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Title: Fibrinolysis : its relationship to coronary heart disease and 'risk factors'
Author: Walker, Isobel D.
ISNI:       0000 0001 3553 6401
Awarding Body: University of Glasgow
Current Institution: University of Glasgow
Date of Award: 1983
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This thesis reviews the Literature relating to the various factors which are important in the development of clinically significant coronary artery atherosclerosis. The pathogenesis and progress of atherosclerotic lesions are considered and the Literature regarding the various so-called coronary heart disease (C.H.D.) "risk factors" examined. The importance of two main non-modifiable "risk factors", age and sex, and three main modifiable "risk factors", cigarette-smoking, hypertension and increased plasma Lipid levels, is discussed. A possible relationship between poor plasma fibrinolytic activity and the risk of developing C.H.D. is postulated. Current knowledge about the various components of the fibrinolytic system is presented and evidence of physiological and pathological variations in fibrinolysis consi -dered. A standardised procedure for measuring plasma fibrinolytic activity in euglobulin fractions applied to fibrin plates was introduced and details of this procedure are presented along with the results of a number of experiments carried out to examine the effect of varying different aspects of the standardised procedure. As previously reported by other researchers, plasma fibrinolytic activity has been shown, normally to increase locally in response to venous occlusion of a limb. A fifteen minute venous occlusion test of an arm was developed and assessed as a means of studying the fibrinolytic response to a challenge. This test has been found to be reproducible and acceptable to both healthy male volunteers and male patients. In agreement with other workers, plasma fibrinolytic activity, resting and post venous occlusion, has been found to vary in relation to the existence of a number of the C.H.D. "risk factors" - in particular to plasma lipid levels but also, probably, to age and to diastolic blood pressure. No direct relationship between cigarette smoking habit and plasma fibrinolytic activity could be defined. Male subjects only were studied. The relationships between plasma fibrinolytic activity and C.H.D. "risk factors" were present both in healthy controls and in men known to have C.H.D. Results are presented which suggest that C.H.D. itself is associated with reduced plasma fibrinolytic activity at rest and, possibly, post venous occlusion. This impaired fibrinolytic activity appears to be independent of co-existing C.H.D. "risk factors". It is not possible, from the evidence obtained in this study, to comment on whether impaired plasma fibrinolytic activity is an important factor contributing to the risk of developing C.H.D. or is a secondary effect of the disease.
Supervisor: Not available Sponsor: Not available
Qualification Name: Thesis (M.D.) Qualification Level: Doctoral
Keywords: Medicine