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Fibrinogen: its role in the hemostatic regulation in atherosclerosis
1Department of Internal Medicine, Karl-Franzens-University Graz, Austria.
Insights
High plasma fibrinogen levels strongly predict cardiovascular events like heart attack and stroke. Measuring fibrinogen is recommended for cardiovascular risk assessment due to its role in thrombosis.
Area of Science:
- Cardiovascular Medicine
- Hematology
- Epidemiology
Background:
- Epidemiologic studies consistently link elevated plasma fibrinogen to increased incidence of myocardial infarction, stroke, and peripheral atherosclerosis.
- Thrombosis is the central pathophysiological mechanism underlying these atherosclerotic vascular events.
- Fibrinogen's role in platelet aggregation, blood rheology, and endothelial cell injury implicates it in thrombogenesis.
Purpose of the Study:
- To evaluate the predictive value of plasma fibrinogen levels in cardiovascular disease.
- To determine fibrinogen's utility in cardiovascular risk factor profiling.
- To assess fibrinogen's influence on thrombotic complications and procedural outcomes.
Main Methods:
- Review and synthesis of existing epidemiologic data.
- Analysis of fibrinogen's functional roles in hemostasis and thrombosis.
- Evaluation of fibrinogen's predictive capacity for specific cardiovascular events and interventions.
Main Results:
- High plasma fibrinogen is a strong predictor of myocardial infarction, stroke, and peripheral atherosclerosis.
- Fibrinogen may predict bypass occlusion but does not significantly influence restenosis after coronary angioplasty.
- Fibrinogen levels are influenced by various factors including genetics, lifestyle, and medications, and decrease with interventions like smoking cessation and fibrate therapy, though risk reduction is unproven.
Conclusions:
- Plasma fibrinogen measurement should be incorporated into cardiovascular risk factor assessment.
- Fibrinogen's predictive value for thrombotic complications is significant.
- While modifiable, the definitive risk-lowering effect of interventions reducing fibrinogen levels requires further investigation.
Abstract:
Numerous epidemiologic studies have clearly shown that high plasma fibrinogen levels are strongly correlated with the frequency of myocardial infarction, stroke, and peripheral atherosclerosis. These data indicate that measurements of fibrinogen should be included in cardiovascular risk factor profiles. Since thrombosis is recognized as the central mechanism of these atherosclerotic complications, it seems advisable to accept the predictive value of this protein. Fibrinogen is involved in platelet aggregation, blood rheology, and endothelial cell injury, which are thought to play a key role in thrombogenesis. Fibrinogen may predict bypass occlusion but appears to have no significant influence on restenosis following successful coronary angioplasty. Furthermore, fibrinogen represents an acute-phase protein, being of no specificity. Its level varies genetically, as well as circadian and seasonal variations, and is influenced by a number of circumstances and drugs. Plasma levels of fibrinogen decrease by life-style changes, smoking cessation, and different medications such as fibrates, but the risk-lowering effect is not proven yet.