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The Importance of Fibrinogen in Coronary Disease
and the Atherosclerotic Process

E-Newsletter No. 55

Identification of Fibrinogen as an Associative Risk Element by the American Heart Association
A study funded by the NIH and American Biogenetic Sciences1 reported that a clotting protein called fibrinogen was found to be “higher in people with heart disease but also seems to be a common pathway by which other risk factors cause heart disease.”

Fibrinogen: What is it?
Fibrinogen is a plasma glycoprotein which is synthesized by the liver and is involved in the final steps of coagulation in response to vascular or tissue injury. Aside from its role in thrombosis, fibrinogen has a number of actions that add to its participation in atherosclerosis and coronary artery disease2, including:
• Regulation of cell adhesion and proliferation
• Vasoconstriction at sites of vascular injury
• Stimulation of platelet aggregation
• Influence on blood viscosity

Why is it Important to Measure?
Although fibrinogen is needed for normal blood clotting, elevated levels may promote excessive clumping of platelets, the type of blood cells largely responsible for clotting. If this happens, a clot can form in an artery, which may lead to a heart attack or stroke3. Additionally, elevated fibrinogen has been associated with a prothrombotic state, one of the metabolic risk factors characteristic of the Metabolic Syndrome.4

In clinical settings, it is important to consider both genetic and environmental influence on fibrinogen levels. Genetic predisposition for elevated fibrinogen levels, coupled with other environmental factors that are known to elevate fibrinogen levels, increase patients' risk for this disorder5.

Environmental Factors that Could Increase Fibrinogen Include:
• Tobacco use
• Gender (males routinely have higher values)
• Use of drugs (i.e., some statins, hormone
replacement therapy, and oral contraceptives)
• Excess weight
• Sedentary lifestyle
• Inflammatory processes (chronic or temporary)
• Diabetes

Relationship of Fibrinogen and Other Cardiac Risk Markers
Lipoprotein(a), Lp(a)
Both Lp(a) and fibrinogen are pro-thrombotic, potentially adding to increased risk for vascular events when both are elevated.6
C-Reactive Protein, CRP
Both CRP and fibrinogen are acute phase reactants and may indicate an active atherosclerotic process. When both are elevated, consider patient history to eliminate noncardiovascular disease-related contributing factors such as chronic or acute inflammatory conditions.

Factors that Lower Fibrinogen:
• Smoking cessation
• Weight Loss7
• Exercise2
• Alcohol8
• Medication class – fibrates9
• Medication class – nicotinic acid10

1. D'Agostino, RB. Circulation 2000; 102
2. Wahrenberger, JW, DHMC Card. Update Symp. Dec 2003
3. Ernst, E, Journal of Internal Medicine, June 1990
4. Grundy, SM et al. Circulation 2004;109
5. Vischetti M, et al. Ital. Heart J. 2002 Jan;3(1)
6. Sechi, LA, De Marchi, SJ. Investig. Med. 2001; 49 (1)
7. Ditschuneit, HH. Obesity Research 1995; 3
8. Mennen LI et al. Arterioscler Thromb Vasc Biol 1999;19
9. Guyton, JR et al; Arch Intern Med. 2000;160
10. Current Medical Scene 2002; vol.17 No.3

Contact Berkeley HeartLab at 1-877-4-LIPIDS (Ext. 1) or visit us at to learn more about how we can help you with your approach to Advanced Cardiovascular Risk Reduction.

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