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Thromb Haemost 2009; 101(01): 100-107
DOI: 10.1160/TH08-06-0384
Blood Coagulation, Fibrinolysis and Cellular Haemostasis
Schattauer GmbH

Antiphospholipid antibodies predict imminent vascular events independently from other risk factors in a prospective cohort

Carolyn Neville   *
1   Division of Clinical Epidemiology, Department of Medicine, McGill University Health Centre, Montreal, Quebec, Canada
,
Joyce Rauch   *
2   Division of Rheumatology, Department of Medicine, McGill University Health Centre, Montreal, Quebec, Canada
,
Jeannine Kassis
3   Department of Hematology, Maisonneuve-Rosemont Hospital, University of Montreal, Montreal, Quebec, Canada
,
Susan Solymoss
4   Division of Hematology, Department of Medicine, McGill University Health Centre, Montreal, Quebec, Canada
,
Lawrence Joseph
1   Division of Clinical Epidemiology, Department of Medicine, McGill University Health Centre, Montreal, Quebec, Canada
5   Department of Epidemiology and Biostatistics, McGill University, Montreal, Quebec, Canada
,
Patrick Belisle
1   Division of Clinical Epidemiology, Department of Medicine, McGill University Health Centre, Montreal, Quebec, Canada
,
Jerrold M. Levine
6   Section of Nephrology, Department of Medicine, University of Illinois at Chicago, and Section of Nephrology, Department of Medicine, Jesse Brown Veterans Administration Medical Center, Chicago, Illinois, USA
,
Paul R. Fortin
7   Division of Health Care and Outcome Research, Toronto Western Research Institute, University of Toronto, Toronto, Ontario, Canada
8   Division of Rheumatology, Department of Medicine, University Health Network, University of Toronto, Toronto, Ontario, Canada
› Author AffiliationsFinancial support: This study has been funded in part by operating grants from The Arthritis Society (97/0007) and the Canadian Institutes of Health Research (MOP-49509 and MOP-64336 [PRF, JK, JR] and MOP-42391 [JR]). PRF is a Distinguished Senior Investigator of The Arthritis Society with additional support from the Arthritis Centre of Excellence, University of Toronto.
Further Information

Publication History

Received: 17 June 2008

Accepted after minor revision: 12 September 2008

Publication Date:
23 November 2017 (online)

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Summary

Antiphospholipid antibodies (aPL) are associated with vascular events, but the magnitude of this risk, alone, or in combination with other atherogenic and thrombophilic risk factors, remains unclear. A prospective cohort of 415 persons was studied for arterial and venous events (AE and VE) over a median time of 7.4 years. aPL and coagulation abnormalities were measured upon beginning of the study and annually for the first four years. Within the cohort, a nested case-control study was conducted to investigate the role of endothelial and inflammatory markers in predicting new vascular events. Forty-five individuals had new vascular events: 18 occurred during the first year of follow-up. The proportion of event-free survivors at eight years was 90% (95%CI = 87%, 94%) for aPL-negative and 72% (60%, 85%) for aPL-positive individuals, respectively. Predictors for new AE were previous AE (HR=5.7 [2.7, 12.0]), diabetes (5.6 [2.4, 13.2]), aPL positivity (2.6 ([1.2, 5.9]), and age (1.04 [1.01, 1.07]). New VE were predicted by previous VE (6.1 [1.9, 19.9]), anti-β2-glyco-protein I (aβ2GPI) positivity (5.8 [1.4, 24.1]), activated protein C resistance (APCR) (4.1 [1.1, 15.1]), and gender (3.7 [1.1, 12.9]). In the nested case-control study, similar predictors were observed for AE, while abnormal APCR (OR=5.5 [1.1, 26.6]) and elevated von Willebrand factor (vWF) (OR=5.0 [1.2, 19.8]) best predicted VE. We demonstrate that aPL independently predict new vascular events and discriminate between individuals with and without events in the first two years of follow-up, indicating that aPL are associated with a short-term risk of developing new and recurrent vascular events.

Keywords

Antiphospholipid antibodies - thrombosis - anti-beta2-glycoprotein I - activated protein C resistance - von Willebrand factor

* These authors contributed equally to this research.


 

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