M656
PIEPER ET AL.
Health Study. Sterioscler Thromb Biol. 1999;19:493–498.
Table 6. Stepwise Logistic Regression Odds Ratios
11. Cushman M, Kuller L, Lemaitre R, Psaty B, Sharrett A, Tracy R. Plas-
min generation and risk of incident cardiovascular disease in the
elderly. Circulation. 1997;96:548. Abstract.
(D-Dimer Ͼ600 g/l)
Variable
Odds Ratio 95% Confidence Interval p Value
12. Cushman M, Kuller L, Psaty B, Lemaitre R, Macy E, Sharret A.
D-dimer level in predicition of incident cardiovascular disease events
in the elderly. Circulation. 1996;94:2670. Abstract.
13. Cushman M, Psaty B, Macy E, et al. Correlates of thrombin markers in
an elderly cohort free of clinical cardiovascular disease. Arterioscler
Thromb Vas Biol. 1996;16:1163–1169.
14. Tracy R, Macy E, Bovill E, et al. Lifetime smoking exposure affects
the association of C-reactive protein with cardiovascular disease risk
factors and subclinical disease in healthy elderly subjects. Arterioscler
Thromb Vas Biol. 1997;17:2167–2176.
15. Rao KMK, Pieper C, Currie MS, Cohen HJ. Variability of plasma IL-6
and crosslinked fibrin dimers over time in community dwelling elderly
subjects. Am J Clin Pathol. 1994;102:802–805.
Age (per 10 years)
Women
Black
Years of school
Income (in 1,000s of dollars)
Income missing
Rosow-Breslau (0–3)
1.83
0.89
3.94
1.02
1.06
0.96
1.54
1.35, 2.48
0.60, 1.33
2.54, 6.10
0.97, 1.07
0.95, 1.19
0.39, 2.35
1.38, 1.90
.0001
.57
.0001
.40
.29
.93
.0001
Notes: Age, gender, race, income, education forced into model. All other
variables entered by stepwise regression. North Carolina Established Popula-
tions for Epidemiologic Studies of the Elderly (1992); n ϭ 1727. ADLs ϭ activ-
ities of daily living.
16. Currie MS, Rao KMK, Blazer DG, Cohen HJ. Age and functional cor-
relations of markers of coagulation and inflammation in the elderly:
functional implications of elevated crosslinked fibrin degradation
products (D-dimers). J Am Ger Soc. 1994;42:738–742.
17. Currie MS, Vala M, Pisetsky DS, Greenberg CS, Crawford J, Cohen
HJ. Correlation between erythrocyte CR-I reduction and other blood
proteinase markers in patients with malignant and inflammatory disor-
ders. Blood. 1990;75:1699–1704.
18. Ridker PM, Hennekens CH, Cerskus A, Stampfer MJ. Plasma concen-
tration of cross-linked fibrin degradation product (D-dimer) and the
risk of future myocardial infarction among apparently healthy men.
Circulation. 1994;90:2236–2240.
19. Cornoni-Huntley J, Blazer DG, Lafferty ME, Everett DF, Brock DB,
Farmer ME. Established Populations for Epidemiologic Studies of the
Elderly, Volume II: Resource Data Book. Washington, DC: National
Institute on Aging, U.S. Department of Health and Human Services,
Public Health Service, National Institutes of Health; 1990. Publication
90-495.
tively the impact of control of vascular phenomena, such as
hypertension, on the level of D-dimers in blacks and whites.
Regardless, our work suggests that one adverse risk factor
for subsequent vascular events, D-dimer, is remarkably in-
creased in elderly community-dwelling subjects and, espe-
cially, in older black subjects. In future studies, we plan to
determine whether this risk factor is correlated with in-
creased mortality, changes in function, and cardiovascular
events. If so, it could serve an important role in the overall
approach to geriatric assessment.
Acknowledgments
The research was performed pursuant to contract NO1-AG1-2102, with
the National Institute of Aging, and the Duke University Claude D. Pepper
Older American Independence Center Grant NIH AG112618. The content
of this publication does not necessarily reflect the views of the U.S. Depart-
ment of Health and Human Services.
20. Cohen HJ, Pieper CF, Harris T, Rao RKM, Currie MS. The association
of plasma IL-6 with functional disability in community dwelling el-
derly. J Gerontol Med Sci. 1997;52A:M201–M208.
21. Nagi SZ. An epidemiology measure of disability among adults in the
United States. Milbank Memorial Fund Q. 1976;54:439–467.
22. Rosow I, Breslau N. A Guttman Health Scale for the aged. J Gerontol.
1966;21:556–559.
Address correspondence to Dr. Carl Pieper, Box 3003, Center for Ag-
ing and Human Development, DUMC, Durham, NC 27710. E-mail:
23. Katz S, Akpom CA. A measure of primary sociobiological functions.
Int J Health Serv. 1976;6:493–508.
24. Fillenbaum GG. Multidimensional Functional Assessment of Older
Adults: The Duke Older Americans Resources and Services Proce-
dures. Hillsdale, NJ: Erlbaum; 1988.
25. Pfeiffer E. A Short Portable Mental Status Questionnaire for the as-
sessment of organic brain deficit in elderly patients. J Am Geriatr Soc.
1975;23:433–441.
26. Radloff LS. The CES-D Scale: a self-report depression scale for research
in the general population. Appl Psychiatr Meas. 1977;1:385–401.
27. Hager K, Platt D. Fibrin degeneration product concentrations (D-dimers)
in the course of aging. Gerontology. 41;1995:159–165.
References
1. Becker K. Inflammation and acute stroke. Curr Opinion Neurol. 1998;
11:45–49.
2. Braunwald E. Shattuck lecture—cardiovascular medicine at the turn of
the century. Triumphs, concerns, and opportunities. New Engl J Med.
1997;337:1360–1369.
3. Wilhemsen L, Svardsudd K, Korsan-Bengston B, Larsson B, Welin L,
Tibblin G. Fibrinogen as a risk factor for stroke and myocardial infarc-
tion. New Engl J Med. 1984;311:501–505.
28. Kario K, Matsuo T, Kobayashi H. Which factors affect high D-dimer
levels in the elderly? Thromb Res. 1991;62:501–508.
4. Baker IA, Eastham R, Elwood PC, Etherington M, O’Brien JR, Sweet-
nam P. Haemostatic factors associated with ischaemic heart disease in
men aged 45–64 years. The Speedwell Study. Br Heart J. 1982;47:
490–494.
5. Kannel WB, Wolf PA, Castelli WP, D’Agostino RB. Fibrinogen and
risk of cardiovascular disease: The Framingham Study. JAMA. 1987;
258:1183–1186.
6. DiCuccio M, Shami P, Hoffman M. A functional tethered ligand
thrombin receptor is present on human hematopoietic progenitor cells.
Exp Hematol. 1996;24:914–918.
7. Meade TW, Cooper J, Miller GJ, Horwath DJ, Stirling Y. Antithrom-
bin III and arterial disease. Lancet. 1991;337:850–851.
8. Ross R. The pathogenesis of atherosclerosis: a perspective for the
1990’s. Nature. 1993;362:2394–2403.
29. Cadroy Y, Pierrejean D, Fontan B, Sie P, Boneu B. Influence of aging
on the activity of the hemostatic system: prothrombin fragment 1 ϩ 2,
thrombin-antithrombin III complexes and D-dimers in 80 healthy sub-
jects ranging from 20–94 years. Nouv Rev Fr Hematol. 1992;34:43–46.
30. Paramo J, Colucci M, Collen D, Van de Werf F. Plasminogen activator
inhibitor in the blood of patients with coronary artery disease. Br Med
J. 1985;291:573–574.
31. Hamsten A, De Faire U, Walldius G, et al. Plasminogen activator in-
hibitor in plasma: risk factor for recurrent myocardial infarction.
Lancet. 1987;2(8549):3–9.
32. Kruskal JB, Commerford PJ, Franks JJ, Kirsch RE. Fibrin and fibrino-
gen-related antigens in patients with stable and unstable coronary
artery disease. New Engl J Med. 1987;317:1361–1365.
33. Bocci V, Conti T, Muscettola M, Pacini A, Pessing GP. Factors regu-
lating plasma protein synthesis IV. Influence of fragments D and E on
plasma fibrinogen concentration. Thromb Diathes Haemorrh. 1974;
31:395–402.
9. Trip MD, Manger Cats V, van Capelle FJI, Vreeken J. Platelet hyper-
reactivity and prognosis in survivors of myocardial infarction. New
Engl J Med. 1990;322:1549–1554.
10. Cushman M, Lamaitre R, Kuller L, et al. Fibrinolytic activation mark-
ers predict myocardial infarction in the elderly: the Cardiovascular