The role of fibrinogen in cardiovascular disease

Povišena razina fibrinogena u plazmi povezana je s povećanim rizikom za razvoj kardiovaskularnih bolesti, uključujući ishemijsku bolest srca, moždani udar i okluzivnu bolest perifernih arterija. Fibrinogen ima važnu ulogu u brojnim patofiziološkim procesima u tijelu, uključujući upalu, aterosklerozu i trombogenezu. Nekoliko je mehanizama kojima fibrinogen povećava kardiovaskularni rizik. Predloženi mehanizmi uključuju infiltraciju stijenke krvne žile fibrinogenom, promjenu reoloških svojstava krvi, u smislu povećane viskoznosti, povećanu agregaciju trombocita i stvaranje tromba. Nadalje, koncentracija fibrinogena u plazmi povezana je s gotovo svim ostalim kardiovaskularnim čimbenicima rizika, kao što su pušenje, dob, pretilost, hipertenzija i šećerna bolest, a moguće je da predstavlja jedan od zajedničkih mehanizama kojima ti čimbenici rizika pridonose razvoju kardiovaskularnih događaja. Fibrinogen je i jedan od proteina akutne faze. Upalno stanje, infekcije dovode do povišene koncentracije fibrinogena u plazmi te time, također, mogu pridonijeti ukupnom kardiovaskularnom riziku. Razina fibrinogena u plazmi, pod utjecajem je brojnih čimbenika; povećava se s dobi, indeksom tjelesne mase, pušenjem, dijabetesom te nakon menopauze, a smanjuje se umjerenim unosom alkohola, tjelesnom aktivnosti, porastom koncentracije lipoproteina visoke gustoće (HDL) te uz hormonsku nadomjesnu terapiju. Prema nekim istraživanjima, koncentracija fibrinogena je prediktor povišenog rizika za razvoj velikog kardiovaskularnog događaja, jednako kao koncentracija kolesterola, dijastolički krvni tlak i indeks tjelesne mase. Dakle, povišena razina fibrinogena u plazmi ima značajne prognostičke implikacije, fibrinogen je snažan prediktor ishemijske bolesti srca, fatalnog i ne-fatalnog infarkta miokarda te smrti nepoznatog razloga, podjednako za muškarce i žene. Razina fibrinogena u plazmi potencijalno se može koristiti u programu probira za prepoznavanje osoba s visokim rizikom za nastanak kardiovaskularnih događaja. Ohrabruje činjenica da je razina fibrinogena, djelomično, promjenjivi faktor rizika, a pozitivne promjene načina života obično rezultiraju smanjenjem razine fibrinogena.Elevated plasma fibrinogen levels are associated with an increased risk of all the major atherosclerotic cardiovascular events, including coronary heart disease, stroke and peripheral artery disease. Fibrinogen plays a vital role in a number of physiopathological processes in the body, including inflammation, atherogenesis and thrombogenesis. There are several mechanisms by which fibrinogen may increase cardiovascular risk. Proposed mechanisms include the infiltration of the vessel wall by fibrinogen, hemorrheological effects due to increase in blood viscosity, increased platelet aggregation and thrombus formation. Furthermore, plasma fibrinogen concentration is positively correlated with nearly all other cardiovascular risk factors, such as smoking, age, obesity, hypertension and diabetes and may be a common mechanism by which these risk factors predispose to cardiovascular events. Fibrinogen is also a prominent acute-phase reactant. Thus, elevated concentrations of fibrinogen, secondary to inflammation or infection, implicated in cardiovascular risk may operate, in part, by increasing the reactivity of platelets. Plasma fibrinogen is also influenced by many factors: it increases with age, body mass index, smoking, diabetes and post menopause but it decreases with moderate alcohol intake, physical activity, increased high-density-lipoprotein cholesterol, and with hormone replacement therapy. It appears that fibrinogen concentration and plasma viscosity are at least as predictive of cardiovascular events as are cholesterol concentration, diastolic blood pressure and body mass index. Furthermore, raised plasma fibrinogen levels have prognostic implications, being a strong predictor of coronary heart disease, fatal or non-fatal, and of death from an unspecified cause, for both men and women. Plasma fibrinogen levels could potentially be considered for screening programs to identify people at high risk of vascular events. Encouragingly, plasma fibrinogen is partly modifiable risk factor and suitable lifestyle changes usually result in favorable decreases in plasma fibrinogen levels