Update on fibrinogen as a cardiovascular risk factor

Area of Science:

• Cardiovascular Medicine
• Hematology
• Epidemiology

Background:

• Mounting evidence suggests a causal link between elevated fibrinogen and atherosclerotic cardiovascular disease (ASCVD).
• Fibrinogen plays a thrombogenic role in atherosclerosis, influencing clinical manifestations.
• Identifying high-risk individuals and implementing protective strategies by managing fibrinogen levels is a key possibility.

Purpose of the Study:

• To examine the relationship between antecedent fibrinogen levels and the subsequent development of cardiovascular disease.
• To investigate associations with coronary heart disease, stroke, peripheral arterial disease, and cardiac failure.
• To analyze these relationships in a cohort of men and women aged 47-79 over 18 years.

Main Methods:

• Prospective surveillance of 1274 men and women from the Framingham Study over 18 years.
• Age-adjusted statistical analysis to determine relationships between fibrinogen levels and cardiovascular outcomes.
• Adjustment for coexistent risk factors including hypertension, diabetes, smoking, obesity, and hematocrit.

Main Results:

• Significant age-adjusted relationships were found between fibrinogen levels and coronary heart disease (CHD) and general cardiovascular disease (CVD) in both sexes.
• In women, significant associations were observed for cardiac failure and peripheral arterial disease (PAD), but not stroke.
• Each standard deviation increase in fibrinogen was associated with a 30% increase in CHD for men and 40% for women. Elevated fibrinogen independently contributes to CVD risk, especially in smokers, hypertensives, and diabetics.

Conclusions:

• Fibrinogen should be recognized as a major cardiovascular risk factor.
• Elevated fibrinogen levels within the "normal range" are associated with excess cardiovascular events.
• Further trials are needed to evaluate interventions aimed at lowering fibrinogen in high-risk individuals.