Fibrin D-dimer and coronary heart disease: prospective study and meta-analysis. Circulation

Background—It is unknown whether modest increases of fibrin D-dimer, a circulating marker of fibrin turnover, are relevant to coronary heart disease (CHD) in the general population. Methods and Results—We measured serum concentrations of D-dimer antigen in the stored baseline blood samples of 630 CHD cases and 1269 controls “nested ” in a prospective cohort of 5661 men who were monitored for 16 years, and we conducted a meta-analysis of previous relevant studies to place our findings in context. In a comparison of men in the top third compared with those in the bottom third of baseline fibrin D-dimer values (tertile cutoffs,.94 versus,49 ng/mL), the odds ratio for CHD was 1.67 (95 % CI, 1.31 to 2.13; P,0.0001) after adjustments for age and town. The odds ratio increased slightly after further adjustment for smoking, other classic risk factors, and indicators of socioeconomic status (1.79; 95 % CI, 1.36 to 2.36). Strong correlations were observed of fibrin D-dimer values with circulating concentrations of C-reactive protein and serum amyloid A protein but not with smoking, blood lipids, blood pressure, and other risk factors. Conclusion—Although there may be an association between circulating D-dimer values and CHD, further studies are needed to determine the extent to which this is causal. (Circulation. 2001;103:2323-2327.) Key Words: heart diseases n epidemiology n coagulation n fibrinolysis Circulating concentrations of fibrin D-dimer reflect theextent of fibrin turnover in the circulation, as this antige