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Level of fibrinogen and risk of fatal and non-fatal stroke. EUROSTROKE: a collaborative study among research centres in Europe
  1. M L Bots1,2,
  2. P C Elwood3,
  3. J T Salonen4,
  4. A Freire de Concalves5,
  5. J Sivenius6,
  6. A Di Carlo7,
  7. Y Nikitin8,
  8. V Benetou9,
  9. J Tuomilehto10,
  10. P J Koudstaal11,
  11. D E Grobbee1,2
  1. 1Epidemiology and Biostatistics, Erasmus University Medical School, Rotterdam, the Netherlands
  2. 2Julius Centre for General Practice and Patient Oriented Research, University Medical Centre Utrecht, Utrecht, the Netherlands
  3. 3MRC Epidemiology Unit, Llandough Hospital, Penarth, South Glamorgan, UK
  4. 4Research Institute of Public Health, University of Kuopio, Kuopio, Finland
  5. 5Neurology, Hospitais da Universidade de Coimbra, Coimbra, Portugal
  6. 6Department of Neurology, University of Kuopio, Kuopio, Finland
  7. 7National Research Council of Italy (CNR-CSFET) Italian Longitudinal Study on Ageing, Florence, Italy
  8. 8Russian Academy of Medical Sciences Siberian Branch, Institute of Internal Medicine, Novosibirsk, Russia
  9. 9Hygiene and Epidemiology, University of Athens Medical School, Athens, Greece
  10. 10Epidemiology and Health Promotion, National Public Health Institute, Helsinki, Finland
  11. 11Neurology, University Hospital Rotterdam Dijkzigt, Rotterdam, the Netherlands
  1. Correspondence to:
 Dr M L Bots, Julius Centre for General Practice and Patient Oriented Research, University Medical Centre Utrecht, room D01.335, Heidelberglaan 100, 3584 CX Utrecht, the Netherlands;


Background: It is well established that raised levels of fibrinogen increase the risk of coronary heart disease. For stroke, however, data are much more limited and restricted to overall stroke. This study investigated the association between fibrinogen and fatal, non-fatal, haemorrhagic and ischaemic stroke in three European cohorts participating in EUROSTROKE.

Methods: EUROSTROKE is a collaborative project among ongoing European cohort studies on incidence and risk factors of stroke. EUROSTROKE is designed as a nested case-control study. For each stroke case, two controls were sampled. Strokes were classified according to MONICA criteria or reviewed by a panel of four neurologists. Recently, data on stroke and fibrinogen became available from cohorts in Cardiff (79 cases/194 controls), Kuopio (74/124), and Rotterdam (62/203). Results were adjusted for age, sex, smoking, and systolic blood pressure.

Results: The risk of stroke gradually increased with increasing fibrinogen levels: the odds ratios per quartile increase were 1.08 (95% CI 0.63 to 1.84), 1.91 (1.12 to 3.26) and 2.78 (1.64 to 4.72), respectively. This association was similar for ischaemic (n=138) and haemorrhagic stroke (n=25). Associations between fibrinogen and stroke were similar across strata of smoking, diabetes mellitus, previous myocardial infarction, and HDL cholesterol. The odds ratio, however, tended to increase with increasing systolic blood pressure: from 1.21 among those with a systolic pressure <120 mm Hg to 1.99 among subjects with a systolic pressure of 160 mm Hg or above.

Conclusion: This analysis of the EUROSTROKE project indicates that fibrinogen is a powerful predictor of stroke. Results did not disclose a differential in this relation of fibrinogen and fatal or non-fatal stroke, or with type of stroke (ischaemic or haemorrhagic).

  • cohort
  • blood pressure, lipids

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  • Funding: EUROSTROKE is supported by grant BMH1-CT93-1786 from the European Community BIOMED I programme and by grant CIPD-CT94-0256 from the European Community PECO programme.