title: Fibrinogen concentration and risk of ischemic stroke and acute coronary events in 5113 patients with transient ischemic attack and minor ischemic stroke.
abstract: OBJECTIVE
  Fibrinogen is an independent risk factor for coronary events in population-based studies and in patients with coronary heart disease, but there is uncertainty about prediction of stroke, particularly in secondary prevention.
  
  
  METHODS
  We studied unpublished data from 3 prospective studies of patients with recent transient ischemic attack (TIA) or minor ischemic stroke: the United Kingdom TIA Aspirin (UK-TIA) trial (n=1860); the Dutch TIA trial (n=2960); and the Oxford TIA Study (n=293). By separate and pooled analysis, we used Cox models to determine the relationship between fibrinogen and risk of ischemic stroke and other vascular events during 23,272 patient-years of follow-up and adjusted for other risk factors.
  
  
  RESULTS
  There was no significant heterogeneity in fibrinogen risk associations between studies. Fibrinogen predicted subsequent ischemic stroke, with a pooled hazard ratio (HR) for values above the median of 1.34 (95% CI, 1.13 to 1.60; P=0.001). The association tended to be stronger in patients with nonlacunar (HR=1.42; 95% CI, 1.13 to 1.78; P=0.002) than lacunar syndromes (HR=1.09; 95% CI, 0.80 to 1.49; P=0.58), but was not significantly so (P=0.18). There was no association with hemorrhagic stroke (adjusted HR=1.09; 95% CI, 0.55 to 2.17; P=0.81). Fibrinogen predicted acute coronary events (adjusted HR=1.42; 95% CI, 1.18 to 1.70; P<0.001) and all ischemic vascular events (adjusted HR=1.31; 95% CI, 1.15 to 1.49; P<0.001), but not nonvascular death (adjusted HR=1.24; 95% CI, 0.90 to 1.70; P=0.19).
  
  
  CONCLUSIONS
  In patients with a previous TIA or ischemic stroke, risks of recurrent ischemic stroke and acute coronary events increase linearly with fibrinogen levels, but the relationships are weaker than in some previous population-based studies.
authors.affiliation: Stroke Prevention Research Unit, University of Oxford, UK. peter.rothwell@clneuro.ox.ac.uk
authors.forename: Peter M
authors.initials: PM
authors.lastname: Rothwell
authors.forename: Sally C
authors.initials: SC
authors.lastname: Howard
authors.forename: Dermot A
authors.initials: DA
authors.lastname: Power
authors.forename: Sergei A
authors.initials: SA
authors.lastname: Gutnikov
authors.forename: Ale
authors.initials: A
authors.lastname: Algra
authors.forename: Jan
authors.initials: J
authors.lastname: van Gijn
authors.forename: Tanne G
authors.initials: TG
authors.lastname: Clark
authors.forename: Michael F G
authors.initials: MF
authors.lastname: Murphy
authors.forename: Charles P
authors.initials: CP
authors.lastname: Warlow
mesh_terms: D000368:Aged; D005260:Female; D005340:Fibrinogen / Q000032:analysis*; D006801:Humans; D002546:Ischemic Attack, Transient / Q000097:blood*; D008297:Male; D015201:Meta-Analysis as Topic; D008875:Middle Aged; D009203:Myocardial Infarction / Q000097:blood*; D016016:Proportional Hazards Models; D012307:Risk Factors; D020521:Stroke / Q000097:blood*
chemical_list: D005340:Fibrinogen