DETERMINANTS OF PLASMA-FIBRINOGEN - RELATION TO BODY-WEIGHT, WAIST-TO-HIP RATIO, SMOKING, ALCOHOL, AGE, AND SEX - RESULTS FROM THE 2ND MONICA AUGSBURG SURVEY, 1989-1990

In the second World Health Organization MONItoring Trends and Determinants in CArdiovascular Disease (MONICA) Augsburg survey in 1989-1990 (n=4,940), the association between nephelometric plasma fibrinogen level and lifestyle-related potential determinants was assessed in 4,434 subjects aged 25-74 years (89.8% of participants). Irrespective of pregnancy and the use of oral contraceptives, crude fibrinogen values were consistently higher in women than in men of all ages (age-standardized difference, 12.2 mg/dl; 95% confidence interval, 7.0-17.4 mg/dl). Fibrinogen concentrations were positively correlated (p less-than-or-equal-to 0.0001) with age, body mass index, and waist-to-hip ratio in both sexes and with cigarette smoking in men and were negatively correlated with alcohol consumption in both sexes. In multiple linear regression analyses using categorized determinants as independent variables, a strongly J-shaped relation for body mass index in women and a linear association for waist-to-hip ratio in men were revealed. Smoking had a dose-dependent effect on fibrinogen concentration in men but a lesser effect in women. For alcohol consumption a U-shaped association was found, particularly in men. The curvilinear relations were confirmed in multiple polynomial regression models using continuous determinant variables. The potential epidemiological impact of a determinant was assessed by calculating differences in adjusted fibrinogen concentrations associated with the 10th and 90th percentile values of the determinant distributions actually observed among the study participants. This impact on the population fibrinogen level was most pronounced for age in both sexes, followed by body mass index, cigarette smoking, and alcohol consumption in women and by smoking, waist-to-hip ratio, and alcohol consumption in men. About 29% of the total variance in female and 26% in male fibrinogen values were explained by the three lifestyle factors plus age. Our findings are consistent with the hypothesis that fibrinogen may be an etiologic link between certain lifestyle characteristics and the course of cardiovascular disease.