Introduction & Aim:
Plaque micro-ruptures and associated thrombosis are a contributor to the progression of coronary artery disease (CAD). We sought to determine if disorders of haemostasis detectable by a global coagulation assay was a novel risk factor for CAD, or if hypercoagulation was associated with any of the traditional cardiac risk factors.
Methods:
Using the BioHEART biobank of clinical data, imaging data and pathology specimens, a cohort of patients (mean age 62.9 +/- 9.9 years, n=103 female, 103 male) had platelet poor plasma assessed by the overall haemostatic potential (OHP) assay. This assay measures the integrated effect of procoagulant, anticoagulant and fibrinolytic factors via calculation of area under a fibrin time curve. All patients had CT coronary angiograms scored; calcified plaque was identified by the coronary artery calcium score, and non-calcified plaque burden by a soft plaque score (SPS). Analysis was segregated by sex because of baseline differences in coagulation between males and females.
Results:
The OHP was found to be elevated in male patients who had non-calcified CAD [SPS>0 - 10.4 +/- 0.6 (n=62) vs SPS=0 - 8.78 +/- 0.5 (n=41), p=0.04], male patients with obesity [BMI >= 30 - 12.6 +/- 1.1 (n=26) vs BMI < 30 - 8.8 +/- 0.4 (n=77), p<0.01] and in female patients with hyperlipidaemia [hyperlipidaemic 11.8 +/- 0.6 (n=63) vs normolipidaemic 9.2 +/- 0.6 (n=40), p<0.01]. No differences were seen in OHP with calcified CAD, hypertension, diabetes mellitus, current or previous smoking history, or significant family history of CAD.
Conclusions:
These results indicate that hypercoagulation is associated with more biologically active non-calcified plaque, and that disordered coagulation is associated with two significant cardiac risk factors in a sex-discrepant manner. These findings underscore the importance of global coagulation assessments as potential novel, sex-specific biomarker for subclinical atherosclerosis.
Investigating the Relationship between Coronary Artery Calcium Score and Framingham Cardiac Risk Factors with Blood Groups
