Hemostatic function and coronary artery disease.

To the Editor: The lack of an independent relationship between fibrinogen level and recurrent coronary events reported by Moss et al1 in their recent article is at variance with previous evidence linking fibrinogen to coronary artery disease in individuals with and without preexisting cardiovascular disease.2 The fibrinogen levels reported by Moss et al are high in both patients who had recurrent events (3876112 mg/dL) and in those who did not (350685 mg/dL; P,0.05; upper limit of normal for the method used, 300 mg/dL). These high values may be due, in part, to the acute phase reaction of the index infarction. If so, these values obtained 2 months after the event do not accurately represent fibrinogen levels during the mean 26-month follow-up. A strong relationship between fibrinogen and reinfarction was observed when fibrinogen was measured an average of 23.5 months after the index event.3 These findings are further supported by the consistency of previous reports linking fibrinogen to coronary artery disease and the biological plausibility of such an association (increased blood viscosity, platelet aggregation, coagulation, etc). Fibrinogen is a risk factor for infarction and reinfarction in both population-based studies and those performed on patients with preexisting cardiovascular disease.