Background

Cardiovascular disease (CVD) is responsible for up to a third of deaths in patients with COPD¹. Fibrinogen predicts mortality in COPD² but is also a well-known marker of CVD. The extent to which it reflects cardiovascular risk in COPD is uncertain.

Aims

We investigated how plasma fibrinogen level predicted future risk of cardiovascular event (CVE) among patients with COPD.

Methods

We included subjects enrolled in the London COPD exacerbation cohort from 1995-2022. Follow-up was from first baseline fibrinogen measurement until last recorded study interaction. Archived records identified baseline characteristics and incidence of CVE (myocardial infarction (MI) or stroke/transient ischaemic attack (TIA)). We used Kaplan-Meier curves and Cox proportional hazards models to compare event free survival in subjects with a fibrinogen level of ?3.5g/L versus <3.5g/L.

Results

437 subjects were followed for a median of 1140 days (IQR 416-2159). 116 (27%) had known CVD. During follow-up MI and stroke/TIA occurred in 16(4%) and 10(2%) subjects respectively. Those with fibrinogen ?3.5g/L had a shorter CVE-free survival on log-rank test (all CVE P=0.001, MI P=0.009, stroke/TIA P=0.03). From Cox proportional hazards model adjusted for age, smoking and sex, acute CVE risk was higher among those with baseline fibrinogen ?3.5g/L relative to <3.5g/L (HR 4.46, 95%CI:1.63-12.25, P=0.004).

Conclusions

In patients with COPD an elevated plasma fibrinogen level indicated higher future CVE risk. Known links between fibrinogen and mortality in COPD might, in part, be driven by this. Fibrinogen could be a useful biomarker for cardiovascular risk in COPD.

1.Berry, C.E. et al. COPD 2010;7(5):375-82

2.Mannino, D.M. et al. COPD 2015;2(1):23-34