Key result
Elevated sialylated fibrinogen linked to ~2.5-fold higher ischemic stroke risk in recent T2D.
Why the study?
Stroke is a major cause of death in type 2 diabetes, and while fibrinogen predicts stroke risk, whether specific fibrinogen variants can improve prediction was unknown.
Do elevated levels of total fibrinogen and its variants predict the development of ischemic stroke in patients with recently diagnosed type 2 diabetes?
Case-Control (n=288)
Yes
Do elevated levels of total fibrinogen and its variants predict the development of ischemic stroke in patients with recently diagnosed type 2 diabetes?
Elevated absolute levels of total fibrinogen, fibrinogen γ′, and sialylated fibrinogen are associated with an approximately 2-fold increased risk of ischemic stroke in patients with recently diagnosed type 2 diabetes.
Answers are grounded in this paper and cite their sources.
Should not yet change stroke risk assessment in new T2D; leaves open incremental value of sialylated fibrinogen over standard predictors.
Background Stroke is a major cause of death globally, especially in type 2 diabetes (T2D) patients. Fibrinogen is known to predict stroke risk, but fibrinogen is a highly variable protein and we hypothesized that fibrinogen variants can improve stroke prediction. Objectives To investigate the association of total fibrinogen and fibrinogen variants with risk of ischemic stroke in T2D patients. Methods In a nested case-control study with a median follow-up of 4.1 years, we included 144 T2D patients with ischemic stroke (cases) and 144 matched T2D patients without ischemic stroke (controls). We measured total fibrinogen, absolute and relative (ratio between variant and total fibrinogen) levels of three fibrinogen variants (fibrinogen α E , fibrinogen γ′, and sialylated fibrinogen) and compared levels between cases and controls. We used logistic regression to determine the association with stroke risk. Results Total fibrinogen and absolute levels of fibrinogen α E , fibrinogen γ′, and sialylated fibrinogen were higher in stroke cases than controls (total fibrinogen 3.55 and 3.44 g/l; fibrinogen α E : 8.95 and 8.55 µg/ml; fibrinogen γ′: 638 and 626 µg/ml; sialylated fibrinogen: 1.32 and 1.18 arbitrary units). Absolute levels of fibrinogen positively associated with risk of stroke, both for total fibrinogen (highest vs lowest tertile; adjusted odds ratio (OR) 1.9 (95% CI 0.9-4.2)), fibrinogen γ′ (OR 1.8 (0.8-3.8)), and sialylated fibrinogen (OR 2.5 (1.1-5.8)). Relative levels of fibrinogen variants did not convincingly associate with stroke risk. Conclusion Patients with T2D who developed stroke had increased levels of total fibrinogen, fibrinogen α E , fibrinogen γ′, and sialylated fibrinogen compared with T2D controls. Total fibrinogen and absolute, but not relative, levels of fibrinogen γ′ and sialylated fibrinogen prospectively associated with a 2-fold increased risk of ischemic stroke.
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Daugaard et al. (2024) conducted a case-control in Type 2 diabetes (n=288). Sialylated fibrinogen (highest tertile) vs. Sialylated fibrinogen (lowest tertile) was evaluated on Ischemic stroke (OR 2.5, 95% CI 1.1-5.8). Absolute levels of sialylated fibrinogen were associated with a 2.5-fold increased risk of ischemic stroke compared to the lowest tertile in patients with recently diagnosed type 2 diabetes.
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