Plasma Fibrinogen Level as a Predictor of Cardiovascular Diseases, Independent of Diabetes, in a Population-Based 16-Year Prospective Study in Hong Kong

Abstract

Recent evidence from prospective studies in the United States and Europe suggest plasma fibrinogen level is useful for prediction of cardiovascular risk in addition to conventional risk factors. As one of the acute-phase reactant proteins, fibrinogen increases in response to the inflammatory process of atherosclerosis. Baseline data of the population-based Hong Kong Cardiovascular Risk Factor Prevalence Study (CRISPS), commenced in 1995-6, showed close positive relationship between circulating fibrinogen levels and diabetes, a major cardiovascular risk factor. In this study, we examined whether plasma fibrinogen was predictive of incident cardiovascular diseases (CVD) over 15.9 years (IQR 15.5 [[unable to display character: –]] 16.5) in the CRISPS cohort, and whether the prediction was dependent on its association with diabetes. Of a total of 2774 subjects, 374 had confirmed incident CVD. In addition to male sex and age, baseline body mass index (BMI), waist circumference (WC), fasting glucose, 2-hour glucose after oral glucose tolerance test, insulin resistance index HOMA-IR, systolic and diastolic BP, triglycerides (TGs), high-density lipoprotein, the presence of diabetes, hypertension, dyslipidaemia, and fibrinogen level were all predictive of incident CVD over 15.9 years (all p<0.001). Fibrinogen level correlated positively with fasting glucose, HOMA-IR, BMI, WC, systolic and diastolic BP, and TGs after sex and age adjustment (all p<0.001).On multivariate analysis, baseline age, WC, diabetes, hypertension, and fibrinogen level were independent risk factors (p≤0.001) for incident CVD. In conclusion, the findings from this 16-year prospective study confirmed plasma fibrinogen level as a strong predictor of CVD, independent of diabetes, in community-based Chinese adults.