Endocrinology & Cardiometabolic Center, State Key Laboratory of Cardiovascular Disease, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, No 167 BeiLiShi Road, XiCheng District, Beijing, 100037, China.
Cardiovasc Diabetol. 2020 Mar 19;19(1):36. doi: 10.1186/s12933-020-01012-9.
BACKGROUND: The present cohort study aims to examine the relationship between fibrinogen (Fib) levels and glucose metabolism [fasting blood glucose (FBG) and hemoglobin A1c (HbA1c)] and investigate the impact of high Fib on cardiovascular outcomes in patients with stable CAD and pre-diabetes mellitus (pre-DM) or diabetes mellitus (DM). METHODS: This study included 5237 patients from March 2011 to December 2015. Patients were distributed into three groups according to Fib levels (low Fib, median Fib, high Fib) and further categorized by glucose metabolism status [normal glucose regulation (NGR), Pre-DM, DM]. All patients were followed up for the occurrences of major adverse cardiovascular events (MACEs), including cardiovascular mortality, nonfatal MI, stroke, and unplanned coronary revascularization. RESULTS: Linear regression analyses showed that FBG and HbA1c levels were positively associated with Fib in overall CAD participants, either with or without DM (all P < 0.001). During an average of 18,820 patient-years of follow-up, 476 MACEs occurred. High Fib was independently associated with MACEs after adjusting for confounding factors [Hazard Ratio (HR): 1.57, 95% confidence interval (CI) 1.26-1.97, P < 0.001]. Furthermore, DM but not pre-DM was a significant predictor of MACEs (P < 0.001 and P > 0.05, respectively). When patients were stratified by both glucose metabolism status and Fib levels, high Fib was associated with a higher risk of MACEs in pre-DM (HR 1.66, 95% CI 1.02-2.71, P < 0.05). Medium and high Fib levels were associated with an even higher risk of MACEs in DM (HR 1.86, 95% CI 1.14-3.05 and HR 2.28, 95% CI 1.42-3.66, all P < 0.05). After adding the combination of Fib and glucose status to the Cox model, the C-statistic was increased by 0.015 (0.001-0.026). CONCLUSIONS: The present study suggested that Fib levels were associated with FBG and HbA1c in stable CAD patients. Moreover, elevated Fib was independently associated with MACEs in CAD patients, especially among those with pre-DM and DM, suggesting that Fib may provide incremental value in the cardiovascular risk stratification of pre-DM and DM patients.
背景：本队列研究旨在探讨纤维蛋白原（Fib）水平与葡萄糖代谢[空腹血糖（FBG）和糖化血红蛋白（HbA1c）]之间的关系，并研究高 Fib 水平对稳定性冠心病合并糖尿病前期（Pre-DM）或糖尿病（DM）患者心血管结局的影响。
方法：本研究纳入了 2011 年 3 月至 2015 年 12 月期间的 5237 例患者。根据 Fib 水平（低 Fib、中位数 Fib、高 Fib）将患者分为三组，并根据葡萄糖代谢状态[正常血糖调节（NGR）、Pre-DM、DM]进一步分类。所有患者均进行了主要不良心血管事件（MACEs）的随访，包括心血管死亡、非致死性心肌梗死、卒中和计划外冠状动脉血运重建。
结果：线性回归分析显示，在所有 CAD 患者中，无论是否合并 DM，FBG 和 HbA1c 水平均与 Fib 呈正相关（均 P<0.001）。在平均 18820 患者年的随访期间，发生了 476 例 MACEs。在校正混杂因素后，高 Fib 与 MACEs 独立相关[风险比（HR）：1.57，95%置信区间（CI）1.26-1.97，P<0.001]。此外，DM 而非 Pre-DM 是 MACEs 的显著预测因素（P<0.001 和 P>0.05）。当根据葡萄糖代谢状态和 Fib 水平对患者进行分层时，高 Fib 与 Pre-DM 患者的 MACEs 风险升高相关（HR 1.66，95%CI 1.02-2.71，P<0.05）。中 Fib 和高 Fib 水平与 DM 患者的 MACEs 风险升高甚至更相关（HR 1.86，95%CI 1.14-3.05 和 HR 2.28，95%CI 1.42-3.66，均 P<0.05）。在校正 Cox 模型中添加 Fib 和葡萄糖状态的组合后，C 统计量增加了 0.015（0.001-0.026）。
结论：本研究表明 Fib 水平与稳定性冠心病患者的 FBG 和 HbA1c 相关。此外，升高的 Fib 与 CAD 患者的 MACEs 独立相关，尤其是在 Pre-DM 和 DM 患者中，这表明 Fib 可能为 Pre-DM 和 DM 患者的心血管风险分层提供额外价值。
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