Background: Hypercoagulability is thought to play a pivotal role in cardiovascular disease, but it is difficult to assess through traditional coagulation tests. The thrombin generation assay, a global coagulation test able to measure the endogenous thrombin potential (ETP), may explore the individual's propensity to form a blood clot. The aim of the present study was to investigate thrombin generation in a subset of patients from the angiography-based Verona Heart Study (VHS), with or without objectively proven coronary artery disease (CAD). Methods: A total number of 761 subjects (608 CAD and 153 CAD-free) not assuming anticoagulants at enrolment in the VHS were included in the present study. Thrombin generation assay was determined using the Endogenous Thrombin Potential Assay (For Research use only, Siemens Healthcare Diagnostics Products GmbH, Marburg, Germany). Results: CAD patients had significantly higher lag-time, time-to-peak and ETP levels as compared to CAD-free. However, after including all these variables in a multiple logistic regression model adjusted for the traditional CAD risk factors (sex, age, smoke, diabetes, hypertension, BMI, cholesterol and triglycerides), only ETP levels remained significantly associated with CAD (OR for 50 mA ETP increase: 1.33 with 95%CI 1.10–1.61). Stratifying the population on the basis of ETP tertiles, the prevalence of CAD subjects increased progressively from the lowest to the highest tertile (P < 0.001 by Chi-square for linear trend). ETP in the highest tertile (> 402.3 mA) conferred a significantly increased risk of CAD as compared to the lowest tertile (< 366.9 mA) in a multiple logistic regression model adjusted for the traditional CAD risk factors (OR 2.79 with 95%CI 1.59–4.90). Conclusions: Our results suggest that elevated ETP are associated with angiographically confirmed CAD.
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