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Diabetes, fibrinogen, and risk of cardiovascular disease: the Framingham experience
W B Kannel1, R B D'Agostino, P W Wilson
1Section of Preventive Medicine and Epidemiology, Boston University Medical Center, MA.
Insights
Diabetes significantly increases cardiovascular disease risk, even after accounting for common risk factors. Elevated fibrinogen levels are linked to diabetes, but glucose intolerance shows an independent effect on cardiovascular risk.
Area of Science:
- Cardiology
- Endocrinology
- Epidemiology
Background:
- Cardiovascular disease (CVD) remains a leading cause of mortality worldwide.
- Diabetes mellitus is a known risk factor for CVD, but the underlying mechanisms are complex.
- Fibrinogen, a key protein in blood clotting, has been implicated in CVD risk.
Purpose of the Study:
- To investigate the influence of fibrinogen on cardiovascular disease risk in individuals with varying glucose tolerance.
- To determine the independent effect of diabetes and glucose intolerance on cardiovascular disease outcomes.
- To explore the relationship between fibrinogen levels, blood sugar, and cardiovascular risk in the Framingham Heart Study cohort.
Main Methods:
- Longitudinal follow-up of 1314 subjects initially free of cardiovascular disease over 16 years.
- Assessment of cardiovascular disease outcomes, diabetes status, blood sugar levels, fibrinogen, hypertension, hypertriglyceridemia, obesity, and HDL cholesterol.
- Multivariate analysis to adjust for standard cardiovascular risk factors and assess independent effects.
Main Results:
- Diabetes was associated with all major cardiovascular disease outcomes studied.
- Diabetic individuals exhibited higher fibrinogen, hypertension, hypertriglyceridemia, and obesity, with lower HDL cholesterol.
- Fibrinogen levels increased across the spectrum of blood sugar levels, suggesting a thrombogenic role.
- Multivariate analysis revealed a residual independent effect of glucose intolerance on cardiovascular risk, even after adjusting for fibrinogen and other risk factors.
Conclusions:
- Diabetes significantly elevates cardiovascular disease risk, influenced by coexistent risk factors like hypertension and dyslipidemia.
- While fibrinogen levels rise with increasing blood sugar, they do not fully explain the heightened cardiovascular risk associated with diabetes.
- Glucose intolerance exerts an independent effect on cardiovascular disease risk, underscoring the importance of glycemic control beyond fibrinogen levels.
Abstract:
The influence of fibrinogen on the risk of cardiovascular disease is examined over 16 years of follow-up in 1314 subjects who were initially free of cardiovascular disease in the Framingham Study. Of these subjects, 46 men and 43 women developed diabetes, and 56 men and 53 women had blood sugar levels that exceeded 120 mg/dl. Diabetes predisposed subjects to all of the 408 major cardiovascular disease outcomes. Diabetics had higher levels of fibrinogen, hypertension, hypertriglyceridemia, and obesity, but lower HDL cholesterol values. The influence of diabetes on cardiovascular disease was greatly dependent on these coexistent risk factors, but there was a substantial independent effect of glucose intolerance when all the standard risk factors had been taken into account. There was a rise in fibrinogen values throughout the range of blood sugar levels, which suggests a thrombogenic explanation for the unique diabetic effect. However, multivariate analysis indicates no further reduction in diabetic cardiovascular risk ratios after adjustment for fibrinogen; thus, there is a residual effect for glucose intolerance after all of the standard risk factors and fibrinogen have been taken into account.