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[The risk indices for atherothrombotic disease: the coagulation factors]
1Cattedra di Fisiopatologia Medica, Università degli Studi di Bologna.
Insights
Plasma fibrinogen is a significant predictor of cardiovascular events, comparable to blood cholesterol. While hyperfibrinogenemia is increasingly recognized as a risk factor, its causal role requires further investigation through interventional studies.
Area of Science:
- Cardiovascular Medicine
- Hematology
- Epidemiology
Context:
- Growing body of evidence links coagulation factors to cardiovascular disease risk and prognosis.
- Studies have investigated primary and secondary predictivity of these factors in healthy and patient cohorts.
- Key factors identified include plasma fibrinogen, coagulation factor VII, and plasminogen activator inhibitor PAI-1.
Purpose:
- To review the epidemiological significance of coagulation factors as risk indices for cardiovascular events.
- To evaluate the predictive value of plasma fibrinogen, factor VII, and PAI-1 in atherothrombotic disease.
- To assess the current understanding of hyperfibrinogenemia as a cardiovascular risk factor.
Summary:
- Plasma fibrinogen emerges as the coagulation parameter most strongly correlated with cardiovascular events, acting as both a primary and secondary predictor.
- Its predictive power is comparable to that of blood cholesterol.
- Hyperfibrinogenemia is gaining recognition as a significant risk factor, though its causal role is not yet definitively established.
Impact:
- Highlights plasma fibrinogen as a key biomarker for cardiovascular risk assessment.
- Suggests potential for novel therapeutic targets aimed at modulating coagulation factors.
- Underscores the need for interventional studies to confirm the causal role and therapeutic efficacy of lowering these factors.
Abstract:
During the last decade interesting data have been collected on the epidemiological significance of some coagulation factors as risk indices for major cardiovascular events and, also, for the prognosis of atherothrombotic disease. The factors for which evidence is most convincing include: plasma fibrinogen, coagulation factor VII, and an inhibitor of fibrinolysis, namely the plasminogen activator inhibitor PAI-1. These data have been provided by studies of primary predictivity, in which the said parameters were measured in healthy subjects whose cardiovascular outcome was followed. Studies of secondary predictivity, or prevalence studies have also been extremely helpful. In these, the coagulation factors measured in patients already suffering from atherothrombotic disease were correlated with its severity, extension and outcome. From these data, the plasma fibrinogen level emerges as the coagulation parameter best correlated with cardiovascular events, that is, as both a primary and a secondary predictor. The predictive power of plasma fibrinogen level appears to be no less significant than that of blood cholesterol. Although a few methodological problems must still be overcome, hyperfibrinogenemia is gaining increasing consideration as a new, important risk factor for cardiovascular events. It is however premature to consider the said parameters not only as risk indices but also as causal factors of atherothrombotic disease. In fact, their pathogenic and causal role, although supported by high biological plausibility, has not yet been confirmed by interventional studies aimed at assessing whether or not therapeutic lowering of these values is associated with reduced cardiovascular risk.