Q J Med 2003; 96: 711-729
© 2003 Association of Physicians
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Fibrinogen: biochemistry, epidemiology and determinants
From the Haemostasis Thrombosis and Vascular Biology Unit, University Department of Medicine, City Hospital, Birmingham, UK
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Introduction |
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Plasma fibrinogen is an important component of the coagulation cascade, as well as a major determinant of blood viscosity and blood flow. Increasing evidence from epidemiological studies suggests that elevated plasma fibrinogen levels are associated with an increased risk of cardiovascular disorders, including ischaemic heart disease (IHD), stroke and other thromboembolism.1,2 This increase in plasma fibrinogen levels may promote a prothrombotic or hypercoagulable state, and may in part explain the risk of stroke and thromboembolism in conditions such as atrial fibrillation (AF).
Nevertheless, the relationship between hyperfibrinogenemia, atherosclerosis and thrombosis is complicated. As the process of thrombogenesis is very closely related to atheroma formation (atherogenesis), it follows that specific thrombogenic factors such as fibrinogen (with important effects on blood rheology) may play key roles in the process of atherosclerotic lesion formation, with subsequent effects on cardiovascular diseases (Figure 1). However, knowledge about the precise determinants of plasma fibrinogen
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Search strategy |
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Pathophysiology |
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Fibrinogen and inflammation
Fibrinogen and atherogenesis
Fibrinogen and thrombogenesis
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Determining plasma fibrinogen levels |
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Epidemiological studies |
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The Northwick Park Heart Study (NPHS)
Gothenburg study
Leigh General Practice Study
Framingham Study
Munster Heart Study
Caerphilly and Speedwell studies
European Concerted Action on Thrombosis and disabilities study (ECAT)
Gottingen Risk Incidence and Prevalence Study (GRIPS)
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Determinants of plasma fibrinogen levels |
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Genetic influences
Extrinsic influences
Gender
Age
Body mass index and body habitus
Metabolic syndrome
Physical exercise
Acute exercise
Regular exercise
Seasonal differences
Vitamin C and infection
Psychosocial factors
Hormonal status
Smoking
Alcohol
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Fibrinogen: cause or effect? |
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The clinical scenario
Fibrinogen as an acute-phase reactant
Genetic variation in plasma fibrinogen—a causal relationship?
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Conclusions |
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Address correspondence to Professor G.Y.H. Lip, Haemostasis Thrombosis and Vascular Biology Unit, University Department of Medicine, City Hospital, Birmingham B18 7QH. e-mail: g.y.h.lip@bham.ac.uk
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