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Fibrinogen and preclinical echocardiographic target organ damage: the strong heart study
V Palmieri1, A Celentano, M J Roman
1Weill Medical College of Cornell University, New York, NY, USA. vpalmier@med.cornell.edu
Insights
Elevated fibrinogen levels are linked to preclinical cardiovascular damage, including left ventricular hypertrophy and arterial stiffness, in individuals without overt heart disease. This finding highlights fibrinogen as a potential marker for early cardiovascular risk.
Area of Science:
- Cardiovascular Medicine
- Biomarkers
- Epidemiology
Background:
- Fibrinogen's role in preclinical cardiovascular target organ damage is not well understood in populations without overt coronary heart disease.
- Traditional risk factors do not fully explain the relationship between fibrinogen and subclinical cardiovascular changes.
Purpose of the Study:
- To investigate the association between fibrinogen levels and preclinical target organ damage in American Indians without symptomatic atherosclerosis.
- To determine if fibrinogen is an independent predictor of cardiovascular abnormalities.
Main Methods:
- Analysis of clinical and echocardiographic data from 2709 American Indians in the Strong Heart Study.
- Participants were stratified into tertiles based on plasma fibrinogen levels.
- Statistical adjustments were made for traditional cardiovascular risk factors and covariates.
Main Results:
- Higher fibrinogen tertiles were associated with increased body mass index, hypertension, and diabetes.
- Elevated fibrinogen correlated with lower HDL cholesterol, higher plasma creatinine, and increased urinary albumin/creatinine ratio.
- Independent associations were found between higher fibrinogen and left ventricular mass index, arterial stiffness (pulse pressure/stroke index), and systolic myocardial dysfunction.
Conclusions:
- Elevated fibrinogen is an independent correlate of prognostically relevant cardiovascular target organ damage in adults without clinically overt coronary heart disease.
- Fibrinogen may serve as an important biomarker for identifying individuals at increased risk for subclinical cardiovascular disease.
Abstract:
Relations of fibrinogen to preclinical target organ damage, such as left ventricular hypertrophy, systolic dysfunction, and increased arterial stiffness while accounting for traditional risk factors, are unknown in a population-based sample free of clinically overt coronary heart disease. Therefore, we studied clinical and echocardiographic characteristics of 2709 American Indians participating in the Strong Heart Study without symptomatic atherosclerosis. The study sample was divided into tertiles of fibrinogen (cut-points, 3.24 and 3.83 g/L). Mean age, body mass index, proportion of women, and prevalences of hypertension and diabetes increased from the first to third tertile of fibrinogen. After adjustment for covariates, systolic and pulse pressures did not significantly differ among tertiles of fibrinogen, whereas diastolic pressure was slightly lower in the third than in lower tertiles of fibrinogen. HDL cholesterol was lower and plasma creatinine and urinary albumin/creatinine ratio was higher in the third tertile of fibrinogen. Left ventricular mass index, pulse pressure/stroke index, an estimate of arterial stiffness, and cardiac index were higher and left ventricular systolic function and total peripheral resistance were lower in the third than in two lower tertiles of fibrinogen independent of major covariates. In multiple regression analyses, left ventricular mass and pulse pressure/stroke index were positively associated with, and stress-corrected midwall shortening negatively associated with fibrinogen, independent of major covariates. Participants with fibrinogen >3.83 g/L were more likely to have at least 1 preclinical cardiovascular abnormality such as left ventricular hypertrophy, elevated arterial stiffness, or systolic myocardial dysfunction independent of covariates including renal dysfunction (adjusted odds ratio, 1.38; P<0.001). Thus, in a population sample of adults without clinically overt coronary heart disease, elevated fibrinogen is an independent correlate of prognostically relevant cardiovascular target organ damage.