Fibrin D-Dimer and Cardiovascular Risk

Hyperreactivity to stress may be one explanation for the increased risk of cardiovascular disease (CVD) in individuals with essential hypertension. We investigated blood lipid reactivity to the Montreal Imaging Stress Task (MIST), a psychosocial stressor, in hypertensive and normotensive men and tested for prospective associations with biological risk factors. Fifty-six otherwise healthy and medication-free hypertensive and normotensive men underwent the MIST. We repeatedly measured cortisol and blood lipid profiles (total cholesterol (TC), low-density lipoprotein cholesterol (LDL-C), high-density lipoprotein cholesterol (HDL-C), and triglycerides (TG)) immediately before and up to 1 h after stress. Lipid levels were corrected for stress hemoconcentration. Thirty-five participants completed follow-up assessment 2.9 ± 0.12 (SEM) years later. CVD risk was assessed by prospective changes in TC/HDL-C ratio, IL-6, D-dimer, and HbA1c from baseline to follow-up. The MIST induced significant changes in all parameters except TC (p-values ≤ 0.043). Compared with normotensives, hypertensives had higher TC/HDL-C-ratio and TG (p-values ≤ 0.049) stress responses. Blood lipid stress reactivity predicted future cardiovascular risk (p = 0.036) with increases in HbA1c (ß = 0.34, p = 0.046), IL-6 (ß = 0.31, p = 0.075), and D-dimer (ß = 0.33, p = 0.050). Our results suggest that the greater blood lipid reactivity to psychosocial stress in hypertensives, the greater their future biological CVD risk. This points to lipid stress reactivity as a potential mechanism through which stress might increase CVD risk in essential hypertension.

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Gambaran Pasien Stroke Iskemik Akut dengan COVID-19 yang Masuk Ruang Perawatan Intensif

e-CliniC ◽

10.35790/ecl.v9i1.32302 ◽

2021 ◽

Vol 9 (1) ◽

Author(s):

Anastasia T. Thambas ◽

Diana Ch. Lalenoh ◽

Barry I. Kambey

Keyword(s):

Intensive Care Unit ◽

Intensive Care ◽

Ischemic Stroke ◽

Cardiovascular Risk ◽

Literature Review ◽

Acute Ischemic Stroke ◽

Pulmonary Infiltrate ◽

Ground Glass ◽

Age Group ◽

D Dimer

Abstract: Acute ischemic stroke (AIS) has been reported in patients with coronavirus disease 2019 (COVID-19). The cause of AIS in COVID-19 patients has not been fully understood, but COVID-19 is known to cause hypercoagulation characterized by increased d-dimer levels, and cytokine storms. Some AIS patients with COVID-19 require intensive care. This study was aimed to determine the description of AIS patients with COVID-19 admitted to the intensive care unit. This was a literature review study using three databases, as follows: Pubmed, ClinicalKey, and Science Direct. The keywords used were acute ischemic stroke AND COVID-19 AND intensive care unit. The results showed that after being selected based on inclusion and exclusion criteria, 10 literatures were obtained. There were 20 subjects and most were female (55%) and age group of 60-69 years old (35%). The most common cardiovascular risk factor was hypertension (80%, n=10). There were some increases in the levels of LDH, CRP, d-dimer, ferritinin, and fibrinogen. On radiological examination performed, there were cases with bilateral pulmonary infiltrate (33%) and ground-glass opacities (67%) (n = 6). In conclusion, the characteristics of AIS patients with COVID-19 admitted to the intensive care room were mostly female, age group 60-69 years, had cardiovascular risk factors for hypertension, had elevated levels of LDH, CRP, d-dimer, ferritinin, and fibrinogen, and had ground-glass opacity on radiological imaging.Keywords: acute ischemic stroke, COVID-19, intensive care unit Abstrak: Stroke iskemik akut telah dilaporkan pada pasien dengan coronavirus disease 2019 (COVID-19). Penyebab stroke iskemik akut pada COVID-19 belum diketahui secara menyeluruh, tetapi COVID-19 dapat menyebabkan kejadian hiperkoagulasi ditandai dengan peningkatan kadar d-dimer serta menyebabkan badai sitokin. Beberapa pasien stroke iskemik akut dengan COVID-19 membutuhkan perawatan di ruang perawatan intensif. Penelitian ini bertujuan untuk mengetahui gambaran pasien stroke iskemik akut dengan COVID-19 yang masuk di ruang perawatan intensif. Jenis penelitian ialah literature review dengan pencarian data menggunakan tiga database yaitu Pubmed, ClinicalKey dan Science Direct dengan kata kunci acute ischemic stroke AND COVID-19 AND intensive care unit. Hasil penelitian mendapatkan 10 literatur dengan jumlah subyek penelitian sebanyak 20 orang, jenis kelamin terbanyak ialah perempuan (55%) dengan kelompok usia terbanyak ialah 60-69 tahun (35%). Faktor risiko kardiovaskular yang paling banyak dimiliki subyek penelitian ialah hipertensi (80%, n=10). Terdapat peningkatan kadar LDH, CRP, d-dimer, ferritinin, dan fibrinogen. Pada pemeriksaan radiologi ditemukan bilateral pulmonary infiltrate (33%) dan ground-glass opacitiy (67%) (n=6). Simpulan penelitian ini ialah karakteristik pasien stroke iskemik akut dengan COVID-19 yang masuk ruang perawatan intensif paling banyak ialah perempuan, usia 60-69 tahun, memiliki faktor risiko kardiovaskular hipertensi, mengalami peningkatan kadar LDH, CRP, d-dimer, ferritinin, fibrinogen, dan ditemukan ground-glass opacitiy pada gambaran radiologi.Kata kunci: Stroke iskemik akut, COVID-19, ruang perawatan intensif

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Guidance for the Management of Patients with Vascular Disease or Cardiovascular Risk Factors and COVID-19: Position Paper from VAS-European Independent Foundation in Angiology/Vascular Medicine

Thrombosis and Haemostasis ◽

10.1055/s-0040-1715798 ◽

2020 ◽

Vol 120 (12) ◽

pp. 1597-1628 ◽

Cited By ~ 2

Author(s):

Grigoris T. Gerotziafas ◽

Mariella Catalano ◽

Mary-Paula Colgan ◽

Zsolt Pecsvarady ◽

Jean Claude Wautrecht ◽

...

Keyword(s):

Risk Factors ◽

Cardiovascular Risk ◽

High Risk ◽

Vascular Disease ◽

Cardiovascular Risk Factors ◽

Oral Anticoagulants ◽

Direct Oral Anticoagulants ◽

Vascular Medicine ◽

Post Discharge ◽

D Dimer

AbstractCOVID-19 is also manifested with hypercoagulability, pulmonary intravascular coagulation, microangiopathy, and venous thromboembolism (VTE) or arterial thrombosis. Predisposing risk factors to severe COVID-19 are male sex, underlying cardiovascular disease, or cardiovascular risk factors including noncontrolled diabetes mellitus or arterial hypertension, obesity, and advanced age. The VAS-European Independent Foundation in Angiology/Vascular Medicine draws attention to patients with vascular disease (VD) and presents an integral strategy for the management of patients with VD or cardiovascular risk factors (VD-CVR) and COVID-19. VAS recommends (1) a COVID-19-oriented primary health care network for patients with VD-CVR for identification of patients with VD-CVR in the community and patients' education for disease symptoms, use of eHealth technology, adherence to the antithrombotic and vascular regulating treatments, and (2) close medical follow-up for efficacious control of VD progression and prompt application of physical and social distancing measures in case of new epidemic waves. For patients with VD-CVR who receive home treatment for COVID-19, VAS recommends assessment for (1) disease worsening risk and prioritized hospitalization of those at high risk and (2) VTE risk assessment and thromboprophylaxis with rivaroxaban, betrixaban, or low-molecular-weight heparin (LMWH) for those at high risk. For hospitalized patients with VD-CVR and COVID-19, VAS recommends (1) routine thromboprophylaxis with weight-adjusted intermediate doses of LMWH (unless contraindication); (2) LMWH as the drug of choice over unfractionated heparin or direct oral anticoagulants for the treatment of VTE or hypercoagulability; (3) careful evaluation of the risk for disease worsening and prompt application of targeted antiviral or convalescence treatments; (4) monitoring of D-dimer for optimization of the antithrombotic treatment; and (5) evaluation of the risk of VTE before hospital discharge using the IMPROVE-D-dimer score and prolonged post-discharge thromboprophylaxis with rivaroxaban, betrixaban, or LMWH.

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Fibrinogen, D-Dimer and Thrombin-Antithrombin Complexes in a Random Population Sample: Relationships with Other Cardiovascular Risk Factors

Thrombosis and Haemostasis ◽

10.1055/s-0038-1642486 ◽

1994 ◽

Vol 71 (05) ◽

pp. 581-586 ◽

Cited By ~ 23

Author(s):

Carlo Giansante ◽

Nicola Fiotti ◽

Luigi Cattin ◽

Paolo Giovanni Da Col ◽

Salvatore Calabrese

Keyword(s):

Risk Factors ◽

Cardiovascular Risk ◽

Cardiovascular Risk Factors ◽

Population Sample ◽

Normal Subjects ◽

Mean Value ◽

Normal Range ◽

The Mean ◽

Random Population Sample ◽

D Dimer

SummaryFibrinogen is an independent risk factor for cardiovascular disease and both D-Dimer and Thrombin-Antithrombin complexes may be suitable as laboratory markers of deep venous thrombosis and are becoming more widespread in clinical practice. The aim of our study was to evaluate their normal range and to examine their correlation with various cardiovascular risk factors. Fibrinogen, D-Dimer and Thrombin-Antithrombin complexes were assessed in 516 normal subjects randomly selected from the National Health Service register of Trieste (Italy). In our community the mean value of fibrinogen was 283 ± 71 mg/dl. Fibrinogen increases with age in males and was significantly higher in male smokers. In non-smokers, females had significantly higher fibrinogen values than males. The mean value of D-Dimer was 306 ± 130 ng/ml. In females it is significantly higher. The fibrinogen and D-Dimer correlation coefficient was 0.20 (p < 0.001). The mean level of Thrombin-Antithrombin complexes was 6.25 ±6.8 ng/ml with a distribution markedly skewed towards the left; males had lower concentration than females (p = 0.047). Multiple regression analysis for fibrinogen as a dependent variable showed that D-Dimer, LDL- eholesterol, Body-Mass Index and Thrombin-Antithrombin complexes were poor predictors for fibrinogen plasma levels (R2 = 0.23) and that fibrinogen, ApoAl and age can explain only about 10% of the observed variability in D-Dimer.

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Cardiovascular risk and D-dimer levels in HIV-infected ART-naïve Africans

Cardiovascular Diagnosis and Therapy ◽

10.21037/cdt.2019.12.02 ◽

2020 ◽

Vol 10 (3) ◽

pp. 526-533

Author(s):

Ana Olga Mocumbi ◽

Igor Dobe ◽

Sandra Cândido ◽

Nick Kim

Keyword(s):

Cardiovascular Risk ◽

D Dimer

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Plasma D-dimer as a biomarker of cardiovascular risk in patients with atrial fibrillation on antiplatelet agents

Clinica Chimica Acta ◽

10.1016/j.cca.2019.03.368 ◽

2019 ◽

Vol 493 ◽

pp. S177

Author(s):

S. Zadvorev ◽

D. Piskunov ◽

V. Dorofeykov ◽

A. Zamytskaia ◽

A. Yakovlev ◽

...

Keyword(s):

Atrial Fibrillation ◽

Cardiovascular Risk ◽

Antiplatelet Agents ◽

D Dimer

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

Thrombosis and Haemostasis ◽

10.1160/th16-07-0519 ◽

2017 ◽

Vol 117 (03) ◽

pp. 618-624 ◽

Cited By ~ 18

Author(s):

Leslie A. McClure ◽

Suzanne E. Judd ◽

Brett Kissela ◽

George Howard ◽

Monika M. Safford ◽

...

Keyword(s):

Risk Factors ◽

Cardiovascular Disease ◽

Coronary Heart Disease ◽

Heart Disease ◽

Cardiovascular Risk ◽

Vascular Disease ◽

Cardiovascular Risk Factors ◽

Hazard Ratio ◽

The Difference ◽

D Dimer

SummaryD-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.

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