D-dimer Level is Associated With Increased Long-term Cancer Incidence and All-cause Mortality

According to a recently published article in Circulation, it was found that D-dimer level is an independent predictor of the long-term (up to 16 years) risk of arterial and venous events, cause-specific mortality, and the incidence of new cancers. The results of the study are based on a  subanalysis of the LIPID trial.

“Prior studies have already demonstrated that D-dimer is associated with an increased risk of cardiovascular events or a greater risk of cancer” says Dr. Mathieu Kerneis, “However, and it is the major strength of this study, investigators have made a great effort to conduct a follow–up  for up to 16 years and thus, have been able to demonstrate an independent association between D-dimer and the very long-term occurrence of cardiovascular, cancer events and finally all-cause mortality”.

During the first 6 years, higher D-dimer was associated with significantly increased risk of a major coronary event, major CVD event, and venous thromboembolism. After 16 years follow up, higher D-dimer levels were found to be an independent predictor of all-cause mortality, CVD mortality, cancer mortality and non-CVD noncancer mortality.

 

The authors report that despite the fact that high levels of D-dimer were associated with other factors that might contribute to a worse outcome such as older age, hypertension, elevated C-reactive protein, elevated D-dimer was still associated with worse outcome even after adjustment of all these confounders and more.

It was also found that elevated D-dimer was associated with increased risk of developing deep vein thrombosis independent from other markers such as troponin I and cystatin C.

According to Dr. Kerneis, “It is extraordinary to observe an increase independent risk of event 10 years beyond the last D-dimer measurement. As pointed out by the authors, the link between thrombosis, inflammation, and cancer is complex, and the underlying question remains how to fully  understand the exact mechanism and the potential target behind this association.”

The authors point out that the use of anticoagulants was associated with a higher baseline D-dimer level. They believe that the association between the higher D-dimer levels and the fatal outcomes would have been stronger in the absence of use of anticoagulants.

When asked to comment, Dr. Kerneis said “This study adds a new piece of evidence to the growing literature on the clinical significance of D-dimer. However, Although D-dimer may be useful as a risk assessment tool, additional studies are clearly needed to establish its role in clinical practice, and the potential benefit of new anticoagulants in this subset of patients.”