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Plasma fibrinogen and coronary heart disease in elderly Japanese-American men
D S Sharp1, R D Abbott, C M Burchfiel
1Honolulu Epidemiology Research Section, National Heart, Lung, and Blood Institute, Hawaii, Honolulu 96817, USA. dan@hhs.cba.hawaii.edu
Insights
Elevated plasma fibrinogen levels are linked to coronary heart disease (CHD) in elderly Japanese-American men, especially in smokers. This association persists even after accounting for other risk factors.
Area of Science:
- Cardiovascular Medicine
- Epidemiology
- Biochemistry
Background:
- Plasma fibrinogen concentration is consistently linked to coronary heart disease (CHD) development.
- Elevated fibrinogen is strongly correlated with smoking, potentially mediating the smoking-CHD relationship.
Purpose of the Study:
- To investigate the association between plasma fibrinogen levels and coronary heart disease (CHD) in elderly Japanese-American men.
- To examine the role of fibrinogen as a potential risk factor for CHD in this specific demographic.
Main Methods:
- Cross-sectional survey of 3571 elderly Japanese-American men (aged 71-93) from the Honolulu Heart Program cohort.
- Analysis of plasma fibrinogen distribution, smoking status, and prevalence of CHD.
- Statistical adjustments for smoking, blood pressure, cholesterol, diabetes, hematocrit, and white cell count.
Main Results:
- Active smokers were nearly twice as likely to be in the highest fibrinogen quintile compared to the lowest.
- The highest CHD prevalence (34%) was observed in past and current smokers within the highest fibrinogen quintile.
- A statistically significant association between fibrinogen levels and prevalent CHD remained after multivariate adjustment (P < .05).
Conclusions:
- Findings in elderly Japanese-American men are consistent with previous studies linking fibrinogen to CHD indicators and risk factors.
- Plasma fibrinogen is associated with prevalent coronary heart disease in this cohort.
- The cross-sectional design limits the ability to establish causality, suggesting fibrinogen may be a marker of active disease.
Abstract:
Clinical and epidemiological studies consistently indicate that elevations in plasma fibrinogen concentration are associated with the presence and development of coronary heart disease (CHD). These elevations are strongly correlated with smoking behavior and may play a significant role in mediating a relation of smoking to CHD. This cross-sectional survey of 3571 elderly Japanese-American men, aged 71 through 93 years, represents survivors of the Honolulu Heart Program cohort. Active smokers are almost twice as likely to be represented in the highest quintile of the fibrinogen distribution compared with the lowest quintile (9.8% versus 5.3%, respectively). The highest prevalence of CHD (34%) was noted in past and current smokers who were in the highest quintile of fibrinogen. The age-adjusted relative odds of prevalent CHD comparing the average fibrinogen levels in the first and fifth quintiles were 1.36 (95% confidence interval, 1.13 to 1.64). After adjustment for smoking status, blood pressure, total and HDL cholesterol, diabetes status, hematocrit, and white cell count, the association between fibrinogen and CHD was changed slightly and remained statistically significant (P < .05). These findings in an elderly cohort of Japanese-American men are consistent with previous studies among middle-aged adults demonstrating fibrinogen to be associated with indicators of clinical CHD and CHD risk factors. Because of the cross-sectional nature of this study, it is not possible to distinguish whether the observed relation of fibrinogen to prevalent CHD is causal or whether it represents a marker of active and progressive disease.