Diabetes

Hemorheological disorders in diabetes mellitus

The objective of the present study is to review hemorheological disorders in diabetes mellitus. Several key hemorheological parameters, such as whole blood viscosity, erythrocyte deformability, and aggregation, are examined in the context of elevated blood glucose level in diabetes. The erythrocyte deformability is reduced, whereas its aggregation increases, both of which make whole blood more viscous compared to healthy individuals. The present paper explains how the increased blood viscosity adversely affects the microcirculation in diabetes, leading to microangiopathy.

Fibrinogen and cardiovascular risk

The hypothesis that fibrinogen is closely related to cardiovascular risk has been strengthened through the results of various lines of research, which this review will aim to unravel. Several prospective epidemiological studies convincingly show elevated fibrinogen to represent a major, independent cardiovascular risk factor. Cross-sectional studies strongly associate fibrinogen and conventional cardiovascular risk factors. Clinical cohort studies demonstrate that increased fibrinogen is also a risk factor for the sequelae of cardiovascular disease. Our knowledge about the determinants of the variable plasma level of fibrinogen in health and disease is incomplete. Understanding of the mechanisms that might be involved in the atherothrombogenic action of fibrinogen is also fragmentary. Fibrinogen strongly affects blood coagulation, blood rheology and platelet aggregation. In addition, it has direct effects on the vascular wall and is a prominent acute phase reactant. All of these phenomena might constitute pathophysiological mechanisms involved in the association between fibrinogen and cardiovascular events. Their relative importance is unclear at present. Even though many crucial questions await conclusive answers, little doubt exists that fibrinogen represents a major, independent risk factor.

Fibrinogen: an important risk factor for atherothrombotic diseases

Epidemiological follow-up studies have suggested that fibrinogen is a major, primary cardiovascular risk factor. Cross-sectional results also show associations between fibrinogen and cardiovascular risk factors or diseases. Clinical cohort studies demonstrate that fibrinogen might also be a secondary risk factor. The determinants of the plasma level of fibrinogen in health and disease are known only incompletely. Our understanding of the mechanisms involved in the atherogenic actions of fibrinogen is similarly fragmentary. These might include blood coagulation, blood rheology, platelet aggregation, direct effects on the vascular wall, and the acute phase response. Thus, many questions are yet to be answered. Nevertheless, the data available at present strongly suggest that fibrinogen represents a major, independent cardiovascular risk factor. Fibrinogen should be considered for screening programmes aimed at identifying individuals at risk.

Fibrinogen: its emerging role as a cardiovascular risk factor

Several epidemiologic studies have produced longitudinal data identifying fibrinogen as a major cardiovascular risk factor. Cross-sectional results show strong associations between fibrinogen and cardiovascular risk factors or diseases. Clinical cohort studies demonstrate that fibrinogen might also be a risk factor for the sequelae of cardiovascular disease. At present, knowledge about the determinants of the plasma level of fibrinogen in health and disease is incomplete. Understanding of the mechanisms that might be involved in the atherogenic action of fibrinogen is also fragmentary. Fibrinogen strongly affects blood coagulation, blood rheology, and platelet aggregation, and in addition it has direct effects on the vascular wall and is a prominent acute-phase reactant. All of these phenomena might provide some insight into the pathophysiologic mechanisms involved in the association between fibrinogen and cardiovascular events. Even though many crucial questions await answers, it is concluded that fibrinogen represents a major, independent risk factor that should be considered for screening programs aimed at identifying individuals at high risk for cardiovascular disease.

Plasma fibrinogen--an independent cardiovascular risk factor

Apart from being an acute phase reactant, fibrinogen appears to play an important although not widely recognized role in athero-/thrombogenesis. Arteriosclerotic diseases are associated with elevated levels of plasma fibrinogen. Strategies that lower the cardiovascular risk also lower fibrinogen levels. Virtually all accepted risk factors are associated with hyperfibrinogenaemia, while low risk populations usually have low fibrinogen levels. Epidemiological studies show that fibrinogen is a predictor of arteriosclerotic diseases. Its predictive power seems to be as high as or higher than accepted risk factors. These findings and other circumstantial, as well as experimental, evidence suggest that fibrinogen is a powerful, independent cardiovascular risk factor.