Background and aims: It is as yet unknown whether antithrombin levels are associated with arterial thromboembolism (ATE) at a young age. To investigate the association between antithrombin levels and premature and recurrent ATE, we performed a case-control study and a subsequent nested cohort study of premature coronary heart disease (CHD) patients. Methods: In the case-control study, we included 571 patients who had a recent premature ATE, including CHD and ischemic stroke (IS), and 461 healthy controls. The association between antithrombin levels (dichotomized: ≤median vs. >median) and ATE was investigated. Subsequently we studied the association between antithrombin levels and recurrent cardiac events, ATE or death in a nested cohort of 323 CHD patients. Results: Low antithrombin levels (≤median, 1.04 IU/mL) are associated with an increased risk of ATE (OR 1.46; 95% CI:1.09–1.96), after adjustment for classical cardiovascular risk factors. This was observed in the subgroups of CHD patients (1.43; 1.01–2.02) and IS patients (1.48; 1.01–2.19). CHD patients with low antithrombin levels had a higher risk of recurrent cardiac events (HR 2.16, 95% CI:1.07–4.38). Especially in women with low antithrombin levels, the risk of recurrent cardiac events was high (HR 5.97, 95% CI 1.31–27.13) as was the risk of recurrent ATE or death (HR 4.22, 95% CI 1.19–15.00). Conclusions: Individuals with relatively low antithrombin levels have an increased risk for ATE at a younger age. CHD patients with low antithrombin levels, especially women, have a higher risk of recurrent cardiac events.

Additional Metadata
Persistent URL dx.doi.org/10.1016/j.atherosclerosis.2018.01.014, hdl.handle.net/1765/105062
Journal Atherosclerosis
Citation
Croles, F.N, van Loon, J.E, Dippel, D.W.J, de Maat, M.P.M, & Leebeek, F.W.G. (2018). Antithrombin levels are associated with the risk of first and recurrent arterial thromboembolism at a young age. Atherosclerosis, 269, 144–150. doi:10.1016/j.atherosclerosis.2018.01.014