Aims Traditional atherosclerotic cardiovascular disease (ASCVD) risk factors fail to address the full spectrum of the complex interplay of atherosclerotic and atherothrombotic factors integral to ASCVD events. This study sought to examine the association between atherothrombotic biomarkers and ASCVD events. Methods and results The association between atherothrombotic biomarkers and 877 ASCVD events with and without adjustment for traditional risk factors was evaluated via Cox proportional hazards models and factor analysis in 5789 Multi-Ethnic Study of Atherosclerosis participants over a median follow-up of 14.7 years. Factor analysis accounted for multidimensional relationship and shared variance among study biomarkers, which identified two new variables: a thrombotic factor (Factor 1), principally defined by shared variance in fibrinogen, plasmin–antiplasmin complex, factor VIII, D-dimer, and lipoprotein(a), and a fibrinolytic factor (Factor 2), principally defined by shared variance of plasminogen and oxidized phospholipids on plasminogen. In a model including both factors, the thrombotic factor was associated with the higher risk of ASCVD events [hazard ratio (HR) 1.57, 95% confidence interval (CI) 1.45, 1.70], while the fibrinolytic factor was associated with the lower risk of ASCVD events (HR 0.76, 95% CI 0.70, 0.82), with estimated ASCVD free survival highest for low atherothrombotic Factor 1 and high atherothrombotic Factor 2. Conclusion Two atherothrombotic factors, one representative of thrombotic propensity and the other representative of fibrinolytic propensity, were significantly and complementarily associated with incident ASCVD events, remained significantly associated with incident ASCVD after controlling for traditional risk factors, and have promise for identifying patients at high ASCVD event risk specifically due to their atherothrombotic profile.

中文翻译：

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动脉粥样硬化血栓形成因素和动脉粥样硬化心血管事件：动脉粥样硬化的多种族研究


传统的动脉粥样硬化性心血管疾病 (ASCVD) 危险因素未能全面解决 ASCVD 事件中动脉粥样硬化和动脉粥样硬化血栓形成因素之间复杂的相互作用。本研究旨在探讨动脉粥样硬化血栓生物标志物与 ASCVD 事件之间的关联。方法和结果 在 5789 名动脉粥样硬化参与者的多种族研究中，通过 Cox 比例风险模型和因素分析，评估了动脉粥样硬化血栓生物标志物与 877 例 ASCVD 事件之间的关联，并在中位随访时间为 14.7 年的情况下进行了调整或不调整。因子分析解释了研究生物标志物之间的多维关系和共享方差，确定了两个新变量：血栓形成因子（因子 1），主要由纤维蛋白原、纤溶酶-抗纤溶酶复合物、因子 VIII、D-二聚体和脂蛋白的共享方差定义。 a) 和纤溶因子（因子 2），主要由纤溶酶原和纤溶酶原上的氧化磷脂的共同方差定义。在包含这两个因素的模型中，血栓形成因素与 ASCVD 事件的较高风险相关[风险比 (HR) 1.57，95% 置信区间 (CI) 1.45，1.70]，而纤溶因素与 ASCVD 事件的较低风险相关。 ASCVD 事件（HR 0.76，95% CI 0.70，0.82），低动脉粥样硬化血栓因子 1 和高动脉粥样硬化血栓因子 2 的估计无 ASCVD 生存率最高。 结论 两种动脉粥样硬化血栓形成因素，一种代表血栓形成倾向，另一种代表纤溶倾向，与 ASCVD 事件显着且互补相关，在控制传统危险因素后仍与 ASCVD 事件显着相关，有望识别高 ASCVD 患者事件风险特别是由于其动脉粥样硬化血栓形成的特征。