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[Fibrinogen: factor and marker of cardiovascular risk]
1Angio-hématologie, Hôpital Lariboisière, 2, rue Ambroise Paré, 75010 Paris, France. ludovic.drouet@lrb.ap-hop-paris.fr
Insights
Higher fibrinogen levels, even within the normal range, indicate increased risk for cardiovascular events like heart attack and stroke. Fibrinogen acts as both an inflammation marker and a thrombosis determinant.
Area of Science:
- Cardiovascular Medicine
- Inflammation Research
- Thrombosis Biology
Context:
- Atherosclerosis pathogenesis involves inflammation and thrombosis.
- Cardiovascular events frequently stem from thrombotic complications.
- Fibrinogen is implicated in both inflammation and thrombosis.
Purpose:
- To explore fibrinogen's dual role as an inflammation marker and thrombosis determinant.
- To evaluate fibrinogen's predictive value for cardiovascular events.
- To discuss gene-environment interactions influencing fibrinogen levels.
Summary:
- Elevated serum fibrinogen levels, even within the normal range, predict primary and secondary cardiovascular events.
- Fibrinogen is uniquely recognized as both a cardiovascular risk factor and marker.
- Gene-environment interactions influence fibrinogen levels, impacting cardiovascular risk.
Impact:
- Highlights fibrinogen's significance in atherothrombotic ischemic events.
- Provides insights into cardiovascular risk assessment and management.
- Suggests fibrinogen's utility beyond routine risk stratification, particularly in conjunction with other markers.
Abstract:
Most cardiovascular events result from a thrombotic complication in patients with atherosclerosis. Inflammation plays a central role both in the pathogenesis of atherosclerosis and in the development of complications (particularly plaque rupture). Fibrinogen is both a marker of inflammation and a major determinant of thrombosis and hemorrheology. Clinical data corroborate with epidemiological data showing that higher serum fibrinogen level (compared with matched controls) is predictive of both the risk of primary cardiovascular events in the general population and the risk of secondary events among patients. Fibrinogen level, determined by both environmental and genetic factors, is a good example of gene-environment interaction. The rise in fibrinogen level indicative of significantly increased risk is actually very small, lying within the normal range. This explains why epidemiological data cannot be used to establish cardiovascular risk for individual patients in routine practice (excepting very high elevations rarely encountered). To date, fibrinogen is the only compound formally recognized as both a risk factor and a marker of cardiovascular risk. Other compounds, including CRP, von Willebrand factor, and more recently the CD40-CD40 ligand system, have also been shown to play a double role as predictors and markers. These new developments shed new light on fibrinogen as a risk marker/factor for atherothrombotic ischemic events.