Tissue plasminogen activator antigen is strongly associated with myocardial infarction in young women

Authors

  • P. M. MANNUCCI,

    1. Angelo Bianchi Bonomi Hemophilia and Thrombosis Center, Fondazione Luigi Villa and Department of Internal Medicine and Dermatology, IRCCS Maggiore Hospital and University of Milano; Department of Health Sciences, Section of Medical Statistics and Epidemiology, University of Pavia
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  • L. BERNARDINELLI,

    1. Angelo Bianchi Bonomi Hemophilia and Thrombosis Center, Fondazione Luigi Villa and Department of Internal Medicine and Dermatology, IRCCS Maggiore Hospital and University of Milano; Department of Health Sciences, Section of Medical Statistics and Epidemiology, University of Pavia
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  • L. FOCO,

    1. Angelo Bianchi Bonomi Hemophilia and Thrombosis Center, Fondazione Luigi Villa and Department of Internal Medicine and Dermatology, IRCCS Maggiore Hospital and University of Milano; Department of Health Sciences, Section of Medical Statistics and Epidemiology, University of Pavia
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  • M. GALLI,

    1. Division of Cardiology, ASL6 Hospital of Livorno
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  • F. RIBICHINI,

    1. Catheterization Laboratory, Maggiore Hospital and East Piedmont University, Novara
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  • M. TUBARO,

    1. Coronary Care Unit, Cardiovascular Department, San Filippo Neri Hospital, Rome, Italy
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  • F. PEYVANDI

    1. Angelo Bianchi Bonomi Hemophilia and Thrombosis Center, Fondazione Luigi Villa and Department of Internal Medicine and Dermatology, IRCCS Maggiore Hospital and University of Milano; Department of Health Sciences, Section of Medical Statistics and Epidemiology, University of Pavia
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P.M. Mannucci, Via Pace 9, 20122 Milan, Italy.
Tel.: +39 02 55035421; fax: +39 0250320723; e-mail: pmmannucci@libero.it

Abstract

Summary.  Women who develop acute myocardial infarction (AMI) at a young age have fewer classical risk factors and less coronary stenosis than older women. In this rare population, it is plausible that a heightened hemostatic system may play an important mechanistic role in thrombus formation and in the development of AMI. We chose to investigate whether or not there is an association between premature AMI and the plasma concentrations of five hemostatic measurements that had been previously established as risk factors for AMI, and of the inflammation marker C-reactive protein (CRP). Women who had survived AMI at the age of 45 years or less (n = 141) were drawn from those admitted to 125 Italian coronary care units over a 3-year period. In them, and in an equal number of controls, plasma levels of immunoreactive tissue plasminogen activator (tPA), plasminogen activation inhibitor 1 (PAI-1), von Willebrand factor (VWF), fibrinogen, D-dimer and CRP were measured. Higher levels of VWF, fibrinogen, CRP and tPA were associated with AMI. After adjustment for both classical and hemostatic risk factors, only tPA maintained an independent association with AMI: the odds ratios (taken as an index of relative risk) for tPA values in the middle and higher tertiles were 2.86 (CI 1.63–5.02) and 8.18 (CI 2.66–25.20), respectively. In conclusion, there is a strong association between non-fatal AMI and increased plasma levels of tPA antigen. This finding is thought to be the expression of a reduced rather than enhanced fibrinolytic activity.

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