D-dimer Predicts Long-Term Mortality, Vascular Events, Cancer
How well does the D-dimer level predict long-term vascular outcomes, cause-specific mortality, and new cancers?
The authors studied 7,863 patients who participated in the LIPID randomized trial, which compared placebo to pravastatin 40 mg/day 5-38 months after a myocardial infarction or unstable angina. D-dimer levels were measured both at baseline and at 1 year. Patients were then followed for a median 6.0 years in the trial, and for a total of 16 years. Risk of major coronary events, major cardiovascular events, venous thromboembolism, and mortality were assessed after adjusting for 30 risk factors.
Patients were grouped into quartiles based on their baseline D-dimer levels. During the first 6 years, higher D-dimer levels were independently associated with an increased risk of major coronary events (Q4 vs. Q1 hazard ratio [HR], 1.45; 95% CI, 1.21-1.74), major cardiovascular events (HR, 1.45; 95% CI, 1.23-1.71), and venous thromboembolism (HR, 4.03; 95% CI, 2.31-7.03). During the total 16 years of follow-up, higher baseline D-dimer levels were independently associated with all-cause mortality (HR, 1.59), cardiovascular mortality (HR, 1.61), cancer mortality (HR, 1.54), and noncardiovascular mortality (HR, 1.57).
The authors concluded that D-dimer levels predict long-term risk of arterial and venous events as well as mortality, independent of other risk factors.
While many clinicians use D-dimer levels to aid in the diagnosis of venous thromboembolism, this study confirms prior work associating higher D-dimer levels with poor long-term outcomes. Despite the limitations of post hoc analyses compared with randomized trials, this study extends the association between high D-dimer levels and mortality risk over 10-15 years. Use of D-dimer levels and associated mortality risk to guide therapy decisions needs further study.
Keywords: Angina, Unstable, Biological Markers, Coronary Disease, Fibrin Fibrinogen Degradation Products, Mortality, Myocardial Infarction, Neoplasms, Pravastatin, Primary Prevention, Risk Factors, Vascular Diseases, Venous Thromboembolism
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