The following interview with Neil Zakai, M.D., M.Sc., hematologist and oncologist at the UVM Medical Center and associate professor of medicine at the Larner College of Medicine at the University of Vermont, originally appeared on the Facebook page of the Thrombosis and Haemostasis journal and focused on his research publication, titled “D-dimer and the Risk of Stroke and Coronary Heart Disease: The REasons for Geographic and Racial Differences in Stroke (REGARDS),” which was pre-published online in December 2016. (Key: TH = Thrombosis and Haemostasis; NZ = Neil Zakai)
TH: Why did you (and your colleagues) write this paper? What was its primary purpose?
NZ: African-Americans (Blacks) have a higher incidence of stroke at younger ages than Caucasian-Americans (Whites) and differences in the presentation of coronary heart disease. Blacks also have known differences in hemostasis compared to whites. We sought to determine whether D-dimer as a marker of coagulation activation was associated with cardiovascular disease, and whether there were differences by vascular disease type and by race.
TH: What are the main conclusions?
NZ: D-dimer was associated with both stroke and coronary heart disease. The association seemed stronger for coronary heart disease versus stroke especially in Blacks. These data suggest that the causes of cardiovascular disease may differ by disease type and by race.
The study, the REasons for Geographic and Racial Differences in Stroke is a large prospective study of vascular disease and cognitive decline done in the United States to help determine the reasons for vascular disease, and thus potential strategies to reduce vascular disease in everyone.
TH: What is the main message for consumers? For healthcare providers?
NZ: Though vascular diseases are a leading cause of morbidity and mortality in most nations, we still do not understand why different manifestations (i.e., stroke and coronary artery disease) have different risk factors, have different incidences based on race, or some groups experience vascular disease at younger ages. In order to best prevent vascular disease, we need the government and individuals engaged to help promote research into the risk factors for and efforts to prevent vascular disease.
TH: What are the paper’s implications, for the public and for medical professionals?
NZ: Cardiovascular disease is not a “one-size fits all.” In this paper, risk factors differ for stroke versus coronary heart disease as well as by race. In the future, we need to develop ways to tailor our approach to vascular disease prevention.
TH: Are the findings clinically significant? Should the findings change practice?
NZ: The findings should not change practice immediately, but may help identify people at risk for vascular disease for future prevention studies.
TH: What action would the public want to take based on this study?
NZ: Encourage their legislators and government representatives to support research in the risk factors for and prevention of vascular disease in diverse populations by age, race, gender, and geographic location.