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I have read with great interest the article entitled "Early Markers of Atherosclerotic
Disease in Individuals with Excess Weight and Dyslipidemia" by Menti et al.1 recently published in Arquivos
Brasileiros de Cardiologia 2016; 106: 457-63. The investigators reported
that fibrinogen is associated with subclinical atherosclerosis in individuals with
excess weight.1
Several studies have shown that high serum levels of fibrinogen are strongly associated
with coronary artery disease.2,3 High serum levels of fibrinogen may
contribute to vascular disease by increasing blood viscosity, stimulating fibrin
formation, or increasing platelet-platelet interaction.2,3
Catena et al.4 reported that plasma
homocysteine (Hcy) levels were directly correlated with age, waist circumference,
fasting glucose, triglyceride, uric acid, and fibrinogen levels, and inversely
correlated with creatinine clearance and high-density lipoprotein cholesterol, vitamin
B12, and folate levels. Low vitamin B12 concentration and hyperhomocysteinemia are
common, and might affect serum fibrinogen levels.
25-hydroxyvitamin D [25(OH)D] deficiency with increased risks of cardiovascular disease
and venous thromboembolism may relate to adverse hemostatic and inflammatory responses.
Blondon et al.5 reported that low
levels of serum [25(OH)D] were cross-sectionally associated with higher levels of
interleukin-6, homocysteine, total tissue factor pathway inhibitor and plasminogen
activator inhibitor-1.
In light of these findings, it might be beneficial to evaluate serum levels of vitamin
B12, Hcy, and [25(OH)D] because of their close association with fibrinogen levels.
References
1.Menti E, Zaffari D, Galarraga T, Lessa JR, Pontin B, Pellanda LC, et al. Early markers of atherosclerotic disease in individuals with
excess weight and dyslipidemia. Arq Bras Cardiol. 2016;106(6):457–463. doi: 10.5935/abc.20160060. [DOI] [PMC free article] [PubMed] [Google Scholar]
2.Folsom AR, Wu KK, Rosamond WD, Sharrett AR, Chambless LE. Prospective study of hemostatic factors and incidence of coronary
heart disease: the Atherosclerosis Risk in Communities (ARIC)
Study. Circulation. 1997;96(4):1102–1108. doi: 10.1161/01.cir.96.4.1102. [DOI] [PubMed] [Google Scholar]
3.Heinrich J, Balleisen L, Schulte H, Assmann G, Loo J. Fibrinogen and factor VII in the prediction of coronary risk:
results from the PROCAM study in healthy men. Arterioscler Thromb. 1994;14(1):54–59. doi: 10.1161/01.atv.14.1.54. Erratum in: Arterioscler Thromb. 1994;14(8):1392. [DOI] [PubMed] [Google Scholar]
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inflammatory biomarkers in the multi-ethnic study of
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We were honored by your interest in our article entitled "Early Markers of
Atherosclerotic Disease in Individuals with Excess Weight and
Dyslipidemia" published in Arquivos Brasileiros de
Cardiologia.
The finding of high fibrinogen levels in patients with atherosclerotic disease has
generated a large volume of clinical evidences in the past few decades, and has been
considered a risk marker for cardiovascular events. High fibrinogen levels are also
known to promote atherosclerotic disease by increasing blood viscosity, stimulating
fibrin formation and increasing platelet aggregation. In the setting of an
inflammatory status such as that seen in individuals with excess weight, the higher
hepatic production of fibrinogen regulated by inflammatory cytokines may be an
important link in the progression of the atherosclerotic disease in its different
subclinical and clinical stages. Our study had a small sample size, however large
enough to bring this association to light.1
As regards the assessment of serum levels of vitamin B12 and vitamin D, in a recent
study with a small sample, Baser et al2 observed the association of vitamin D deficiency with high
fibrinogen levels and pro-oxidative serum markers. Vitamin B12 deficiency, by
hyperhomocysteinemia induction, also plays a role in the development of
cardiovascular disease. Every 5-mcmol/L increase above 10 mcmol/L in serum levels of
homocystein is associated with a 20% increase in the risks of circulatory
disorders.3
Although the assessment of changes in endothelial function in patients with vitamin
B12 and vitamin D deficiency had not been included in this study, it is a promising
research field. In a study with a small sample assessing endothelial function using
flow-mediated brachial artery dilatation in patients with vitamin B12 deficiency,
increased dilatation after proper vitamin B12 replacement was observed.4 A similar finding was observed in a
sample of individuals undergoing hemodialysis after vitamin D replacement.5
We thank Dr. Cerit's remarks and are satisfied to stimulate discussion regarding this
important field of clinical cardiology, which has been a frequent concern in daily
practice, in view of the growing incidence of obesity among our society.
Eduardo Menti
References
1.Menti E, Zaffari D, Galarraga T, Lessa JR, Pontin B, Pellanda LC, et al. Early markers of atherosclerotic disease in individuals with
excess weight and dyslipidemia. Arq Bras Cardiol. 2016;106(6):457–463. doi: 10.5935/abc.20160060. [DOI] [PMC free article] [PubMed] [Google Scholar]
2.Baser H, Can U, Baser S, Hidayetoglu BT, Aslan U, Buyuktorun I, et al. Serum total oxidant/anti-oxidant status, ischemia-modified
albumin and oxidizedlow density lipoprotein levels in patients with
vitamin D deficiency. Arch Endocrinol Metab. 2015;59(4):318–324. doi: 10.1590/2359-3997000000055. [DOI] [PubMed] [Google Scholar]
3.Pawlak R. Is vitamin B12 deficiency a risk factor for cardiovascular
disease in vegetarians? Am J Prev Med. 2015;48(6):e11–e26. doi: 10.1016/j.amepre.2015.02.009. [DOI] [PubMed] [Google Scholar]
4.Kwok T, Qiao M, Tam L, Poon YK, Ahuja AT, et al. Vitamin B-12 supplementation improves arterial function in
vegetarians with subnormal vitamin B-12 status. J Nutr Health Aging. 2012;16(6):569–573. doi: 10.1007/s12603-012-0036-x. [DOI] [PubMed] [Google Scholar]
5.Karakas Y, Sahin G, Urfali FE, Bal C, Degirmenci NA, Sirmagul B. Effect of vitamin D supplementation on endothelial
dysfunction in hemodialysis patients. Hemodial Int. 2016 Jun 29; doi: 10.1111/hdi.12439. Epub ahead of print. [DOI] [PubMed] [Google Scholar]
