D-dimer and the Risk of Stroke and Coronary Heart Disease

Neil A. Zakai; Leslie A. McClure; Suzanne E. Judd; Brett Kissela; George Howard; Monika M. Safford; Mary Cushman

doi:10.1160/TH16-07-0519

Thrombosis and Haemostasis, Table of Contents

Thromb Haemost 2017; 117(03): 618-624
DOI: 10.1160/TH16-07-0519

Atherosclerosis and Ischaemic Disease

Schattauer GmbH

D-dimer and the Risk of Stroke and Coronary Heart Disease

The REasons for Geographic and Racial Differences in Stroke (REGARDS) Study

Authors

Neil A. Zakai

¹University of Vermont Larner College of Medicine, Burlington, Vermont, USA
Leslie A. McClure

²University of Alabama at Birmingham, Birmingham, Alabama, USA

³Drexel University, Philadelphia, Pennsylvania, USA
Suzanne E. Judd

²University of Alabama at Birmingham, Birmingham, Alabama, USA
Brett Kissela

⁴University of Cincinnati, Cincinnati, Ohio, USA
George Howard

²University of Alabama at Birmingham, Birmingham, Alabama, USA
Monika M. Safford

²University of Alabama at Birmingham, Birmingham, Alabama, USA

⁵Weill Cornell Medical College, New York, New York, USA
Mary Cushman

¹University of Vermont Larner College of Medicine, Burlington, Vermont, USA

Abstract

Summary

D-dimer, a biomarker of coagulation, is higher in blacks than in whites and has been associated with stroke and coronary heart disease (CHD). It was our objective to assess the association of higher D-dimer with stroke and CHD in blacks and whites. REGARDS recruited 30,239 black and white participants across the contiguous US and measured baseline D-dimer in stroke (n=646) and CHD (n=654) cases and a cohort random sample (n=1,104). Cox models adjusting for cardiovascular risk factors determined the hazard ratio (HR) for increasing D-dimer for cardiovascular disease with bootstrapping to assess the difference in HR for CHD versus stroke by race. D-dimer was higher with increasing age, female sex, diabetes, hypertension, pre-baseline cardiovascular disease and higher C-reactive protein (CRP). Accounting for cardiovascular risk factors, each doubling of D-dimer was associated with increased stroke (hazard ratio [HR] 1.15; 95 % confidence interval [CI] 1.01, 1.31) and CHD (HR 1.27; 95 % CI 1.11, 1.45) risk. The difference in the HR between CHD and stroke was 0.20 (95 % CI >0.00, 0.58) for blacks and 0.02 (95 % CI –0.30, 0.27) for whites. CRP mediated 22 % (95 % CI 5 %, 41 %) of the association between D-dimer and CHD and none of the association with stroke. Higher D-dimer increased the risk of stroke and CHD independent of cardiovascular risk factors and CRP, with perhaps a stronger association for CHD versus stroke in blacks than whites. These findings highlight potential different pathophysiology of vascular disease by disease site and race suggesting potential further studies targeting haemostasis in primary prevention of vascular disease.

Keywords

Continental population groups - coronary disease - D-dimer - epidemiology stroke

Full Text

References

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