Kannel W B, D'Agostino R B, Belanger A J
Department of Medicine, Evans Memorial Research Foundation, School of Medicine, Framingham Heart Study, MA 01701.
Ann Epidemiol. 1992 Jul;2(4):457-66. doi: 10.1016/1047-2797(92)90095-8.
Mounting data support a causal connection between high-normal fibrinogen levels and atherosclerotic cardiovascular disease. There is clearly a thrombogenic component to atherosclerosis and the onset of clinical manifestations. This offers the possibility to better identify high-risk candidates and also to protect them by reducing blood fibrinogen concentration or blocking its action. The relationship of antecedent fibrinogen to the subsequent development of cardiovascular disease is examined, based on 18 years of surveillance of a cohort of 1274 men and women aged 47 to 79 years who participated in the Framingham Study. The association with the development of peripheral arterial disease and cardiac failure is now examined in addition to previously studied relationships to coronary heart disease and stroke. In men and women, there is a significant age-adjusted relationship of fibrinogen level to coronary heart disease and to cardiovascular disease in general. In women, a significant relationship to cardiac failure and peripheral arterial disease, but not to stroke, was also found. These data on women are unique as they are not available elsewhere. Age-adjusted cardiovascular, all-cause, and coronary heart disease mortality were all related to fibrinogen in both sexes. In men, fibrinogen impact was the greatest for stroke and the least for peripheral arterial disease. For women, the impact on coronary heart disease was greatest. The absolute risk for an elevated fibrinogen level was greatest for coronary heart disease in both sexes. Average fibrinogen values are higher in women and in persons with other risk factors, including hypertension, cigarette smoking, diabetes, obesity, and elevated hematocrit. However, there is an independent contribution of fibrinogen to cardiovascular disease in general and coronary disease in particular, on adjustment for coexistent risk factors. Fibrinogen enhances the risk of cardiovascular disease in hypertensives, diabetics, and cigarette smokers. About half the cardiovascular risk of cigarette smoking appears due to the higher fibrinogen values. Now, five prospective studies document the excess incidence of cardiovascular events in persons with elevated fibrinogen levels within the "normal range." Each standard deviation increase in fibrinogen is associated with a 30% increment of coronary heart disease in men and a 40% increase in women. Fibrinogen should be added to the list of major cardiovascular risk factors. Trials of intervention to lower fibrinogen in high-risk coronary candidates are needed.
越来越多的数据支持高正常纤维蛋白原水平与动脉粥样硬化性心血管疾病之间存在因果关系。动脉粥样硬化及临床表现的发作显然存在致血栓形成因素。这为更好地识别高危人群以及通过降低血液纤维蛋白原浓度或阻断其作用来保护他们提供了可能性。基于对参加弗雷明汉姆研究的1274名年龄在47至79岁的男性和女性进行的18年监测，研究了先前的纤维蛋白原与心血管疾病后续发展之间的关系。除了先前研究的与冠心病和中风的关系外，现在还研究了与外周动脉疾病和心力衰竭发展的关联。在男性和女性中，纤维蛋白原水平与冠心病及总体心血管疾病之间存在显著的年龄调整后关系。在女性中，还发现与心力衰竭和外周动脉疾病存在显著关系，但与中风无关。这些关于女性的数据是独一无二的，因为其他地方没有这些数据。年龄调整后的心血管疾病、全因死亡率和冠心病死亡率在两性中均与纤维蛋白原有关。在男性中，纤维蛋白原对中风的影响最大，对外周动脉疾病的影响最小。对于女性，对冠心病的影响最大。纤维蛋白原水平升高的绝对风险在两性中对冠心病都是最大的。女性以及患有包括高血压、吸烟、糖尿病、肥胖和血细胞比容升高在内的其他危险因素的人群的平均纤维蛋白原值更高。然而，在调整共存的危险因素后，纤维蛋白原对总体心血管疾病尤其是冠心病有独立影响。纤维蛋白原会增加高血压患者、糖尿病患者和吸烟者患心血管疾病的风险。吸烟导致的心血管风险约有一半似乎是由于较高的纤维蛋白原值。现在，五项前瞻性研究记录了“正常范围”内纤维蛋白原水平升高的人群心血管事件的额外发生率。纤维蛋白原每增加一个标准差，男性患冠心病的风险增加30%，女性增加40%。纤维蛋白原应被列入主要心血管危险因素清单。需要对高危冠心病患者进行降低纤维蛋白原的干预试验。
