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(Hypertension. 2001;38:1068.)
© 2001 American Heart Association, Inc.

Scientific Contributions

Fibrinogen and Preclinical Echocardiographic Target Organ Damage

The Strong Heart Study

Vittorio Palmieri; Aldo Celentano; Mary J. Roman; Giovanni de Simone; Michael R. Lewis; Lyle Best; Elisa T. Lee; David C. Robbins; Barbara V. Howard; Richard B. Devereux; for the Strong Heart Study Investigators

From Weill Medical College of Cornell University (V.P., M.J.R., R.B.D.), New York, NY; Federico II University of Naples (A.C., G.d.S.), Italy; the University of Vermont (M.R.L.), Burlington; Aberdeen Area Tribal Chairmen’s Health Board, Rapid City (L.B.), SD; University of Oklahoma, Health Sciences Center (E.T.L.), Oklahoma City; and MedStar Research Institute (D.C.R., B.V.H.), Washington, DC.

Correspondence to Vittorio Palmieri, MD, Weill Medical College of Cornell University, Division of Cardiology, 525 E 68th St (Box 222), New York, NY 10021. E-mail vpalmier{at}med.cornell.edu

Abstract—— Relations of fibrinogen to preclinical target organ damage, such as left ventricular hypertrophy, systolic dysfunction, and increased arterial stiffness while accounting for traditional risk factors, are unknown in a population-based sample free of clinically overt coronary heart disease. Therefore, we studied clinical and echocardiographic characteristics of 2709 American Indians participating in the Strong Heart Study without symptomatic atherosclerosis. The study sample was divided into tertiles of fibrinogen (cut-points, 3.24 and 3.83 g/L). Mean age, body mass index, proportion of women, and prevalences of hypertension and diabetes increased from the first to third tertile of fibrinogen. After adjustment for covariates, systolic and pulse pressures did not significantly differ among tertiles of fibrinogen, whereas diastolic pressure was slightly lower in the third than in lower tertiles of fibrinogen. HDL cholesterol was lower and plasma creatinine and urinary albumin/creatinine ratio was higher in the third tertile of fibrinogen. Left ventricular mass index, pulse pressure/stroke index, an estimate of arterial stiffness, and cardiac index were higher and left ventricular systolic function and total peripheral resistance were lower in the third than in two lower tertiles of fibrinogen independent of major covariates. In multiple regression analyses, left ventricular mass and pulse pressure/stroke index were positively associated with, and stress-corrected midwall shortening negatively associated with fibrinogen, independent of major covariates. Participants with fibrinogen >3.83 g/L were more likely to have at least 1 preclinical cardiovascular abnormality such as left ventricular hypertrophy, elevated arterial stiffness, or systolic myocardial dysfunction independent of covariates including renal dysfunction (adjusted odds ratio, 1.38; P<0.001). Thus, in a population sample of adults without clinically overt coronary heart disease, elevated fibrinogen is an independent correlate of prognostically relevant cardiovascular target organ damage.

Key Words: fibrinogen • risk factors • cardiovascular diseases • hypertrophy • echocardiography

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