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(Circulation. 2000;101:e195.)
© 2000 American Heart Association, Inc.

Circulation Electronic Pages

Hemostatic Function and Coronary Artery Disease

John B. Kostis, MD; Clifton R. Lacy, MD

Department of Medicine, UMDNJ-Robert Wood Johnson Medical School, New Brunswick, NJ

	Introduction

 
To the Editor:

The lack of an independent relationship between fibrinogen level and recurrent coronary events reported by Moss et al¹ in their recent article is at variance with previous evidence linking fibrinogen to coronary artery disease in individuals with and without preexisting cardiovascular disease.² The fibrinogen levels reported by Moss et al are high in both patients who had recurrent events (387±112 mg/dL) and in those who did not (350±85 mg/dL; P<0.05; upper limit of normal for the method used, 300 mg/dL). These high values may be due, in part, to the acute phase reaction of the index infarction. If so, these values obtained 2 months after the event do not accurately represent fibrinogen levels during the mean 26-month follow-up. A strong relationship between fibrinogen and reinfarction was observed when fibrinogen was measured an average of 23.5 months after the index event.³ These findings are further supported by the consistency of previous reports linking fibrinogen to coronary artery disease and the biological plausibility of such an association (increased blood viscosity, platelet aggregation, coagulation, etc). Fibrinogen is a risk factor for infarction and reinfarction in both population-based studies and those performed on patients with preexisting cardiovascular disease.

	References

 
1. Moss AJ, Goldstein RE, Marder VJ, et al. Thrombogenic factors and recurrent coronary events. Circulation. 1999;99:2517–2522.[Abstract/Free Full Text]

2. Danesh J, Collins R, Appleby P, et al. Association of fibrinogen, C-reactive protein, albumin, or leukocyte count with coronary heart disease: meta-analyses of prospective studies. JAMA. 1998;279:1477–1482.[Abstract/Free Full Text]

3. Kostis JB, Baughman DJ, Kuo PT. Association of recurrent myocardial infarction with hemostatic factors: a prospective study. Chest. 1982;81:571–575.[Abstract/Free Full Text]

Response

Arthur J. Moss, MD; Robert E. Goldstein, MD; Victor J. Marder, MD; Charles E. Sparks, MD; David Oakes, PhD; Henry Greenberg, MD; Jarvey J. Weiss, MD; Wojciech Zareba, MD, PhD; Mary W. Brown, MD; Chang-Seng Liang, MD; Edgar Lichstein, MD; William C. Little, MD; John A. Gillespie, MD; Lucy Van Voorhees, MD; Ronald J. Krone, MD; Monty M. Bodenheimer, MD; Judith Hochman, MD; Edward M. Dwyer, Jr, MD; Rohit Arora, MD; Frank I. Marcus, MD; Luc F. Miller Watelet, PhD; Robert B. Case, MD

University of Rochester Medical Center Rochester, NY

	Introduction

 
We thank Drs Kostis and Lacy for their comments and focus on fibrinogen. Our post-myocardial infarction cohort^R1 differed considerably from the one reported by Kostis et al^R2 in terms of size of population (1045 versus 147 patients), number of cardiac end points (81 versus 20), average enrollment time after infarction (2 months . . . [Full Text of this Article]