[Fibrinogen: factor and marker of cardiovascular risk].
Most cardiovascular events result from a thrombotic complication in patients with atherosclerosis. Inflammation plays a central role both in the pathogenesis of atherosclerosis and in the development of complications (particularly plaque rupture). Fibrinogen is both a marker of inflammation and a major determinant of thrombosis and hemorrheology. Clinical data corroborate with epidemiological data showing that higher serum fibrinogen level (compared with matched controls) is predictive of both the risk of primary cardiovascular events in the general population and the risk of secondary events among patients. Fibrinogen level, determined by both environmental and genetic factors, is a good example of gene-environment interaction. The rise in fibrinogen level indicative of significantly increased risk is actually very small, lying within the normal range. This explains why epidemiological data cannot be used to establish cardiovascular risk for individual patients in routine practice (excepting very high elevations rarely encountered). To date, fibrinogen is the only compound formally recognized as both a risk factor and a marker of cardiovascular risk. Other compounds, including CRP, von Willebrand factor, and more recently the CD40-CD40 ligand system, have also been shown to play a double role as predictors and markers. These new developments shed new light on fibrinogen as a risk marker/factor for atherothrombotic ischemic events.
Drouet
L
L
Angio-hématologie, Hôpital Lariboisière, 2, rue Ambroise Paré, 75010 Paris, France. ludovic.drouet@lrb.ap-hop-paris.fr
Bal Dit Sollier
C
C
D017398:Alternative Splicing; D000595:Amino Acid Sequence; D015415:Biomarkers / Q000097:blood*; D002318:Cardiovascular Diseases / Q000097:blood* / Q000453:epidemiology; D005340:Fibrinogen / Q000737:chemistry / Q000235:genetics / Q000378:metabolism*; D006470:Hemorrhage / Q000097:blood; D006801:Humans; D007249:Inflammation / Q000097:blood; D012307:Risk Factors; D016415:Sequence Alignment; D013927:Thrombosis / Q000097:blood
D015415:Biomarkers; D005340:Fibrinogen