Fibrinogen, viscosity and the 10-year incidence of ischaemic heart disease: The Caerphilly and Speedwell Studies

Sweetnam, P. M.; Thomas, Helen; Yarnell, John; Beswick, Andrew D; Baker, Ian; Elwood, Peter Creighton

doi:10.1093/oxfordjournals.eurheartj.a014797

Cited by 155 publications

(103 citation statements)

References 6 publications

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“…9 The association between plasma viscosity and incident CHD and stroke is partly (Ϸ50%) explained by their mutual associations with fibrinogen. 7 Plasma viscosity can be measured quickly, cheaply, and reproducibly. 25 Furthermore, it shows only minimal intraindividual variability.…”

Section: Discussionmentioning

confidence: 99%

“…Plasma viscosity, as well as fibrinogen and white blood cell count, was positively associated with the incidence of CHD events in a population-based study of middle-aged men. 6,7 Plasma viscosity and fibrinogen were also associated with incident CHD and stroke in a study of older men and women 8 and with recurrence of stroke in another study. 9 In the first cross-sectional study of the MONICA Project, Augsburg, 1984 to 1985, plasma viscosity but not fibrinogen was measured in addition to conventional risk factors.…”

mentioning

confidence: 98%

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Plasma Viscosity and the Risk of Coronary Heart Disease

Köenig

Sund²,

Filipiak³

et al. 1998

ATVB

135

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Abstract-Plasma viscosity is determined by various macromolecules, eg, fibrinogen, immunoglobulins, and lipoproteins.It may therefore reflect several aspects involved in cardiovascular diseases, including the effects of classic risk factors, hemostatic disturbances, and inflammation. We examined the association of plasma viscosity with the incidence of a first major coronary heart disease event (CHD; fatal and nonfatal myocardial infarction and cardiac death; nϭ50) in 933 men aged 45 to 64 years of the MONICA project of Augsburg, Germany. The incidence rate was 7.23 per 1000 person-years (95% confidence interval [CI], 5.37 to 9.53), and the subjects were followed up for 8 years. All suspected cases of an incident CHD event were classified according to the MONICA protocol. There was a positive and statistically significant unadjusted relationship between plasma viscosity and the incidence of CHD. The relative risk of CHD events associated with a 1-SD increase in plasma viscosity (0.070 mPa ⅐ s) was 1. Key Words: viscosity Ⅲ plasma Ⅲ coronary heart disease Ⅲ incidence Ⅲ prospective studies P ositive associations of various factors, like smoking, blood pressure, and cholesterol, with the incidence of CHD are well established. However, high-risk patients identified by hypertension, smoking, and elevated cholesterol accounted for only 32% of all future MIs in one study. 1 Furthermore, event rates vary considerably across countries, a fact that cannot be explained by differences in conventional risk factors.2,3 Plasma viscosity, a major determinant of blood flow in the microcirculation, may be one explanation of such a difference. 4 Thus, other factors might contribute to the pathogenesis of CHD. Evidence from prospective studies has implicated fibrinogen as a major independent cardiovascular risk factor. 5Only three prospective studies are available wherein plasma viscosity (which is determined to some extent by fibrinogen) was measured along with other risk-related parameters. Plasma viscosity, as well as fibrinogen and white blood cell count, was positively associated with the incidence of CHD events in a population-based study of middle-aged men.6,7 Plasma viscosity and fibrinogen were also associated with incident CHD and stroke in a study of older men and women 8 and with recurrence of stroke in another study. 9In the first cross-sectional study of the MONICA Project, Augsburg, 1984 to 1985, plasma viscosity but not fibrinogen was measured in addition to conventional risk factors. This report assesses the prognostic impact of plasma viscosity for a first major incident CHD event in 45-to 64-year-old German men.

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Section: Discussionmentioning

confidence: 99%

mentioning

confidence: 98%

Plasma Viscosity and the Risk of Coronary Heart Disease

Köenig

Sund²,

Filipiak³

et al. 1998

ATVB

135

View full text Add to dashboard Cite

show abstract

“…20,[22][23][24][25][26]28,32 The relationship between fibrinogen levels and cardiovascular events was determined by comparing higher and lower tertiles of fibrinogen. The results of 3 prospective studies (Gothenburg and Scottish Heart Health Study, Caerphilly-Speedwell) 20,25,26 published as quintiles were recalculated into tertiles using a conservative approach that assumes a linear increase in events within quintiles.…”

Section: Prospective Studiesmentioning

confidence: 99%

Measuring Plasma Fibrinogen to Predict Stroke and Myocardial Infarction

Maresca

Blasio

Marchioli

et al. 1999

ATVB

296

182

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Abstract-Plasma fibrinogen is a major determinant of platelet aggregation and blood viscosity. The decrease in plasma fibrinogen by bezafibrate is associated with a decrease in the risk of reinfarctions. To strengthen the predictive value of plasma fibrinogen with respect to cardiovascular risk, we performed a meta-analysis of studies conducted between 1984 and 1998. Emphasis has been put on the relationship between high levels of plasma fibrinogen and fatal and/or nonfatal cardiovascular events in both the general population and in patients with previous cardiovascular events. Twenty-two studies (13 prospective, 5 cross-sectional, and 4 case-control) addressing the association between fibrinogen plasma concentrations and cardiovascular disease were analyzed. The overall estimate of risk of cardiovascular event in subjects with plasma fibrinogen levels in the higher tertile, was twice as high as that of subjects in the lower one (odds ratio, 1.99; 95% confidence interval, 1.85 to 2.13). High plasma fibrinogen levels were associated with an increased risk of cardiovascular disease in healthy as much as in high-risk individuals. A metaregression showed no confounding effects attributable to selected characteristics of retrieved studies. A subgroup analysis (study design, follow up, mean fibrinogen levels, percentage of smokers, and mean age) allowed us to conclude that fibrinogen is an independent risk factor for cardiovascular disease; that it interacts with major determinants of myocardial and cerebrovascular ischemia; and that, in secondary prevention studies, it enhances by 8% the prediction of future events by established risk factors. Thus, fibrinogen measurements should be encouraged to refine the overall risk profiles of individuals and to better tailor preventive interventions.

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“…Plasma viscosity, an index of blood rheology, is positively correlated with blood pressure (BP) 9 and has been related to future cardiovascular events in a number of prospective studies. 10,11 Likewise, plasma fibrinogen, which is a clotting factor and an important determinant of plasma viscosity, has been found to be related to BP, 12 although this has not been consistent across all studies. 13 An extensive body of evidence also indicates a relationship between fibrinogen and incident cardiovascular disease.…”

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confidence: 99%

Von Willebrand Factor, Soluble P-Selectin, and Target Organ Damage in Hypertension

et al. 2002

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Abstract-To investigate the relationship between soluble markers of platelet, endothelial and rheological function, and target organ damage and their response to intensified management in a population of middle-age hypertensive patients at high risk of cardiovascular complications, we studied 382 consecutive patients (308 men; mean age, 63 years, SD 8) along with 60 normotensive controls free of cardiovascular disease. Patients were divided into those with target organ damage (TOD; nϭ107) and those free of end-organ damage. Plasma levels of soluble P-selectin (sP-sel), a marker of platelet activation, and von Willebrand factor (vWF), an index of endothelial damage/dysfunction (both enzyme-linked immunosorbent assay), and the rheological indices fibrinogen, plasma viscosity, hematocrit, platelet, and white cell count were measured. In 53 patients, variables were further measured after 6 months of intensified cardiovascular risk management. Patients with TOD had significantly higher vWF, 137 (SD 33) versus 125 (SD 33) IU/dL (Pϭ0.002,) and a greater proportion of smokers, 31% versus 16% (Pϭ0.002). There were no statistically significant differences in plasma viscosity, fibrinogen, hematocrit, white blood cell count, platelet count, or sP-sel between the 2 subgroups. In multivariate analysis, vWF was a significant independent predictor for TOD. After 6 months of intensified management in 53 patients who entered the trial, there were significant reductions in systolic blood pressure, total cholesterol, hematocrit, plasma viscosity, sP-sel, and vWF (all PϽ0.01) but no significant change in fibrinogen.

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Fibrinogen, viscosity and the 10-year incidence of ischaemic heart disease: The Caerphilly and Speedwell Studies

Abstract: Fibrinogen and viscosity are powerful, long term and independent predictors of the risk of ischaemic heart disease.

Cited by 155 publications

References 6 publications

Plasma Viscosity and the Risk of Coronary Heart Disease

Plasma Viscosity and the Risk of Coronary Heart Disease

Measuring Plasma Fibrinogen to Predict Stroke and Myocardial Infarction

Von Willebrand Factor, Soluble P-Selectin, and Target Organ Damage in Hypertension

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