Background: High factor-VII activity has recently been recognized as an independent risk factor for coronary artery disease. The aim of the present study was to determine whether high levels of factor-VII activity in elderly patients are caused by endothelial cell injury and are related to vascular disease through activation of the coagulation system.
Methods: We studies 27 asymptomatic healthy elderly men with high factor-VII activity (155-206%) and 22 healthy elderly men with low factor-VII activity (96-122%) selected from 246 men over 60 years of age attending annual health examinations. We also studied 36 patients with vascular disease (22 with coronary artery disease and 14 with chronic cerebral infarction).
Results: The levels of endothelium-derived markers (thrombomodulin, tissue plasminogen activator-plasminogen activator inhibitor-1 complex, active plasminogen activator inhibitor 1 and tissue factor pathway inhibitor) did not differ between the subjects with high and those with low factor-VII activity. We therefore conclude that high factor-VII activity is not primarily caused by endothelial cell injury. The high-factor-VII group had higher levels of coagulation inhibitors (protein C, antithrombin III and heparin cofactor II), coagulation activation markers (prothrombin fragment 1 + 2, D-dimer and plasmin-alpha2- plasmin-inhibitor complex), lipoprotein (a) and total cholesterol than the low-factor-VII group. The coagulation and lipid profiles of the group with vascular disease were closer to those of the high-factor-VII group than to those of the low-factor-VII group; the same was true of elevated active plasminogen activator inhibitor-1 levels.
Conclusion: High factor-VII activity in the elderly is accompanied by hyperlipidaemia, including increased levels of lipoprotein (a), and leads to coagulation activation in vivo. Thus, elderly people with high factor-VII activity are predisposed to vascular disease.