Elevated fibrinogen levels and subsequent subclinical atherosclerosis: The CARDIA Study

David Green, Nancy Foiles, Cheeling Chan, Pamela J. Schreiner, Kiang Liu

Research output: Contribution to journalArticlepeer-review

97 Scopus citations


Objective: To determine whether elevated levels of hemostatic factors are associated with the subsequent development of subclinical cardiovascular disease. Methods: Fibrinogen, factors VII (FVII) and VIII (FVIII), and von Willebrand factor (vWF) were measured in 1396 participants in the Coronary Artery Risk Development in Young Adults (CARDIA) study. Coronary artery calcification (CAC) and carotid intimal/medial thickness (CIMT) were determined 13 years later. The adjusted prevalence of CAC and mean CIMT across the quartiles of each hemostatic factor was computed for the total sample and for each race and gender group. Results: The age-, race-, and gender-adjusted prevalences of CAC with increasing quartiles of fibrinogen were 14.4%, 15.2%, 20.0%, and 29.1% (p < 0.001 for trend). This trend persisted after further adjustment for body mass index (BMI), smoking, educational level, center, systolic blood pressure (BP), diabetes, antihypertensive medication use, total and high-density lipoprotein (HDL) cholesterol, and CRP. A similar trend was observed for CIMT (age-, race- and gender-adjusted, p < 0.001; multivariable-adjusted, p = 0.014). Further analyses of race and gender subgroups showed that increasing quartiles of fibrinogen were associated with CAC and CIMT in all subgroups except black men. The prevalence of CAC was not associated with increasing quartiles of FVII, FVIII, or vWF, suggesting they may be less involved in plaque progression. Conclusion: An elevated fibrinogen concentration in persons aged 25-37 is independently associated with subclinical cardiovascular disease in the subsequent decade.

Original languageEnglish (US)
Pages (from-to)623-631
Number of pages9
Issue number2
StatePublished - Feb 2009

Bibliographical note

Funding Information:
Source of funding: This study was supported by grant HL-43758 and contracts NO1-HC-48049 and NO1-HC-95095 from the National Heart, Lung, and Blood Institute, and grant AG032136 from the National Institute on Aging, National Institutes of Health. The funders had no role in the design and conduct of the study; collection, management, analysis, and interpretation of the data; and preparation, review, or approval of the manuscript, except as required of all studies supported by the NIH. The authors had full access to all of the data in the study and take responsibility for the integrity of the data and the accuracy of the data analysis.


  • Atherosclerosis
  • Carotid thickness
  • Coronary calcium
  • Fibrinogen
  • Hemostatic factors


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