PB1202 - Fibrinogen concentration and plasma clot properties as predictors of cardiovascular disease mortality in Black South Africans

Background: Cardiovascular disease (CVD) is a main cause of mortality. Evidence from prospective studies suggests a potential causal role for clot structure in CVD, although less is known regarding CVD mortality. Prospective evidence on a population level is still lacking.

Aims: We determined the prospective association between total (Clauss) and gamma prime (ELISA) fibrinogen concentration and markers of plasma clot formation, structure, and lysis (turbidimetry) and incident total and CVD mortality after 13 years in an African cohort.

Methods: 1 645 apparently healthy Black South Africans took part in the South African arm of the International Prospective Urban and Rural Epidemiology Study, in accordance with the Declaration of Helsinki, after ethical approval from the Health Research Ethics Committee of the North-West University and informed consent were obtained. Mortality status (all cause: n=499, CVD: n=154) and cause of death documented on death certificates by a medically qualified general practitioner according to ICD-10 codes (CVD = ICDI00-I99) was obtained from Statistics SA. The relationship of total and gamma prime fibrinogen and plasma clot properties at baseline with incident mortality, adjusted for known CVD risk markers, was determined using ordinary Cox models.

Results: Longer clot lysis times, and increased rate of clot formation (slope) and clot density (maximum absorbance) were associated with increased risk for all-cause mortality, before but not after adjustment for known CVD risk factors (Table 1). Higher clot density was also associated with CVD mortality in the minimally adjusted model . None of the coagulation markers were related to CVD mortality risk in the fully adjusted models (Table 2).

Conclusion(s): The prothrombotic clot phenotype contributed to an increased risk of incident all-cause and CVD mortality before but not after adjustment for known CVD risk markers, suggesting that they likely do not confer additional, independent risk on an epidemiological level in this African cohort.