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High Plasminogen Activator Inhibitor and Tissue Plasminogen Activator Levels in Plasma Precede a First Acute Myocardial Infarction in Both Men and Women: Evidence for the Fibrinolytic System as an Independent Primary Risk Factor
Abstract
Background —In patients with established ischemic heart disease, prospective cohort studies have indicated that plasminogen activator inhibitor (PAI-1), the inhibitor of the fibrinolytic system, may predict cardiovascular events. So far, there have been no primary prospective studies of PAI-1. Methods and Results —The aim of the present study was to test whether plasma levels of PAI-1, tissue-type plasminogen activator (tPA), von Willebrand factor (vWF), and thrombomodulin (TM) could predict the occurrence of a first acute myocardial infarction (AMI) in a population with high prevalence of coronary heart disease by use of a prospective nested case-control design. Mass concentrations of PAI-1 and tPA were significantly higher for the 78 subjects who developed a first AMI compared with the 156 references matched for age, sex, and sampling time; for tPA, this increase was independent of smoking habits, body mass index, hypertension, diabetes, cholesterol, and apolipoprotein A-I. The ratio of quartile 4 to 1 for tPA was 5.9 for a patient to develop a first AMI. The association between tPA and AMI was seen in both men and women. Increased levels of vWF were associated with AMI in a univariate analysis. High levels of TM were associated with AMI in women but not in men. Conclusions —The plasma levels of PAI-1, tPA, and vWF are associated with subsequent development of a first AMI; for PAI-1 and tPA, this relation was found in both men and women. For tPA but not for PAI-1 and vWF, this association is independent of established risk factors.
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“Increased circulating PAI-1 activity or antigen is associated with increased risk of thrombotic events including myocardial infarction and stroke.”
From The Vasculature in Prediabetes (2018) · cites this paper as [113]
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Metadata
- Authors
- Thögersen, A. M., Jansson, J.-H., Boman, K., Nilsson, T. K., Weinehall, L., Huhtasaari, F., & Hallmans, G.
- Affiliations
- From the Department of Medicine (A.M.T.), Department of Clinical Chemistry (T.K.N.), and Departments of Nutritional Research and Pathology (G.H.), Umeå University Hospital; Department of Medicine-Geriatric, Skellefteå County Hospital (J.-H.J., K.B.) and Department of Epidemiology and Public Health (L.W.), University of Umeå; and Department of Medicine, Luleå Hospital (F.H.), Sweden.
- University Hospital of Umeå (SE)
- Venue
- Circulation
- Published
- 1998-11-24
- Volume
- 98
- Issue
- 21
- Pages
- 2241-2247
- ISSN
- 0009-7322 (ISSN-L)
- 1524-4539
- OpenAlex
- W1976057876
- Cited by
- 602
- References
- 30
- Citations by year
- 2026: 3 · 2025: 5 · 2024: 3 · 2023: 6 · 2022: 19 · 2021: 10 · 2020: 10 · 2019: 6 · 2018: 14 · 2017: 7 · 2016: 17 · 2015: 12 · 2014: 27 · 2013: 20 · 2012: 19
- FWCI
- 10.91
- Type
- journal article
- Language
- en
- Open access
- closed
- Locations
- Circulation (publishedVersion)
- PubMed (publishedVersion)
- Funders
- Umeå Universitet
- Topics
- Health Sciences › Medicine › Hematology › Blood Coagulation and Thrombosis Mechanisms
- Health Sciences › Medicine › Cardiology and Cardiovascular Medicine › Acute Myocardial Infarction Research
- Health Sciences › Medicine › Hematology › Blood properties and coagulation
- Keywords
- plasminogen activator inhibitor-1, tissue plasminogen activator, acute myocardial infarction, von Willebrand factor, thrombomodulin, fibrinolysis, coronary artery disease, cardiovascular risk prediction, sex differences, plasma biomarkers
- MeSH terms
- Adult, Age Factors, Female, Fibrinolysis, Humans, Middle Aged, Myocardial Infarction, Tissue Plasminogen Activator, Predictive Value of Tests, Prospective Studies, Risk Factors, Sex Factors, Sweden, Biomarkers, Plasminogen Inactivators, Incidence, Case-Control Studies, Dehydroepiandrosterone Sulfate
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