Fibrinogen is associated with glucose metabolism and cardiovascular outcomes in patients with coronary artery disease

Abstract

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.

Prognostic Value of Fibrinogen in Patients With Coronary Artery Disease and Prediabetes or Diabetes Following Percutaneous Coronary Intervention: Five-year Findings From a Large Cohort Study

“…Previous evidences suggested that FIB was an independent risk factor of CAD development and cardiovascular events in the general population [6,7]. Similar results on the prognostic value of FIB were also observed in patients with CAD [8][9][10].…”

“…Aside from the positive association with all-cause and CVD mortality in general individuals [6,18,19], FIB was reported to be an independent risk factor of the occurrence and severity of CAD [20]. Further, both small sample and large epidemiological studies showed that FIB was associated with worse clinical outcomes in patients with stable CAD [10,21,22]. A recent prospective study from China indicated elevated FIB was also strongly associated with MACE risk in ACS patients, especially when complicated with DM [9].…”

“…It has been previously demonstrated that DM independently increased the risk of adverse CVD events in CAD patients [28]. Notably, CAD patients with pre-DM seemed to share similar clinical outcomes with those with normoglycemia [10,29]. However, when combined with other disorders, such as dyslipidemia or hypertension, prediabetic patients with CAD were demonstrated to have signi cantly less favorable prognosis[30-32].…”

Prognostic value of NT-proBNP in patients with chronic coronary syndrome and normal left ventricular systolic function according to glucose status: a prospective cohort study

“…Up to now, previous studies including ours have demonstrated a series of risk factors for predicting cardiovascular outcomes in subjects with pre-DM or DM. Besides traditional cardiovascular risk factors [ 19 , 28 ], numerous novel parameters, including lipoprotein(a) [ 29 ], fibrinogen [ 30 ], free fatty acids [ 31 ], cystatin C [ 32 , 33 ] and so on, have emerged as significant cardiovascular risk factors in subjects with dysglycemia. However, given the growing prevalence and the added cardiovascular burden of pre-DM and DM, new avenues for exploration of more valuable prognostic biomarkers in these conditions is of increasing interest in cardiovascular field.…”

D-Dimer to Fibrinogen Ratio as a Novel Prognostic Marker in Patients After Undergoing Percutaneous Coronary Intervention: A Retrospective Cohort Study

“… 27 – 29 Liu et al showed that fibrinogen could be used as an independent predictor of MACEs in stable CAD patients. 30 Song et al found that the plasma FIB level is a useful biomarker to predict death or non-fatal reinfarction within 1 year in patients with NSTE-ACS undergoing PCI. 31 Mahmud et al 32 found that elevated serum fibrinogen was associated with major adverse cardiovascular events at 12 months following percutaneous coronary intervention.…”