Control of plasma fibrinogen levels

It is clear that the control of plasma fibrinogen levels is complex, involving not only many environmental factors such as alcohol intake, smoking habit, age, obesity and the acute phase response, but also genetic factors as shown by the association of the Bcl I RFLP of the beta-fibrinogen gene with plasma fibrinogen levels. The advent of recombinant DNA technology has made the dissection of the different factors controlling plasma fibrinogen levels a valid proposition, and great progress is already being made. The goals of this research are twofold. First, it may be possible to develop DNA tests to identify individuals who, on the basis of their genotype, are at high risk of ischaemic heart disease. Once identified, the subsequent risk of these individuals can be reduced by modifying life-style or by drug therapy to reduce other known risk factors such as cholesterol levels. Second, once the mechanisms controlling fibrinogen concentration are better understood at the molecular level, it may be possible to develop directed therapeutic strategies that will reduce fibrinogen synthesis in a specific manner, an approach that is not possible at present. In the future, such pharmacological agents may have as wide an impact on reducing ischaemic heart disease as cholesterol-lowering drugs do today.