Published Online
on June 2, 2005

A more recent version of this article appeared on July 1, 2005

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Submitted on March 4, 2005
Revised on March 24, 2005
Accepted on March 31, 2005

Prognostic Impact of Fibrinogen in Carotid Atherosclerosis. Nonspecific Indicator of Inflammation or Independent Predictor of Disease Progression?

Schila Sabeti MD; Markus Exner MD; Wolfgang Mlekusch MD; Jasmin Amighi MD; Peter Quehenberger MD; Helmut Rumpold MD; Gerald Maurer MD; Erich Minar MD; Oswald Wagner MD; and Martin Schillinger MD^*

From the Departments of Angiology (S.S., W.M., J.A.E.M., M.S.), Medical and Chemical Laboratory Diagnostics (M.E., P.Q., H.R., O.W.), and Cardiology (G.M.), Medical University of Vienna, Austria.

^* To whom correspondence should be addressed. E-mail: martin.schillinger{at}meduniwien.ac.at.

Background--Fibrinogen is a key factor in the coagulation cascade, it exhibits proinflammatory properties, and it is suggested to play a pivotal role in atherogenesis. We investigated whether fibrinogen predicts future progression of carotid atherosclerosis, analyzing whether fibrinogen levels add to the prognostic information of other inflammatory parameters.

Methods--We prospectively studied 1268 consecutive patients without recent (12 months) symptoms from cerebrovascular disease. Patients underwent serial ultrasound investigations in 6- to 9-month intervals, categorizing carotid arteries as 0% to 29%, 30% to 49%, 50% to 69%, 70% to 89%, or 90% to 99% stenosed, or occluded. Fibrinogen levels were determined at baseline and follow-up. The risk for progressive carotid atherosclerosis according to fibrinogen levels was calculated, adjusting for traditional risk factors and other inflammatory parameters (C-reactive protein and serum amyloid A).

Results--Progression of carotid atherosclerosis was found in 117 of 1268 patients (9.2%) after a median of 8 months (range 6 to 18). Adjusted hazard ratios for atherosclerosis progression with increasing quartiles of baseline fibrinogen were 1.83 (P=0.037), 2.09 (P=0.008), and 2.45 (P=0.002), respectively, compared with the lowest quartile. Fibrinogen at follow-up also was associated with progressive disease (P=0.004). However, additionally adjusting for other inflammatory parameters diminished these associations to a nonsignificant level.

Conclusion--Elevated fibrinogen, reflecting the level of inflammatory activity, is associated with progression of carotid atherosclerosis, as it was demonstrated previously for other inflammatory parameters. However, this association seems to be nonspecifically related to the extent of the inflammatory process in atherosclerotic disease rather than to specific properties of fibrinogen.

Key words: carotid stenosis • ultrasonography • inflammation

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