Relationship of coagulation and fibrinolytic variables with arterial structure and function in Africans

Introduction: Although both coagulation and fibrinolysis are associated with cardiovascular disease (CVD) the underlying nature and pathways of many of these associations are still unclear. Our aim was to determine which of the current or 5-year prior levels of total fibrinogen, fibrinogen gamma', plasminogen activator inhibitor-1 (PAI-1(act)) and global fibrinolytic potential were the stronger determinant of arterial structure and function. Materials and methods: This prospective study consisted of 2010 Africans over the age of 35 years with 5-year follow-up data available for 1288 participants. Cardiovascular measurements included arterial stiffness, blood pressure and carotid intima media thickness. Results: Fibrinogen gamma' showed stronger associations with blood pressure than total fibrinogen also in the presence of other CVD risk factors. PAI-1(act) was positively associated with blood pressure both cross-sectionally and prospectively, with the longitudinal association being the stronger determinant, also after adjustment for known CVD risk factors. Clot lysis time (CLT) was positively associated, both prospectively and crosssectionally, with intima media thickness and negatively with markers of arterial stiffness but not after adjustment for known CVD risk factors. Conclusions: Fibrinogen gamma' was more strongly associated with CVD function than total fibrinogen. PAI-1(act) was significantly associated with blood pressure with changes in PAI-1 levels preceding changes in blood pressure. Different mechanisms may be at play determining arterial wall stiffness/thickening and blood pressure as observed from the opposing associations with PAI-1act and CLT. CLT was not independently related to cardiovascular measures as its associations were weakened in the presence of other known CVD risk factors. (C) 2014 Elsevier Ltd. All rights reserved.