© 2001 American Heart Association, Inc.
Thrombosis |
Influence of Plasma Fibrinogen Levels on the Incidence of Myocardial Infarction and Death Is Modified by Other Inflammation-Sensitive Proteins
A Long-Term Cohort Study
From the Division of Medical Angiology, Department of Internal Medicine (P.L., B.H., L.S., K.F.E., F.L.), and the Division of Epidemiology, Department of Community Medicine (B.H., L.J.), Lund University, Malmö University Hospital, Malmö, Sweden.
Correspondence to Dr Peter Lind, Department of Internal Medicine, Malmö University Hospital, S-205 02 Malmö, Sweden. E-mail Peter.C.Lind{at}skane.se
Abstract—Inflammation
may play an important role in atherosclerotic disease. Plasma
fibrinogen is an established predictor of
cardiovascular events. The aim of this study was to
evaluate whether other inflammation-sensitive plasma proteins modify
this prediction. We studied the incidence of cardiac events and death
in men in relation to fibrinogen levels alone and in combination with
other proteins. The study was based on 6075 men, who were, on average,
46 years old at the time of the screening examination, which included
the quantitative assessment of plasma levels of fibrinogen,
orosomucoid, 
1-antitrypsin, haptoglobin, and
ceruloplasmin. The concentration of each protein was divided into
quartiles for each. This classification made it possible to identify 4
groups, ie, men in the first fibrinogen quartile and at the same time
either not belonging to the fourth quartile of any of the other
proteins (Q1/No group) or also belonging to the fourth quartile of 
1
of the additional proteins (Q1/Yes group) and corresponding groups in
the fourth fibrinogen quartile (Q4/No and Q4/Yes groups). During the
follow-up, which occurred at an average of 16 years, 439 (7.2%) men
experienced a cardiac event, and 653 (10.7%) died; 278 of these men
died of cardiovascular diseases, with 206 deaths
attributed to ischemic heart disease. From the lowest to the
highest quartile, there was for each protein a stepwise increase in the
incidence of cardiac events and mortality. All-cause mortality and
cardiovascular mortality were significantly higher in
the Q4/Yes group compared with the Q4/No group, but they were similar
in the Q4/No and Q1/Yes groups. The incidence of cardiac events was
significantly higher in the Q1/Yes and Q4/Yes groups compared with the
Q1/No and Q4/No groups, respectively. The increased
cardiovascular mortality and cardiac event rates
remained after adjustment for several confounders when the Q4/Yes and
Q4/No groups were compared. The results suggest that the incidence of
cardiac events and death due to cardiovascular diseases
in middle-aged men predicted by plasma levels of fibrinogen is modified
by other inflammation-sensitive
proteins.
Key Words: atherosclerosis • inflammation • fibrinogen • plasma proteins • myocardial infarction
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