Association of European population levels of thrombotic and inflammatory factors with risk of coronary heart disease: the MONICA Optional Haemostasis Study†

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Abstract
Aims Classical risk factors do not fully explain international differences in risk of coronary heart disease (CHD). We therefore measured thrombotic and inflammatory markers in a substudy of the WHO MONICA project and correlated these with CHD event rates. Methods and results We measured levels of fibrinogen (clottable and nephelometric), von Willebrand factor (vWf), tissue plasminogen activator antigen, plasminogen activator inhibitor activity, fibrin D-dimer, plasma viscosity, C-reactive protein, and total cholesterol in 12 MONICA populations (listed at the end of this paper), all but one European. Men and women aged 45–64 years were studied from 10 countries. All samples were collected using a carefully standardized protocol, and analysed centrally. Results were available for 3996 subjects (nephelometric fibrinogen and viscosity), 2378 subjects (other thrombotic assays), and 1757 subjects (C-reactive protein and total cholesterol). Significant differences in levels of thrombotic and inflammatory factors exist in MONICA populations mainly from European countries. These differences persist after adjustment for age, smoking habit, and body mass index. Cross-sectional correlations between coronary event rates and these thrombotic/inflammatory markers were significant for vWF antigen in both sexes, nephelometric fibrinogen in men, and D-dimer in women. Conclusion In particular, vWF, nephelometric fibrinogen, and D-dimer should be examined in further research as potential risk factors which may help explain differences in coronary risk between European populations.