Published Online
on August 31, 2006

A more recent version of this article appeared on October 1, 2006

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Submitted on April 7, 2006
Revised on June 11, 2006
Accepted on July 25, 2006

Plasma Fibrinogen Concentrations and Risk of Stroke and Its Subtypes Among Japanese Men and Women

Shinichi Sato MD^*; Hiroyasu Iso MD; Hiroyuki Noda MD; Akihiko Kitamura MD; Hironori Imano MD; Masahiko Kiyama MD; Tetsuya Ohira MD; Takeo Okada MD; Masayuki Yao MD; Takeshi Tanigawa MD; Kazumasa Yamagishi MD; Masakazu Nakamura MD; Yoshihiko Naito MD; and Takashi Shimamoto MD

From the Osaka Medical Center for Health Science and Promotion (S.S., A.K., H. Imano, M.K., T.O., M.Y., M.N., Y.N., T.S.) and the School of Public Health (H. Iso, H.N.), Department of Social and Environmental Medicine, Osaka University, Graduate School of Medicine, Osaka, and the Department of Public Health Medicine (T.T., K.Y.), Graduate School of Comprehensive Human Sciences, University of Tsukuba, Tsukuba, Japan.

^* To whom correspondence should be addressed. E-mail: xsato{at}kenkoukagaku.jp.

Background and Purpose--We aimed to examine the impact of fibrinogen concentrations on the incidence of stroke.

Methods--We examined the association between fibrinogen and risk of total stroke and stroke subtypes in an 11-year prospective study of 4608 men and 7589 women aged 40 to 79 years with no history of stroke and/or coronary heart disease. The analysis was repeated, stratified by smoking status, to examine whether the association between fibrinogen and stroke was modified by smoking.

Results--There were 317 incident total strokes comprising 103 hemorrhagic strokes (70 intraparenchymal hemorrhages [22.1% of strokes], 33 subarachnoid hemorrhages [10.4%]), 206 ischemic strokes (65.0%), and 8 strokes of undetermined type (2.5%). The multivariable hazard ratio (95% CI) for the highest versus lowest fibrinogen quartiles after adjustment for age, sex, area, and known cardiovascular risk factors was 2.5 (1.3 to 5.0), P<0.01, for hemorrhagic stroke and 3.2 (1.4 to 7.4), P<0.01, for intraparenchymal hemorrhage. There was no positive association of fibrinogen with risk of ischemic stroke or subarachnoid hemorrhage. Among never-smokers, the multivariable hazard ratio (95% CI) for the highest versus lowest fibrinogen quartiles was 3.5 (1.3 to 9.3), P=0.01, for hemorrhagic stroke and 4.4 (1.3 to 15.2), P=0.02, for intraparenchymal hemorrhage.

Conclusions--High plasma fibrinogen concentration can be a predictor for risk of intraparenchymal hemorrhage.

Key words: Japanese • plasma fibrinogen • prospective study • stroke • stroke subtypes

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