Association of Plasma γ′ Fibrinogen With Incident Cardiovascular Disease The Atherosclerosis Risk in Communities (ARIC) Study
Association of Plasma γ′ Fibrinogen With Incident Cardiovascular Disease The Atherosclerosis Risk in Communities (ARIC) Study
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DOI：
10.1161/atvbaha.115.306284
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发表时间：
2015-12-01
影响因子：
8.7
通讯作者：
Folsom, Aaron R.
中科院分区：
文献类型：
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作者：
Appiah, Duke;Schreiner, Pamela J.;Folsom, Aaron R.
目的前瞻性地检测血浆纤维蛋白原与多个心血管疾病(CVD)终点发病率的关系，独立于已确定的心血管疾病危险因素、总纤维蛋白原和其他炎症标记物。方法和结果社区动脉粥样硬化风险(ARIC)研究用酶联免疫吸附试验测量了1993-1995年间储存的血浆样本中的纤维蛋白原及其相关水平，从2012年起10 601名成年人发生心血管终点(冠心病1603例，缺血性中风548例，外周动脉病599例，心力衰竭1411例，心血管病死亡率705例)。在考虑了心血管危险因素和总纤维蛋白原水平的COX模型中，纤维蛋白原与外周动脉疾病(每增加1-SD[8.80 mg/dL]的危险比[HR]，1.14[1.04-1.24])、心力衰竭(HR，1.06[1.01-1.13])和心血管死亡(HR，1.12[1.04-1.21])正相关，但与冠心病(HR，1.01[0.96-1.07])或缺血性中风(HR，HR)无关。0.98[0.89-1.07])。然而，对C反应蛋白的额外调整消除了与外周动脉疾病和心力衰竭的关联。结论这些发现不支持纤维蛋白原通过其血栓前特性影响心血管事件的假设。相反，纤维蛋白原浓度似乎反映了伴随动脉粥样硬化性心血管疾病并可能导致动脉粥样硬化性心血管疾病的全身炎症，而不是纤维蛋白原是致病危险因素。
Objectives To prospectively examine the association of plasma fibrinogen with the incidence of multiple cardiovascular disease (CVD) end points, independent of established CVD risk factors, total fibrinogen, and other inflammatory markers.Approach and Results The Atherosclerosis Risk in Communities (ARIC) study measured fibrinogen by enzyme-linked immunosorbent assay in stored plasma samples from 1993 to 1995 and related levels in 10 601 adults to incident CVD end points (coronary heart disease [n=1603], ischemic stroke [n=548], peripheral artery disease [n=599], heart failure [n=1411], and CVD mortality [n=705]) through 2012 (median follow-up, 18 years). In Cox models accounting for established CVD risk factors and total fibrinogen levels, fibrinogen was associated positively with peripheral artery disease (hazard ratio [HR] per 1-SD [8.80 mg/dL] increment, 1.14 [1.04-1.24]), heart failure (HR, 1.06 [1.01-1.13]), and CVD deaths (HR, 1.12 [1.04-1.21]) but not with incident coronary heart disease (HR, 1.01 [0.96-1.07]) or ischemic stroke (HR, 0.98 [0.89-1.07]). Additional adjustment for C-reactive protein, however, eliminated the associations with peripheral artery disease and heart failure.Conclusions These findings do not lend support to the hypothesis that fibrinogen influences CVD events through its prothrombotic properties. Rather, fibrinogen concentrations seem to reflect general inflammation that accompanies and may contribute to atherosclerotic CVD, instead of fibrinogen being a causal risk factor.