title: Level of fibrinogen and risk of fatal and non-fatal stroke. EUROSTROKE: a collaborative study among research centres in Europe.
abstract: BACKGROUND
  It is well established that raised levels of fibrinogen increase the risk of coronary heart disease. For stroke, however, data are much more limited and restricted to overall stroke. This study investigated the association between fibrinogen and fatal, non-fatal, haemorrhagic and ischaemic stroke in three European cohorts participating in EUROSTROKE.
  
  
  METHODS
  EUROSTROKE is a collaborative project among ongoing European cohort studies on incidence and risk factors of stroke. EUROSTROKE is designed as a nested case-control study. For each stroke case, two controls were sampled. Strokes were classified according to MONICA criteria or reviewed by a panel of four neurologists. Recently, data on stroke and fibrinogen became available from cohorts in Cardiff (79 cases/194 controls), Kuopio (74/124), and Rotterdam (62/203). Results were adjusted for age, sex, smoking, and systolic blood pressure.
  
  
  RESULTS
  The risk of stroke gradually increased with increasing fibrinogen levels: the odds ratios per quartile increase were 1.08 (95% CI 0.63 to 1.84), 1.91 (1.12 to 3.26) and 2.78 (1.64 to 4.72), respectively. This association was similar for ischaemic (n=138) and haemorrhagic stroke (n=25). Associations between fibrinogen and stroke were similar across strata of smoking, diabetes mellitus, previous myocardial infarction, and HDL cholesterol. The odds ratio, however, tended to increase with increasing systolic blood pressure: from 1.21 among those with a systolic pressure <120 mm Hg to 1.99 among subjects with a systolic pressure of 160 mm Hg or above.
  
  
  CONCLUSIONS
  This analysis of the EUROSTROKE project indicates that fibrinogen is a powerful predictor of stroke. Results did not disclose a differential in this relation of fibrinogen and fatal or non-fatal stroke, or with type of stroke (ischaemic or haemorrhagic).
authors.affiliation: Epidemiology and Biostatistics, Erasmus University Medical School, Rotterdam, The Netherlands. M.L.Bots@jc.azu.nl
authors.forename: M L
authors.initials: ML
authors.lastname: Bots
authors.forename: P C
authors.initials: PC
authors.lastname: Elwood
authors.forename: J T
authors.initials: JT
authors.lastname: Salonen
authors.forename: A
authors.initials: A
authors.lastname: Freire de Concalves
authors.forename: J
authors.initials: J
authors.lastname: Sivenius
authors.forename: A
authors.initials: A
authors.lastname: Di Carlo
authors.forename: Y
authors.initials: Y
authors.lastname: Nikitin
authors.forename: V
authors.initials: V
authors.lastname: Benetou
authors.forename: J
authors.initials: J
authors.lastname: Tuomilehto
authors.forename: P J
authors.initials: PJ
authors.lastname: Koudstaal
authors.forename: D E
authors.initials: DE
authors.lastname: Grobbee
mesh_terms: D000328:Adult; D000368:Aged; D015415:Biomarkers / Q000097:blood; D016022:Case-Control Studies; D016208:Databases, Factual; D005060:Europe / Q000453:epidemiology; D005260:Female; D005340:Fibrinogen / Q000032:analysis*; D006801:Humans; D008297:Male; D008875:Middle Aged; D015337:Multicenter Studies as Topic; D012306:Risk; D020521:Stroke / Q000097:blood* / Q000453:epidemiology* / Q000401:mortality
chemical_list: D015415:Biomarkers; D005340:Fibrinogen