Levels of Plasma Fibrinogen and D-Dimer in Patients with Impaired Fasting Glucose

Abstract

Background: Cardiovascular risk associated with impaired fasting glucose has been examined in various studies with conflicting results. During the last 10 years, several risk markers for atherosclerosis such as fibrinogen and D-dimer have been identified. The present study was designed to evaluate plasma fibrinogen and D-dimer levels in patients with impaired fasting glucose compared with normal subjects and those with type 2 diabetes mellitus.

Methods: Age-, sex-, and body mass index-matched 30 normal subjects, 30 patients with impaired fasting glucose (fasting glucose 110 to 125 mg/dl), and 30 patients with type 2 diabetes mellitus (fasting glucose ≥ 126 mg/dl) were included in the study.

Results: The levels of plasma fibrinogen in patients with type 2 diabetes mellitus, impaired fasting glucose, and normal subjects were 449 (306 - 605) mg/dl, 348 (264 - 468) mg/dl, and 216 (179 - 260) mg/dl, respectively. Patients with impaired fasting glucose had significantly lower plasma fibrinogen levels than patients with type 2 diabetes mellitus (p < 0.05). There were significantly higher plasma fibrinogen levels in patients with impaired fasting glucose than in normal subjects (p < 0.05). The levels of plasma D-dimer in patients with type 2 diabetes mellitus, impaired fasting glucose, and normal subjects were 615 (505 - 768) mg/l, 518 (412 - 664) mg/l, and 424 (356 - 557) mg/l, respectively. Patients with impaired fasting glucose had significantly lower plasma D-dimer levels than patients with type 2 diabetes mellitus (p < 0.05). There were significantly higher plasma D-dimer levels in patients with impaired fasting glucose than in normal subjects (p < 0.05). The levels of plasma fibrinogen and D-dimer were related to fasting glucose in type 2 diabetes mellitus and impaired fasting glucose groups (p < 0.05). We also detected positive correlation between plasma fibrinogen levels and age in study groups (p < 0.05).

Conclusion: Our data suggest that patients with impaired fasting glucose pose a hypofibrinolytic status and cardiovascular risk, although this was lower than in patients with type 2 diabetes mellitus.

Key words

Impaired fasting glucose - fibrinogen - D-dimer - cardiovascular risk

References

• 1 American Diabetes Association . Report of the expert committees on the diagnosis and classification of diabetes mellitus.  Diabetes Care. 1997;  20 1183-1197
• 2 Balkau B, Bertrais S, Ducimetiere P, Eschwege E. Is there a glycemic threshold for mortality risk?.  Diabetes Care. 1999;  22 696-699
• 3 Bjørnholt J V, Erikssen G, Aaser E, Sandvik L, Nitter-Hauge S, Jervell J. et al . Fasting blood glucose: an underestimated risk factor for cardiovascular death. Results from a 22-year follow-up of healthy diabetic men.  Diabetes Care. 1999;  22 45-49
• 4 Crook M A, Goldsmith L, Ameerally P, Lumb P, Singh N, Miell J. et al . Serum sialic acid, a possible cardiovascular risk factor is not increased in Fijian Melanesians with impaired glucose tolerance or impaired fasting glucose.  Ann Clin Biochem. 2002;  39 606-608
• 5 Ernst E, Koenig W. Fibrinogen and cardiovascular risk.  Vasc Med. 1997;  2 115-125
• 6 Heinrich J, Assmann G. Fibrinogen and cardiovascular risk.  J Cardiovasc Risk. 1995;  2 197-205
• 7 Henry P, Thomas F, Benetos A, Guize L. Impaired fasting glucose blood pressure and cardiovascular mortality.  Hypertension. 2002;  40 458-463
• 8 Knobl P, Schernthaner G, Schnack C, Pietschmann P, Proidl S, Prager R, Vukovich T. Hemostatic abnormalities persist despite glycaemic improvement by insulin therapy in lean type 2 diabetic patients.  Thromb Haemost. 1994;  71 692-697
• 9 Lip G Y, Lowe G D. Fibrin D-dimer: a useful clinical marker of thrombogenesis?.  Clin Sci. 1995;  89 205-214
• 10 Lip G Y, Blaan A D, Jones A F, Lip P L, Beevers D G. Relation of endothelium, thrombogenesis, and hemorheology in systemic hypertension to ethnicity and left ventricular hypertrophy.  Am J Cardiol. 1997;  80 1566-1571
• 11 Long Z F, Qu G Y, Xu M. Relationship between the level of plasma D-dimer and diabetic microangiopathy.  Hunan Yi Ke Da Xue Xue Bao. 2001;  26 434-438
• 12 Mansfield M W, Heywood D M, Grant P J. Circulating levels of factor VII, fibrinogen, and von Willebrand factor and features of insulin resistance in first-degree relatives of patients with NIDDM.  Circulation. 1996;  94 2171-2176
• 13 Meade T W, Mellows S, Bozovic M. Haemostatic function and ischemic heart disease: principal results of the Northwick Park Heart Study.  Lancet. 1986;  2 533-537
• 14 Meigs J B, Mittleman M A, Nathan D M, Tofler G H, Singer D E, Murphy-Sheehy P M. et al . Hyperinsulinemia, hyperglycemia, and impaired hemostasis: the Framingham Offspring Study.  JAMA. 2000;  283 221-228
• 15 Scheidt-Nave C, Barrett-Connor E, Wingard D L, Cohn B A, Edelstein S L. Sex differences in fasting glycemia as a risk factor for ischaemic heart disease death.  Am J Epidemiol. 1991;  133 565-576
• 16 Shihabi Z K, Konen J C, Mc Cormick C P. Plasma fibrinogen levels in type II diabetics.  Clin Physiol Biochem. 1990;  8 297-300
• 17 Smith F B, Lee A J, Fowkes F G, Price J F, Rumley A, Lowe G D. Hemostatic factors as predictors of ischemic heart disease and stroke in the Edinburgh Artery Study.  Arterioscler Thromb Vasc Biol. 1997;  17 3321-3325
• 18 The DECODE Study Group . Consequence of the new diagnostic criteria for diabetes in older men and women.  Diabetes Care. 1999;  22 1667-1671
• 19 Tominaga M, Eguchi H, Manaka H, Igarashi K, Kato T, Sekikawa A. Impaired glucose tolerance is a risk factor for cardiovascular disease, but not impaired fasting glucose. The Funagata Diabetes Study.  Diabetes Care. 1999;  22 920-924
• 20 Weitzman S. Impaired fasting glucose is not a risk factor for cardiovascular mortality.  Diaberes Care. 1999;  22 2104