[Hyperfibrinogenemia and cardiovascular risk--epiphenomenon or causal relationship?]

During the last decade, a variety of experimental, clinical and epidemiological data have been published, documenting an association between fibrinogen and atherosclerosis as well as with its most frequent clinical complications, myocardial infarction and stroke. Although the design of epidemiological studies was not strictly comparable, and studies were carried out in very different populations, with various methods of fibrinogen measurement, the results are remarkable consistent. Together with clinical and experimental data, they strongly suggest a causal role for fibrinogen in atherogenesis and in the pathophysiology of acute ischemic syndromes. Hence, fibrinogen should be determined in patients at high risk for cardiovascular complications. The clinical benefit of lowering fibrinogen in certain patient groups or alternatively, the inhibition of specific fibrinogen induced effects, should be studied in randomised trials.