DISTRIBUTION AND CORRELATES OF PLASMA-FIBRINOGEN IN MIDDLE-AGED WOMEN- INITIAL FINDINGS OF THE POSTMENOPAUSAL ESTROGEN-PROGESTIN INTERVENTIONS (PEPI) STUDY

Fibrinogen levels have been reported in cohort and case-control studie s to be positively related to the development of coronary heart diseas e. This report presents the distribution and determinants of fibrinoge n in women enrolling in a 3-year randomized trial of hormone replaceme nt therapy (HRT), the Postmenopausal Estrogen/Progestin Interventions (PEPI) trial. Fasting plasma fibrinogen levels were measured in 874 po stmenopausal women, aged 45 to 65 years, who had not used HRT for at l east 3.5 months. Mean (+/-SD) fibrinogen level was 2.83+/-0.45 g/L. Th ere was a significant positive association between fibrinogen and age (P=.03). Significantly higher (P<.005) fibrinogen levels were seen in current smokers versus nonsmokers (2,94 versus 2.81 g/L), in women who reported consuming fewer than 12 alcoholic drinks in the 12 months be fore the baseline visit versus higher consumption (2.90 versus 2.79 g/ L), and in women who reported never versus ever having used HRT (2.90 versus 2.77 g/L). Self-reported leisure time physical activity (LTPA) was negatively associated (P=.0001) with fibrinogen levels as follows: inactive (2.84 g/L), light (2.89 g/L), moderate (2.80 g/L), and heavy (2.60 g/L), with significantly (P=.0001) lower levels in women who re ported heavy LTPA versus each of the other categories and in women rep orting moderate versus light LTPA. A strong positive correlation was f ound between fibrinogen and body mass index (BMI) (r=.32; P<.0001). In a model that included age, smoking, alcohol intake, prior HRT, LTPA, and BMI, LTPA was no longer a statistically significant predictor of f ibrinogen level, while associations with other variables remained sign ificant. Fibrinogen was positively associated (P<.001) with waist, hip , and thigh girths and waist-to-hip ratio, but these relationships wer e no longer significant after adjustment for BMI. In contrast, negativ e associations with HDL cholesterol (r=-.25; P<.001) and positive asso ciations with LDL cholesterol (r=.16; P<.001) remained significant (P< .01 and P<.05, respectively) after simultaneous adjustment for age, sm oking, alcohol, prior HRT, LTPA, and BMI. Statistically significant un ivariate associations between fibrinogen and triglycerides, insulin an d glucose levels before and after oral glucose, and blood pressure wer e not seen in multivariate analyses. In summary, higher fibrinogen lev els were shown to be significantly and independently related to severa l major lifestyle and physical characteristics known to be associated with increased risk of cardiovascular disease in women.