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Plasma fibrinogen and factor VII as risk factors for cardiovascular disease
1MCR Epidemiology and Medical Care Unit, Northwick Park Hospital, Harrow, Middlesex.
Insights
Fibrinogen and factor VIIc are key coagulation factors for predicting ischemic events in coronary heart disease. Lifestyle factors like smoking and diet significantly influence these risk factors.
Area of Science:
- Cardiovascular Medicine
- Hematology
- Epidemiology
Background:
- Coronary heart disease (CHD) risk is increasingly linked to the thrombotic component and coagulation system.
- The Northwick Park Heart study identified fibrinogen and factor VIIc as significant CHD risk factors.
Purpose of the Study:
- To highlight the role of coagulation factors in coronary thrombosis.
- To review environmental influences on fibrinogen and factor VIIc levels.
- To discuss implications for primary and secondary prevention of myocardial infarction.
Main Methods:
- Prospective epidemiological studies were analyzed.
- Risk factor associations with fibrinogen and factor VIIc were examined.
- Data on environmental influences and lifestyle factors were considered.
Main Results:
- Fibrinogen and factor VIIc levels increase with age, body weight, and are elevated in diabetes.
- Smoking is strongly associated with elevated fibrinogen, mediating a substantial portion of smoking-related IHD risk.
- Factor VIIc correlates with total cholesterol and dietary fat intake, impacting CHD risk.
Conclusions:
- Fibrinogen and factor VIIc are crucial biomarkers for ischemic event prediction.
- Environmental and lifestyle factors significantly modulate these coagulation risk factors.
- Anticoagulation and antiplatelet therapies show promise in secondary prevention, with ongoing research for primary prevention strategies.
Abstract:
The importance of the thrombotic component of coronary heart disease is increasingly recognised, and in particular the role of the coagulation system in this process. The Northwick Park Heart study was the first major prospective study to identify both fibrinogen and factor VIIc as risk factors, as powerful as total cholesterol in predicting ischaemic events. Since then, a number of epidemiological studies have confirmed the importance of fibrinogen, not just in CHD but in stroke as well. A variety of environmental factors are known to influence levels of factor VII and fibrinogen and therefore support their role in the development of coronary thrombosis. Both are known to increase with age and body weight and are relatively elevated in diabetes. Fibrinogen is strongly related to smoking habit and a substantial proportion of the IHD risk associated with smoking is mediated through this relationship. There is a dose response effect between number of cigarettes smoked and level of fibrinogen and an inverse relationship with time since cessation of the habit. Factor VII is known to correlate with total cholesterol level, and there is a relationship between dietary variability of fat intake and factor VII, which is likely to play an important role in the risk of CHD. The case for using either anticoagulation or anti platelet agents in secondary prevention of myocardial infarction is now clear, but there are still uncertainties in primary prevention which relate to the ideal dose intensity of either aspirin or anti-coagulation and the type of patient most likely to benefit. The ongoing Thrombosis Prevention Trial identifies middle-aged males at high risk of a myocardial infarction.(ABSTRACT TRUNCATED AT 250 WORDS)