Fibrinogen: its emerging role as a cardiovascular risk factor

Several epidemiologic studies have produced longitudinal data identifying fibrinogen as a major cardiovascular risk factor. Cross-sectional results show strong associations between fibrinogen and cardiovascular risk factors or diseases. Clinical cohort studies demonstrate that fibrinogen might also be a risk factor for the sequelae of cardiovascular disease. At present, knowledge about the determinants of the plasma level of fibrinogen in health and disease is incomplete. Understanding of the mechanisms that might be involved in the atherogenic action of fibrinogen is also fragmentary. Fibrinogen strongly affects blood coagulation, blood rheology, and platelet aggregation, and in addition it has direct effects on the vascular wall and is a prominent acute-phase reactant. All of these phenomena might provide some insight into the pathophysiologic mechanisms involved in the association between fibrinogen and cardiovascular events. Even though many crucial questions await answers, it is concluded that fibrinogen represents a major, independent risk factor that should be considered for screening programs aimed at identifying individuals at high risk for cardiovascular disease.