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Journal article
D-dimer and the Risk of Stroke and Coronary Heart Disease The REasons for Geographic and Racial Differences in Stroke (REGARDS) Study
Thrombosis and haemostasis, v 117(3), pp 618-624
01 Mar 2017
PMID: 28004063
Featured in Collection : UN Sustainable Development Goals @ Drexel
Abstract
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 [FIR] 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.
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Details
- Title
- D-dimer and the Risk of Stroke and Coronary Heart Disease The REasons for Geographic and Racial Differences in Stroke (REGARDS) Study
- Creators
- Neil A. Zakai - University of VermontLeslie A. McClure - Univ Alabama Birmingham, Birmingham, AL USASuzanne E. Judd - Univ Alabama Birmingham, Birmingham, AL USABrett Kissela - Univ Cincinnati, Cincinnati, OH USAGeorge Howard - Univ Alabama Birmingham, Birmingham, AL USAMonika M. Safford - Univ Alabama Birmingham, Birmingham, AL USAMary Cushman - Univ Vermont, Lamer Coll Med, Burlington, VT USA
- Publication Details
- Thrombosis and haemostasis, v 117(3), pp 618-624
- Publisher
- Schattauer Gmbh-Verlag Medizin Naturwissenschaften
- Number of pages
- 7
- Grant note
- K08HL096841; R01HL080477 / National Heart, Lung, and Blood Institute, National Institutes of Health, Department of Health and Human Service, Bethesda, MD, United States U01 NS041588 / National Institute of Neurological Disorders and Stroke, National Institutes of Health, Department of Health and Human Service, Bethesda, MD, United States K08HL096841 / NATIONAL HEART, LUNG, AND BLOOD INSTITUTE; United States Department of Health & Human Services; National Institutes of Health (NIH) - USA; NIH National Heart Lung & Blood Institute (NHLBI) R01NS041588 / NATIONAL INSTITUTE OF NEUROLOGICAL DISORDERS AND STROKE; United States Department of Health & Human Services; National Institutes of Health (NIH) - USA; NIH National Institute of Neurological Disorders & Stroke (NINDS)
- Resource Type
- Journal article
- Language
- English
- Academic Unit
- Epidemiology and Biostatistics
- Web of Science ID
- WOS:000395850600019
- Scopus ID
- 2-s2.0-85014148475
- Other Identifier
- 991019169350704721
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- Collaboration types
- Domestic collaboration
- Web of Science research areas
- Hematology
- Peripheral Vascular Disease