Fibrinogen concentration and its role in CVD risk in black South Africans – effect of urbanisation

 

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Summary

The aim of this study was to investigate correlates of fibrinogen concentration in black South Africans, as well as its association with cardiovascular disease (CVD) risk and whether urbanisation influences this association. A total of 1,006 rural and 1,004 urban black South Africans from the PURE study were cross-sectionally analysed. The association of fibrinogen with CVD risk was determined by investigating the association of fibrinogen with other CVD risk markers as well as with predicted CVD risk using the Reynolds Risk score. The rural group had a significantly higher fibrinogen concentration than the urban group, despite higher levels of risk factors and increased predicted CVD risk in the urban group. Increased levels of CVD risk factors were, however, still associated with increased fibrinogen concentration. Fibrinogen correlated significantly, but weakly, with overall predicted CVD risk. This correlation was stronger in the urban than in the rural group. Multiple regression analysis showed that a smaller percentage of the variance in fibrinogen is explained by the traditional CVD risk factors in the rural than in the urban group. In conclusion, fibrinogen is weakly associated with CVD risk (predicted overall risk as well with individual risk factors) in black South Africans, and is related to the degree of urbanisation. Increased fibrinogen concentration, in black South Africans, especially in rural areas, is largely unexplained, and likely not strongly correlated with traditional CVD-related lifestyle and pathophysiological processes. This does, however, not exclude the possibility that once increased, the fibrinogen concentration contributes to future development of CVD.

• References

• 1 Pieters M, Vorster HH. Nutrition and hemostasis: a focus on urbanization in South Africa. Mol Nutr Food Res 2008; 52: 164-172.
  CrossrefPubMedGoogle Scholar
• 2 Walker AR, Walker BF, Segal I. Some puzzling situations in the onset, occurrence and future of coronary heart disease in developed and developing populations, particularly such in sub-Saharan Africa. J R Soc Promot Health 2004; 124: 40-46.
  CrossrefPubMedGoogle Scholar
• 3 Koenig W. Fibrin(ogen) in cardiovascular disease: an update. Thromb Haemost 2003; 89: 601-609.
  Article in Thieme ConnectPubMedGoogle Scholar
• 4 Kaptoge S, White IR, Thompson SG. et al. Associations of plasma fibrinogen levels with established cardiovascular disease risk factors, inflammatory markers, and other characteristics: individual participant meta-analysis of 154,211 adults in 31 prospective studies: the fibrinogen studies collaboration. Am J Epidemiol 2007; 166: 867-879.
  CrossrefPubMedGoogle Scholar
• 5 James S, Vorster HH, Venter CS. et al. Nutritional status influences plasma fibrinogen concentration: evidence from the THUSA survey. Thromb Res 2000; 98: 383-394.
  CrossrefPubMedGoogle Scholar
• 6 Lee KW, Lip GY. Effects of lifestyle on hemostasis, fibrinolysis, and platelet reactivity: a systematic review. Arch Intern Med 2003; 163: 2368-2392.
  CrossrefPubMedGoogle Scholar
• 7 Folsom AR, Wu KK, Conlan MG. et al. Distributions of hemostatic variables in blacks and whites: population reference values from the Atherosclerosis Risk in Communities (ARIC) Study. Ethn Dis 1992; 2: 35-46.
  PubMedGoogle Scholar
• 8 Folsom AR, Wu KK, Rosamond WD. et al. Prospective study of hemostatic factors and incidence of coronary heart disease: the Atherosclerosis Risk in Communities (ARIC) Study. Circulation 1997; 96: 1102-1108.
  CrossrefPubMedGoogle Scholar
• 9 Vorster HH. The emergence of cardiovascular disease during urbanisation of Africans. Public Health Nutr 2002; 5: 239-243.
  PubMedGoogle Scholar
• 10 Vorster HH, Kruger A, Venter CS. et al. Cardiovascular disease risk factors and socio-economic position of Africans in transition: the THUSA study. Cardiovasc J Afr 2007; 18: 282-289.
  PubMedGoogle Scholar
• 11 Vorster HH, Wissing MP, Venter CS. et al. The impact of urbanization on physical, physiological and mental health of Africans in the North West Province of South Afirca: the THUSA study. SA J Sci 2000; 96: 505-513.
  PubMedGoogle Scholar
• 12 The National Food Consumption Survey (NFCS).. Pretoria: Department of Health; 2000
• 13 MacIntyre UE, Venter CS, Vorster HH. A culture-sensitive quantitative food frequency questionnaire used in an African population: 1. Development and reproducibility. Public Health Nutr 2001; 4: 53-62.
  PubMedGoogle Scholar
• 14 Langenhoven ML, Kruger M, Gouws E. et al. MRC Food Composition Tables.. 3rd ed. Parow: National Research Institute for Nutritional Disease of the South African Medical Research Council; 1991
• 15 Keyes CLM. The subjective well-being of America’s youth: Toward a comprehensive assessment. Adolesc Fam Health 2005; 4: 3-11.
  PubMedGoogle Scholar
• 16 Antonovsky A. Unravelling the mystery of health: How people manage stress and stay well.. San Francisco: Jossey-Bass; 1987
• 17 Goldberg DP, Hillier VF. A scaled version of the General Health Questionnaire. Psychol Med 1979; 9: 139-145.
  CrossrefPubMedGoogle Scholar
• 18 Ridker PM, Buring JE, Rifai N. et al. Development and validation of improved algorithms for the assessment of global cardiovascular risk in women: the Reynolds Risk Score. J Am Med Assoc 2007; 297: 611-619.
  CrossrefPubMedGoogle Scholar
• 19 Nazmi A, Victora CG. Socioeconomic and racial/ethnic differentials of C-reactive protein levels: a systematic review of population-based studies. BMC Public Health 2007; 7: 212.
  CrossrefPubMedGoogle Scholar
• 20 Cushman M, McClure LA, Howard VJ. et al. Implications of elevated C-reactive protein for cardiovascular risk stratification in black and white men and women in the United States. Clin Chem 2009; 55: 1627-1636.
  CrossrefPubMedGoogle Scholar
• 21 De Maat MP. Effects of diet, drugs, and genes on plasma fibrinogen levels. Ann NY Acad Sci 2001; 936: 509-521.
  PubMedGoogle Scholar
• 22 Vorster HH, Cummings JH, Veldman FJ. Diet and haemostasis: time for nutrition science to get more involved. Br J Nutr 1997; 77: 671-684.
  CrossrefPubMedGoogle Scholar
• 23 Jern C, Eriksson E, Tengborn L. et al. Changes of plasma coagulation and fibrinolysis in response to mental stress. Thromb Haemost 1989; 62: 767-771.
  Article in Thieme ConnectPubMedGoogle Scholar
• 24 Wamala SP, Murray MA, Horsten M. et al. Socioeconomic status and determinants of hemostatic function in healthy women. Arterioscler Thromb Vasc Biol 1999; 19: 485-492.
  CrossrefPubMedGoogle Scholar
• 25 Frimerman A, Miller HI, Laniado S. et al. Changes in hemostatic function at times of cyclic variation in occupational stress. Am J Cardiol 1997; 79: 72-75.
  CrossrefPubMedGoogle Scholar