D-dimer Predicts Long-Term Mortality, Vascular Events, Cancer

Study Questions:

How well does the D-dimer level predict long-term vascular outcomes, cause-specific mortality, and new cancers?

Methods:

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.

Results:

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).

Conclusions:

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.

Perspective:

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.

Clinical Topics: Prevention, Pulmonary Hypertension and Venous Thromboembolism, Vascular Medicine, Statins

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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