Fibrinogen concentration and risk of ischemic stroke and acute coronary events in 5113 patients with transient ischemic attack and minor ischemic stroke

• Published in: Stroke (1970) Vol. 35; no. 10; pp. 2300 - 2305
• Main Authors: ROTHWELL, Peter M, HOWARD, Sally C, POWER, Dermot A, GUTNIKOV, Sergei A, ALGRA, Ale, VAN GIJN, Jan, CLARK, Tanne G, MURPHY, Michael F. G, WARLOW, Charles P
• Format: Journal Article
• Language: English
• Published: Hagerstown, MD Lippincott Williams & Wilkins 01-10-2004
• Subjects: Aged; Biological and medical sciences; Blood. Blood coagulation. Reticuloendothelial system; Female; Fibrinogen - analysis; Headache. Facial pains. Syncopes. Epilepsia. Intracranial hypertension. Brain oedema. Cerebral palsy; Humans; Ischemic Attack, Transient - blood; Male; Medical sciences; Meta-Analysis as Topic; Middle Aged; Myocardial Infarction - blood; Nervous system (semeiology, syndromes); Neurology; Pharmacology. Drug treatments; Proportional Hazards Models; Risk Factors; Stroke - blood; Vascular diseases and vascular malformations of the nervous system; Human; Stroke; Nervous system diseases; risk factors; Cardiovascular disease; Coronary heart disease; Epidemiology; Thrombosis; Cerebral disorder; Vascular disease; Prevention; Ischemia; Central nervous system disease; Risk factor; Fibrinogen; Cerebrovascular disease; stroke prevention
• ISSN: 0039-2499; 1524-4628
• DOI: 10.1161/01.STR.0000141701.36371.d1

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.
We studied unpublished data from 3 prospective studies of patients with recent transient ischemic attack (TIA) or minor ischemic stroke: the United Kingdom TIA Aspirin (UK-TIA) trial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.
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).
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.