Associations of factor VIIIc, D‐dimer, and plasmin–antiplasmin with incident cardiovascular disease and all‐cause mortality

To examine the associations of three understudied hemostatic factors—D‐dimer, factor VIIIc, and plasmin‐antiplasmin (PAP) complex—with incident cardiovascular disease (CVD) and all cause mortality in the Multiethnic Study of Atherosclerosis cohort. Hemostatic factors were measured at baseline in 45–84‐year‐old patients (n = 6,391) who were free of clinically recognized CVD. Over 4.6 years of follow‐up, we identified 307 CVD events, 207 hard coronary heart disease events, and 210 deaths. D‐dimer, factor VIIIc, and PAP were not associated with CVD incidence after adjustment for other risk factors. In contrast, each factor was associated positively with total mortality, and D‐dimer and factor VIIIc were associated positively with cancer mortality. When modeled as ordinal variables and adjusted for risk factors, total mortality was greater by 33% (95% CI 15–54) for each quartile increment of D‐dimer, 26% (11–44) for factor VIIIc, and 20% (4–38) for PAP. This prospective cohort study did not find D‐dimer, factor VIIIc, or PAP to be risk factors for CVD. Instead, elevated levels of these three hemostatic factors were associated independently with increased risk of death. Elevated D‐dimer and factor VIIIc were associated with increased cancer death. Am. J. Hematol., 2009. © 2009 Wiley‐Liss, Inc.