Plasma Fibrinogen and Silent Cerebrovascular Lesions

Abstract

[Background and purpose] Silent cerebrovascular lesions are associated with an increased risk of stroke. Although the incidence of cerebral hemorrhage has decreased in Japan, prevalence of cerebral infarction has not decreased. Fibrinogen is a major determinant of plasma viscosity. It is possible that elevated fibrinogen level is associated with the risk of cerebral infarction. We conducted a cross-sectional study to determine the association between plasma fibrinogen and cerebrovascular lesions in a general population.
[Methods] The study population consisted of 662 subjects (32.2% men, mean age 66.6 ± 5.3 years, mean plasma fibrinogen 299.8 ± 63.5 mg/dl) from a general population of rural Japanese community, Ohasama. We evaluated the association between plasma fibrinogen and silent cerebrovascular lesions [number of lacunar infarction and extent of periventricular hyperintensity (PVH)] detected by MRI.
[Results] Fibrinogen levels were significantly higher in subjects with multiple lacunar infarctions. Each 1SD (63.5 mg/dl) increase in fibrinogen was significantly associated with an increase in the risk of lacunar infarction (OR=1.29, 95% CI : 1.09-1.53) after adjustment for age, sex, smoking status, drinking status, use of antihypertensive medication, BMI, 24-h ambulatory blood pressure (24-h ABP), and a history of hypercholesterolemia, diabetes mellitus or atrial fibrillation. Twenty-four hour ABP was also significantly and independently associated with lacunar infarction. Even when 24-h ABP values were within the normal range (<135/80 mmHg), elevated fibrinogen levels were associated with an increased risk of lacunar infarction. There was no association between fibrinogen and PVH.
[Conclusion] The present results demonstrated that fibrinogen was strongly associated with risk of lacunar infarction, suggesting that fibrinogen is an independent risk factor or predictor for lacunar infarction.