Fibrinogen as a prognostic biomarker in patients with type 2 diabetes with coronary artery disease: A propensity-matched study

Abstract

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; P < 0.001). Elevated fibrinogen was also associated with higher risks of heart failure (HR: 1.119), AKI (HR: 1.242), cerebrovascular disease (HR: 1.127), AMI (HR: 1.204), and CKD (HR: 1.186) (all P < 0.001).

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.

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