Fibrinogen as a cardiovascular risk factor--interrelationship with infections and inflammation.

Epidemiological evidence suggests that fibrinogen represents a major cardiovascular risk factor. Clinical data is in full agreement with this hypothesis. As fibrinogen also represents an acute phase protein, its association with atherosclerosis could be linked to infection or inflammation of other organs. Moreover, it could be connected to the inflammatory phenomena of atherosclerosis itself. These two possible explanations for the link between fibrinogen and atherosclerosis are discussed in detail. On balance, the evidence for either is not fully convincing. Therefore the most likely explanation for the striking association between fibrinogen and cardiovascular events is that hyperfibrinogenaemia is causally related to atherothrombosis, independent of its role as an acute phase protein. Several plausible pathophysiological pathways exist which would explain how fibrinogen leads to major cardiovascular disease. It is concluded that fibrinogen is a cardiovascular risk factor in its own right; its measurement should be included in future cardiovascular risk profiles.