Tissue plasminogen activator and leucocyte elastase as predictors of cardiovascular events in subjects with angina pectoris: Edinburgh Artery Study.

Abstract

To evaluate the relationship between haemostatic and rheological factors and cardiovascular outcome in subjects with angina pectoris in the general population. Two hundred and seven men and women aged 55-74 had evidence of angina at baseline. Sixty-seven (32.3%) had a fatal or non-fatal cardiovascular event during follow-up. Median levels of tissue plasminogen activator antigen and leucocyte elastase were higher in the event group compared with the no event group (10.0 ng. ml(-1)vs 7.2 ng. ml(-1);P</=0.001, and 40.3 ng. ml(-1)vs 31.0 ng. ml(-1);P</=0.01, respectively). Whole blood viscosity was also significantly higher in the event group than in the no event group (3.80 mPa.s vs 3.53 mPa.s;P</=0.05). After adjusting for age and sex, unit increases in both tissue plasminogen activator antigen and leucocyte elastase levels were significantly associated with an increased risk of a cardiovascular event. These associations remained after further adjusting for cardiovascular risk factors and baseline myocardial infarction. The relative risks were 2.07 (95% CI, 1.30-3.45;P</=0.01) for tissue plasminogen activator antigen and 1. 95 (95% CI, 1.12-3.50;P</=0.05) for leucocyte elastase. Disturbed fibrinolysis and activation of leucocytes may be implicated in the development of thrombotic cardiovascular events in subjects with angina pectoris in the general population.