OBJECTIVES: To determine plasma fibrinogen level in type 2 diabetic
patients with and without coronary heart disease (CHD) and to find
relationship of fibrinogen with glycemic control and lipid profile in
METHODS: A cross-sectional / analytical study was performed among
the outdoor and indoor patients visiting Khyber Teaching Hospital and
Hayatabad Medical Complex, Peshawar, Pakistan. The study consisted
of two groups. Group A was comprised of 100 type 2 diabetic patients
without CHD and group B was comprised of 100 type 2 diabetic patients
with CHD. Biochemical analysis of samples was carried out in
the Research laboratory of Biochemistry Department, Khyber Medical
College, Peshawar. Plasma fibrinogen level was measured by clotting
method and statistical analysis was done on SPSS 19 soft ware.
RESULTS: Mean plasma fibrinogen level was 413.44±139.75 mg/dL
& 478.63±165.97 mg/dL was observed in group-A & group-B respectively
(p<0.05). Mean fasting blood sugar was 175.61±59.13 mg/dL &
213.80±91.62 mg/dL in group-A & group-B respectively (p<0.05). Mean
HbA1C in group-A and group-B was 8.308±3.03% & 10.166±3.452%
respectively (p<0.05). A strong positive association of fibrinogen was
seen with serum triglycerides (p<0.01), total cholesterol (p<0.05) and
body mass index (p<0.01).
CONCLUSION: Fibrinogen levels are elevated in type 2 diabetic patients
with and without coronary heart disease. Moreover, hyperfibrinogenemia
is associated with serum cholesterol, serum triglycerides and BMI
in these patients.
KEY WORDS: Fibrinogen (MeSH); Diabetes Mellitus (MeSH); Hemoglobin
A, Glycosylated (MeSH); Body Mass Index (MeSH); Hyperlipidemias
(MeSH); Cholesterol (MeSH); Triglycerides (MeSH)
MN Chatergee, Rana Shinde. Text Book
of Medical Biochemistry (seventh edition).
Arjuna YN, Jaypee Brothers Medical Publishers,
New Delhi, 2007, P 321
Pai KJ, Pischon T, Jing MA, Manson JE,
Susan EH, Joshipura K, et al. Inflammatory
markers and the risk of coronary heart
disease in men and women. N Engl Med
; 351: 2599-610.
Bombed AS. A study of plasma Fibrinogen
level in Type-2 Diabetes Mellitus and its
relation to Glycemic control. Indian J
Hematol Blood Transfuse 2012; 28(2):
Shera AS, Basit A, Fawwad A, Hakeem R,
Ahmedani MY, Hydrie MZ, et al. Pakistan
National Diabetes Survey: prevalence of
glucose intolerance and associated factors
in the Punjab Province of Pakistan. Prim
Care Diabetes 2010; 4: 79-83.
Skyler J. Diabetic complications: the importance
of glucose control. Endocrinol
Metab Clin North Am 1996; 25: 243-54.
Davis TM, Fortun P, Mulder J, Davis WA,
Bruce DG. Silent myocardial infarction
and its prognosis in a community based
cohort of type 2 diabetic patients; the
Fremantle diabetes study. Diabetologia
Rubin R, Strayer DDS, Rubin E. Rubin’s Pathology:
of Medicine. Maryland: Lippincott Williams
and Wilkins, 2001, p. 549.
Sanidas EA, Vauranakis M, Papaioannou
TG, Carlier S, Syros G, Dangas G, et al.
Study of atheromatous plaque using intravascular
ultrasound. Hellenic J Cardiol
; 49: 415-21.
Vogiatzi G, tousoulis D, Stefanadis C. The
role of oxidative stress in atherosclerosis,
Hellenic J Cardiol 2009; 50: 402-9.
Kampoli A-M, Tousoulis D, Antoniades
C, Siasos G, Stefanadis C. Biomarkers of
premature atherosclerosis. Trends Mol
Papageorgiou N, Tousoulis D, Siasos G,
Stefandis C. Is fibrinogen a marker of
inflammation in coronary artery diseases?
Hellenic J Cardiol 2010; 51: 1-9.
De Maat MP. Effects of diet, drugs and
genes on plasma fibrinogen level. Ann N
Y Acad Sci 2001; 936: 509-21.
Ilyas S, Waheed U, Saboor M. Coagulation
abnormalities in diabetes mellitus. J Public
Health Biol Sci 2013; 2(4):308-12.
Lee AJ, Lowe GD, Smith WC, Tunstall-Pedoe
H. Plasma fibrinogen in women:
relationship with oral contraception, the
menopause and hormone replacement
therapy. Br J Haematol 1993; 83(4):
Nadeem A, Naveed AK, Hussain MM, Raza
SI. Correlation of inflammatory markers
with type 2 diabetes mellitus in Pakistani
patients. J Postgrad Med Inst 2013; 27(3):
Laurens N, Koolwijhk P, de Maat MP. Fibrin
structure and wound healing. J Thromb
Haemost 2006; 4: 932-9.
Naito M, Funaki C, Hayashi T, Yamada
K, Asai K, Yoshimine N et al. Substrate
bound fibrinogen, fibrin and other cell attachment-
promoting proteins as a scaffold
for cultured vascular smooth musckle cell.
Atherosclerosis 1992; 96: 227-34.
Schulze MB, Rimm EB, Li T, Rifai N,
Stamfer MJ, Hu FB. C-reactive protein
and incident cardiovascular events among
men with diabetes. Diabete Care 2004;
Dandona P, Alijada A. A rational approach
to pathogenesis and treatment of type 2
diabetes mellitus, insulin resistance inflammation
and atherosclerosis. Am J Cardiol
; 90: 27-33.
Kafle DR, Shrestha P. Study of fibrinogen
in patients with diabetes mellitus. Nepal
Med Coll J 2010; 12(1):34-7.
Cristobal JJR, Grote CA, Mercade PT,
Santos JMP, Sendra EP, Lloret AM et al.
Randomised clinical trial of an intensive
intervention in the primary care setting
of patients with high plasma fibrinogen in
the primary prevention of cardiovascular
disease. BMC Research Notes 2012; 5:
Guidelines on fibrinogen assays. Br J Haematol
: 121 (3): 396-404.
Sjohoim A, Nyström T. Endothelial inflammation
in insulin resistance. Lancet 2005;
Venkataramana G, Indira P; Rao DVM.
Changes of plasma total proteins, albumin
and fibrinogen in type 2 diabetes mellitus:
A pilot study. Indian Journal of Basic &
Applied Medical Research; June 2013:
Issue-7, Vol.-2, P. 679-85.
Fuster V, Badimon L, Badimon J. Chesebro
J. The pathogenesis of coronary artery disease
and the acute coronary syndromes.
N Engl J Med. 1992; 326: 242-50.
Lyer MU, Desai P. Assesment of C-reactive
protein and fibrinogen level in type
diabetes mellitus. Biomed Res 2010;21: 208-13.
Alzahrani SH, Ajjan RA. Coagulation and
fibrinolysis in diabetes. Diab Vasc Dis Res
; (4): 260-73.
Mohamed RA, Abdrabo AA, Muddathir
AM. The Association between Microalbuminuria
and Plasma Fibrinogen Levels in
type 2 diabetic Sudanese patients. American
Journal of Research Communication,
, 1(10): 69-75.
Stratmann B, Tschoepe D. Atherogenesis
and atherothrombosis-focus on diabetes
mellitus. Best Pract Res Clin Endocrinol
Metab 2009; 23: 291-303.
Martin-Timon I, Collantes SC, Galindo AS,
Gomez FJC. Type 2 diabetes and cardiovascular
disease: Have all risk factors the
same strength? World J Diabetes 2014;
Hong LF, Li XL, Luo SH, Guo YL, Zhu
CG, Qing P, et al. Association of fibrinogen
with severity of stable coronary artery
disease in patients with type 2 diabetes
mellitus. Disease Markers 2014, Article
ID 485687, 8 pages. http:// dx. Doi.
Bosevski M, Bosevska G, Stojanovska L.
Influence of fibrinogen and C-RP on progression
of peripheral arterial disease in
type 2 diabetes: a preliminary report. Cardiovascular
Diabetology 2013; 12: 29-34.
Rana JS, Cote M, Despris JP, Sandhu MS,
Talmud PJ, Ninio E, et al. Inflammatory
biomarker and the prediction of coronary
events among people at intermediate risk
the EPIC–Norfolk prospective population
study. Heart 2009; 95: 1682-7.
Madhu SV, Kumar V, Gambhir JK. Plasma
fibrinogen in patients with type 2 diabetes
mellitus with and without macrovascular
disease and its relationship with endothelial
function, carotid intima media thickness
and dyslipidemia. Int J Diabetes In Developing
Countries. 2011; 31(3): 143-8.
Bembdi AS. A study of plasma fibrinogen
level in type-2 diabetes mellitus and its
relation to glycemic control. Indian J Hematol
Blood Transfus 2012; 28(2): 105-8.
Lowe G, Woodward M, Hillis G, Rumley
A, Li Q, Harrap S, et al. Circulating inflammatory
markers and the risk of vascular
complications and mortality in people with
type 2 diabetes and cardiovascular disease
or risk factors: The ADVANCE Study.
Diabetes 2014;63(3): 1115-23.
Lawlor DA, Smith GD, Rumley A, Lowe
GDO, Ebrahim S. Association of fibrinogen
and C-reactive protein with prevalent
and incident coronary heart disease are
attenuated by adjustment for confounding
factors. British Women’s Heart and Health
study. Thromb Haemost 2005; 93: 955-63.
Theodore Mazzone. Intensive glucose
lowering and cardiovascular disease
prevention in diabetes: Reconciling the
recent clinical trial data. Circulation 2010;
Mohan V, Venkatraman JV, Pradeepa R.
Epidemiology of cardiovascular disease
in type 2 diabetes: the Indian scenario. J
Diabetes Sci Technol 2010; 4(1): 158-70.
Stec JJ, Silbershatz H, Tofler GH, Matheney
TH, Sutherland P, Lipinska L, et al. Association
of fibrinogen with cardiovascular
risk factors and cardiovascular disease
in the Framingham off spring population.
Circulation 2000; 102: 1634-8.
Ernst E, Resch KL. Fibrinogen as a cardiovascular
risk factor. A meta analysis and
review of the literature. Ann Intern Med
; 118: 956-63.
Kaptoge S, Angelantonio ED, Pennells L,
Wood AM, Ian R, Peri G, et al. C-reactive
protein, fibrinogen and cardiovascular
disease prediction. New Engl J Med 2012;
Work published in KMUJ is licensed under a
Authors are permitted and encouraged to post their work online (e.g., in institutional repositories or on their website) prior to and during the submission process, as it can lead to productive exchanges, as well as earlier and greater citation of published work.