Fibrinogen and preclinical echocardiographic target organ damage - The strong heart study

Relations of fibrinogen to preclinical target organ damage, such as left ve ntricular hypertrophy, systolic dysfunction, and increased arterial stiffne ss while accounting for traditional risk factors, are unknown in a populati on-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 athero sclerosis. The study sample was divided into tertiles of fibrinogen (cut-po ints, 3.24 and 3.83 g/L). Mean age, body mass index, proportion of women, a nd prevalences of hypertension and diabetes increased from the first to thi rd tertile of fibrinogen. After adjustment for covariates, systolic and pul se pressures did not significantly differ among tertiles of fibrinogen, whe reas diastolic pressure was slightly lower in the third than in lower terti les of fibrinogen. HDL cholesterol was lower and plasma creatinine and urin ary albumin/creatinine ratio was higher in the third tertile of fibrinogen. Left ventricular mass index, pulse pressure/stroke index, an estimate of a rterial stiffness, and cardiac index were higher and left ventricular systo lic function and total peripheral resistance were lower in the third than i n two lower tertiles of fibrinogen independent of major covariates. In mult iple regression analyses, left ventricular mass and pulse pressure/stroke i ndex were positively associated with, and stress-corrected midwall shorteni ng 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 independe nt of covariates including renal dysfunction (adjusted odds ratio, 1.38; P <0.001). Thus, in a population sample of adults without clinically overt co ronary heart disease, elevated fibrinogen is an independent correlate of pr ognostically relevant cardiovascular target organ damage.