Fibrinolysis and risk factors of atherosclerotic disease, with special emphasis on diabetes mellitus.

This paper reviews and discusses the evidence supporting the involvement of defective fibrinolysis in the pathogenesis of atherosclerosis, with emphasis on diabetes mellitus. According to the literature, defective fibrinolysis has been observed in association with virtually every major "risk factor" for coronary heart disease, including diabetes mellitus, hypercholesterolemia, hypertriglyceridemia, hypertension, obesity, cigarette smoking and lack of physical exercise. The interrelationships between disturbances in carbohydrate and fat metabolism and fibrinolysis are considered. Attention is drawn to the need for increased clinical attention to the potential role of defective fibrinolysis in atherogenesis, and periodic assessments of the fibrinolytic status are suggested as a promising approach toward early recognition of atherosclerotic tendency and risk. The judicious use of physiologic, dietary and pharmacologic means to correct defective fibrinolysis prophylactically and for the treatment of some forms of atherosclerosis is advocated.