Fibrinogen as a Prognostic Biomarker in Patients with Type 2 Diabetes with Coronary Artery Disease: A Propensity-matched Study
Ekow Essien, Abena Agyekum, Gloria Amoako, Samuel B. GovernorAbstract
Background:
Elevated fibrinogen is associated with increased cardiovascular risk; however, its prognostic significance in patients with coexisting type 2 diabetes mellitus (T2DM) and coronary artery disease (CAD) is not well established.
Aim:
The aim is to evaluate whether elevated fibrinogen levels are independently associated with increased 5-year risk of all-cause mortality and major cardiovascular and renal events in patients with T2DM and established CAD, using a large propensity-matched real-world cohort.
Methods:
We conducted a retrospective cohort study using the TriNetX Global Collaborative Network (130 healthcare organizations). Adults aged 18–90 years with T2DM and CAD were stratified by fibrinogen level into high (≥401 mg/dL) and low (≤400 mg/dL) groups. After propensity score matching, 92,684 patients were included in each cohort and followed for 5 years. The primary outcome was all-cause mortality. Secondary outcomes included heart failure, acute kidney injury (AKI), ventricular tachycardia, cerebrovascular disease, pulmonary embolism, acute myocardial infarction (AMI), and chronic kidney disease (CKD).
Results:
The high-fibrinogen cohort had greater 5-year mortality compared with the low-fibrinogen cohort (36.6% vs. 30.7%; hazard ratio [HR]: 1.267, 95% confidence interval [CI]: 1.247–1.287;
Conclusion:
Among patients with T2DM and CAD, elevated fibrinogen independently predicts increased mortality and major cardiovascular and renal events, supporting its role as a prognostic biomarker in this high-risk population.