Social Determinants of von Willebrand Factor

Abstract

Abstract-Data from the Whitehall II Study and others have demonstrated a role for the metabolic syndrome and fibrinogen underlying the association between social position and coronary heart disease. In this study, we examined the role of an additional hemostatic factor and marker of endothelial dysfunction, von Willebrand factor (vWF). Four thousand five hundred and forty-eight men and 1837 women were examined in the third phase of the study, which took place between 1991 and 1993. Employment grade was used as a measure of socioeconomic position. An inverse relation between employment grade and vWF was evident (PϽ0.0003). This employment grade gradient was apparent overall, and the relation persisted even when nonsmokers and participants with poor health were removed from the analyses (Pϭ0.02). The difference between the highest (unified grades 1 to 6) and lowest (clerical/support) employment grades in vWF concentrations was 8.9 IU/dL (95% CI 6.0, 11.8; PϽ0.001) for men and 6.9 IU/dL (95% CI 4.0, 9.7; Pϭ0.06) for women. vWF was associated with a number of biological factors that themselves showed an employment grade gradient, including fibrinogen (PϽ0.001), fasting and postload glucose (PϽ0.05) levels, and fasting and postload insulin (PϽ0.01) levels. Associations with smoking and alcohol intake were apparent. Smoking showed a threshold effect, such that only men who smoked Ͼ21 cigarettes per day produced a significantly increased vWF level (PϽ0.05) compared with lighter smokers. The health-related behaviors explained 25% of the grade gradient in men and 28% in women, while the biological factors accounted for 32% in men and 22% in women. We conclude that there is a grade gradient in vWF that was not fully explained by health-related behaviors and risk factors for coronary heart disease. These data are consistent with the hypothesis that endothelial dysfunction is part of the explanation for social inequalities in cardiovascular disease.

Relationship between Biomarkers of Cigarette Smoke Exposure and Biomarkers of Inflammation, Oxidative Stress, and Platelet Activation in Adult Cigarette Smokers

“…Kumari and colleagues (46) reported that vWF was higher in male smokers than in male nonsmokers and men who smoked more than 21 CPD had statistically significantly elevated levels of vWF compared with those who smoked fewer CPD. No such differences were found between female smokers as reported by Kumari and colleagues.…”

Genetic Variants Associated with von Willebrand Factor Levels in Healthy Men and Women Identified Using the HumanCVD BeadChip

“…The same standard pool of citrated, platelet-poor plasma from 120 donors was used throughout the study as a control calibrated against the fourth British Standard for Blood Coagulation Factors, Plasma Human 89/592 (established 1990) from the National Institutes for Biological Standards and Control. The coefficient of variation for the measurement of vWF levels was 16% (Kumari et al, 2000). vWF concentration was expressed in international units per deciliter.…”

Relationships Between Sleep Duration and von Willebrand Factor, Factor VII, and Fibrinogen

“…There is a grade gradient in vWF, and the levels of vWF are associated with other confounding factors, including alcohol intake and fasting glucose level. 17 Data from this and other studies have also indicated that individuals and in particular men who were short sleepers were more 6 likely to be in the lowest employment grades and unmarried. To investigate the association between sleep and hemostatic factors, we adjusted for either employment grade or marital status (the latter showing a greater variation with sleep) and other potential confounding factors.…”

“…17 The coefficient of variation was 16.1%. A spline fit was applied to the results to determine the effect of time of sample collection on mean level.…”