent MI, Dr. Victor J. Marder reported at the congress of the International Society on Thrombosis and Haemostasis.

These findings argue for combined anticoagulant and lipid-lowering therapy for patients with chronic coronary disease, said Dr. Marder of the THROMBO Research Group in Rochester, N.Y.

Among 1,045 patients enrolled 2 months after a first MI, 81 had a recurrent coronary event during an average follow-up of 26 months.

Recurrent coronary events were significantly and independently associated with being in the highest quartiles of D-dimer and apo B measures and the lowest quartile of apo A-1 values.

The hazard ratios for the highest quartiles of D-dimer and apo B values were 2.4 and 1.8, respectively, compared with the lower quartiles. The hazard ratio for the lowest quartile of apo A-1 values was 1.8, compared with the higher quartiles.

Having two or three abnormalities had an additive effect on the risk of a recurrent coronary event. Being in the highest-risk quartile of any two of these factors was associated with a hazard ratio greater than 4. Being at high risk for all three parameters raised the hazard ratio to 8.4.

Despite our familiarity with this subject matter, we were still surprised by these results and their magnitude, coinvestigator Dr. Charles B. Spark said in an interview.

Thrombogenic blood assays included hemostatic factors--D-dimer; fibrinogen; factor VII, factor VIIa, von Willebrand factor; and plasminogen activator inhibitor-1--lipid factors--cholesterol, triglycerides, HDL cholesterol, LDL cholesterol, lipoprotein(a), apo A-1, and apo B--and insulin.

A procoagulant state, indicated by high D-dimer levels, and disordered lipid transport, indicated by low apo A-1 and high apo B concentrations, probably contributes to recurrent coronary events through an enhanced prothrombotic state and increased lipid-deposited plaque instability, Dr. Marder said.

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Author:Imperio, Winnie Anne
Publication:Family Practice News
Date:Oct 15, 1999
Words:339
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