D-dimer predicts mortality due to Cardiovascular events and Cancer in Stable CHD

Dr.John Simes from National Health and Medical Research Council (NHMRC) Clinical Trials Centre, University of Sydney, Sydney Australia, and associates conducted The LIPID Study to assess the role of D-dimer levels in predicting long-term vascular outcomes, cause-specific mortality, and new cancers in the context of other risk factors.The researchers found that D-dimer Predicts Long-Term Cause-Specific Mortality, Cardiovascular Events and Cancer in Stable Coronary Heart Disease Patients.D-dimer a degradation product of cross-linked fibrin, is a marker for hypercoagulability and thrombotic events.The Study has been published in Circulation.

LIPID randomized patients to placebo or pravastatin 40 mg/day 5-38 months after myocardial infarction or unstable angina. D-dimer levels were measured at baseline and at 1 year. Median follow-up was 6.0 years during the trial and 16 years in total.

Results—Baseline D-dimer levels for 7863 patients were grouped by quartile (≤112, 112-173, 173-273, >273 ng/mL). Higher levels were associated with older age, female sex, history of hypertension, poor renal function and elevated levels of B-natriuretic peptide, high-sensitivity C-reactive protein, and sensitive troponin I (each P<0.001). During the first 6 years, after adjustment for up to 30 additional risk factors, higher D-dimer was associated with a significantly increased risk of a major coronary event (Q4 vs Q1 HR 1.45; 95% CI 1.21-1.74), major cardiovascular (CVD) event (HR 1.45; 95% CI 1.23-1.71) and venous thromboembolism (HR 4.03 (2.31-7.03; 95% CI 2.31-7.03); each P<0.001. During the 16 years overall, higher D-dimer was an independent predictor of all-cause mortality (HR 1.59), CVD mortality (1.61), cancer mortality (1.54) and non-CVD noncancer mortality (1.57) (each P<0.001), remaining significant for deaths from each cause occurring beyond 10 years of follow-up (each P≤0.01). Higher D-dimer also independently predicted an increase in cancer incidence (HR 1.16, P=0.02).The D-dimer level increased the net reclassification index for all-cause mortality by 4.0 and venous thromboembolism by 13.6.

Conclusions—D-dimer levels predict long-term risk of arterial and venous events, CVD mortality, and non-CVD noncancer mortality, independently of other risk factors. D-dimer is also a significant predictor of cancer incidence and mortality. These results support an association of D-dimer with fatal events across multiple diseases and demonstrate that this link extends beyond 10 years' follow-up.

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https://doi.org/10.1161/CIRCULATIONAHA.117.029901