Atrial fibrillation and the prothrombotic state in the elderly - The Rotterdam Study

Background and Purpose-Atrial fibrillation (AF) is a major cause of stroke among the elderly. Evidence for a prothrombotic state in AF is controversial, and there is a lack of studies among the elderly. We studied the relationships between AF and 3 prothrombotic plasma markers-von Willebrand factor (vWf; a marker of endothelial damage/ dysfunction), soluble P-selectin (sP-sel; a marker of platelet activation), and fibrinogen-in a matched case-control study nested within a large community-based study of an elderly population. Methods-We identified 162 elderly participants (mean+/-SD age, 78+/-8 years; 51% male) in the Rotterdam study with documented AF and matched each case by age and sex to 2 population controls. vWf and sP-sel were measured by enzyme-linked immunosorbent assay; fibrinogen was measured with the Clauss method. We used conditional logistic regression analysis to assess the relationships between the markers and AF, adjusting for potential confounders. Results-There were no significant relationships between either fibrinogen (P=0.8) or sP-sel (P=0.6) and AF. However, a positive linear relationship between vWf level and presence of AF remained significant after adjustment for potential confounders among women (odds ratio [OR], 1.17; 95% Cl, 1.02 to 1.34) per 10-IU/dL increase in vWf but not among men (OR, 1.06; 95% Cl, 0.96 to 1.17). Conclusions-We observed a positive relationship between AF and plasma vWf (or endothelial damage/dysfunction) in our elderly population, which was most apparent among women. Fibrinogen and sP-sel levels were unrelated to AF. The prothrombotic state of AF may be subject to sex differences, but longitudinal studies are needed to determine the relationship between these plasma markers and stroke risk.