Increased Level of von Willebrand Factor Is Significantly and Independently Associated with Diabetes in Postinfarction Patients
Wojciech Zareba(1), George Pancio(1), Arthur J. Moss(1), Vijay G. Kalaria(1), Victor J. Marder(2), Harvey J. Weiss(3), Luc F. Miller Watelet(4), Charles E. Sparks(5), for THROMBO Investigators*
(1)Cardiology Unit, Department of Medicine, and (5)Department of Pathology, and (4)Department of Biostatistics of University of Rochester Medical Center, Rochester, NY, (2)Vascular Medicine Center, Orthopedic Hospital, UCLA School of Medicine, Los Angel
Summary Diabetes is an established risk factor for reinfarction and cardiacdeath in postinfarction patients. Since the underlying mechanism ofdiabetes-related risk is not fully understood we aimed to evaluate theassociation between lipids, thrombogenic factors and diabetes inpostinfarction patients. The study population consisted of 1,045 postinfarctionpatients (846 non-diabetic, 125 non-insulin- and 74 insulinrequiringdiabetics) with the following blood tests performed 2 monthsafter an index myocardial infarction: lipoprotein (a), apolipoprotein-B,apolipoprotein-A, cholesterol, HDL cholesterol, triglycerides, insulin,von Willebrand factor (vWF), fibrinogen, factor VII, D-dimer, andplasminogen activator inhibitor (PAI-1). After adjustment for relevantclinical covariates, non-insulin-requiring diabetes was significantly(p <0.05) associated with elevated levels of (odd ratios per 1 log unitincrease in parenthesis) vWF (1.74) and PAI-1 (1.42) whereas insulinrequiring diabetes was associated with even more elevated levels ofvWF (4.68), but not with increased levels of PAI-1. No significantdifferences in lipid levels were observed among three groups. Inconclusion, increased level of von Willebrand factor is significantlyand independently associated with diabetes in postinfarction patients,suggesting that endothelial damage is the primary mechanisms contributingto an increased occurrence of vascular and cardiac events indiabetic postinfarction patients.