Antithrombin levels are associated with the risk of first and recurrent arterial thromboembolism at a young age

• Published in: Atherosclerosis 2018-02, Vol.269, p.144-150
• Main Authors: Croles, F. Nanne, Van Loon, Janine E., Dippel, Diederik W.J., De Maat, Moniek P.M., Leebeek, Frank W.G.
• Format: Article
• Language: English
• Subjects: Adult; Age of Onset; Antithrombins - blood; Biomarkers - blood; Brain Ischemia - blood; Brain Ischemia - diagnosis; Brain Ischemia - mortality; Case-Control Studies; Coronary Disease - blood; Coronary Disease - diagnosis; Coronary Disease - mortality; Down-Regulation; Female; Follow-Up Studies; Humans; Male; Middle Aged; Netherlands; Prognosis; Recurrence; Risk Assessment; Risk Factors; Stroke - blood; Stroke - diagnosis; Stroke - mortality; Thromboembolism - blood; Thromboembolism - diagnosis; Thromboembolism - mortality; Time Factors
• ISSN: 0021-9150; 1879-1484
• DOI: 10.1016/j.atherosclerosis.2018.01.014

It is as yet unknown whether antithrombin levels are associated with arterial thromboembolism (ATE) at a young age. To investigate the association between antithrombin levels and premature and recurrent ATE, we performed a case-control study and a subsequent nested cohort study of premature coronary heart disease (CHD) patients. In the case-control study, we included 571 patients who had a recent premature ATE, including CHD and ischemic stroke (IS), and 461 healthy controls. The association between antithrombin levels (dichotomized: ≤median vs. >median) and ATE was investigated. Subsequently we studied the association between antithrombin levels and recurrent cardiac events, ATE or death in a nested cohort of 323 CHD patients. Low antithrombin levels (≤median, 1.04 IU/mL) are associated with an increased risk of ATE (OR 1.46; 95% CI:1.09–1.96), after adjustment for classical cardiovascular risk factors. This was observed in the subgroups of CHD patients (1.43; 1.01–2.02) and IS patients (1.48; 1.01–2.19). CHD patients with low antithrombin levels had a higher risk of recurrent cardiac events (HR 2.16, 95% CI:1.07–4.38). Especially in women with low antithrombin levels, the risk of recurrent cardiac events was high (HR 5.97, 95% CI 1.31–27.13) as was the risk of recurrent ATE or death (HR 4.22, 95% CI 1.19–15.00). Individuals with relatively low antithrombin levels have an increased risk for ATE at a younger age. CHD patients with low antithrombin levels, especially women, have a higher risk of recurrent cardiac events. •Low antithrombin levels are associated with an increased ATE risk at a young age.•Young CHD patients low antithrombin levels have an increased recurrent ATE risk.•The recurrence risk was especially high in women with CHD and low antithrombin levels.