Is this test a better biomarker for heart disease? Why don't doctors routinely test for this?
Part I
Much has been written about heart disease, such as this recent post by the Midwestern doctor. Others have also written about enzymes that break down blood clots.
In this post, I want to explore a biomarker that can provide information on blood clot risk and, thus, heart attack/stroke risk.
I divided this post into two separate posts. Friday’s substack will explain what to do if your fibrinogen level is elevated, which enzyme products are best and their differences, and how to understand the ingredient labels on serrapeptase, lumbrokinase, and nattokinase.
Fibrinogen. Why you should get this number tested to understand your CVD risk.
Fibrinogen, also called Factor 1, is a protein necessary for normal clotting and makes your blood sticky. The liver synthesizes it. High levels of fibrinogen can increase the risk of blot clots, heart disease, and strokes.
Risk Factors
People who are overweight, have type 2 diabetes or are sedentary have higher fibrinogen levels. Smoking and chronic stress are also associated with elevated fibrinogen. Croft et al. (2018) state that fibrinogen can also increase when exposed to pollution.
Cholesterol has been demonized as the root factor for CVD. Still, it was reported in the literature over 20 years ago that in the Framingham Offspring study, people with heart disease had higher fibrinogen levels than the rest of the population.
In 1987, when 1,315 participants from that study were free of heart disease, their fibrinogen levels were measured. They found that the CVD risk was related to the fibrinogen level as a separate variable away from blood pressure, smoking, diabetes, and so forth.
The published literature indicated that even if you have what is considered “high-bad-LDL” according to allopathic medicine but low fibrinogen levels, your risk of CVD is reduced to one-sixth compared to men with “high LDL” and elevated fibrinogen levels.
The studies I am citing are from the 1980s and 1990s. Thus, the published literature informed us of the importance of low fibrinogen levels in reducing CVD risk. Yet, allopathic medicine and the MSN have pushed the narrative of the dangers of elevated LDL cholesterol and the “high” total cholesterol instead.
When I search online for drugs that reduce fibrinogen, interestingly, the number one thing that pops up that will reduce fibrinogen levels is exercise. Croft et al. (2018) also stated that if fibrinogen is pollution exposure related, maintaining an omega-3- 3 EFA level above 5.12% will significantly reduce fibrinogen levels. Still, some drugs can reduce its level, such as streptokinase, which sounds much like the natural enzyme serrapeptase.
Could the lipid panel and statin narrative be more profitable than a fibrinogen test since exercise is the primary remedy for elevated fibrinogen, not a pill?
How Knowing Your Fibrinogen Level May Prevent a Cardiovascular Event
Evidence suggests that fibrinogen levels begin to rise many months, even years, before cardiovascular disease is fully present as part of the slow progressive clotting patho-physiology associated with vascular diseases [7].
The presence of fibrinogen levels in ages 27 to 35 has been singularly linked to IMT (carotid intima-media thickness, a marker for early atherosclerosis) 13 years later in the CARDIA study [7].
Therefore, it would be wise to know your fibrinogen level so that you can take necessary measures to improve your health and prevent a stroke or heart attack in the future.
The Relationship to the C-Reactive Protein Test
I always thought the CRP test was a marker for inflammation, but it could not tell you where the inflammation was in the body or the cause. For instance, I have seen people who have elevated CRP when they are heavily drinking or when they have active psoriasis. This marker decreases when the drinking has been discontinued or the psoriasis has been addressed.
However, this article in the Journal of Traditional Medicine & Clinical Naturopathy mentioned that CRP is the primary test given to patients since it is more of a CVD predictor than a fibrinogen test.
Fibrinogen and CRP are both proteins that make up plaque. The CRP test is a sensitive test for inflammation and is more predictive of cardiovascular risk than fibrinogen as suggested by many research papers [2]. Therefore, CRP is the test primarily given to patients. Fibrinogen is part of the clotting factor and there is growing evidence suggesting that its presence is equally as revealing as the CRP.
Combining the CRP and the fibrinogen test results in what is called CRP/Fibrinogen ratio, which has been shown to be more sensitive and a better predictor of CVD risk than each of these test used alone because of their higher level of sensitivity in detecting Disseminating Intravascular Coagulation (DIV), a condition where fibrin ultimately causes excessive clots leading to multiple organ failure [12].
CRP versus hs-CRP
Delving further into hs-CRP and CRP, I see that I was correct. I believe that the authors of the above quote were describing the hs-CRP test, not the CRP test.
The CRP blood test reveals your inflammation status, which can be systemic due to health conditions such as RA, obesity, or IBD.
The high-sensitivity CRP test is a more sensitive test used to assess a person’s heart disease risk. It can measure CRP (a protein produced by the liver in response to inflammation) at much lower levels than the standard test. Elevated levels of the hs-CRP can indicate inflation in the arteries.
Therefore, if you want to assess your heart disease/stroke risk, it may be better to get a hs-CRP (not the CRP) and fibrinogen test done at the same time.
What is a Healthy Fibrinogen Level?
Clotting is not always a bad thing. If a clot forms at the site of a broken or cut blood vessel, it can save your life. But if the clot develops inside a blood vessel in the absence of a wound or trauma, it can be deadly.
The Framingham study defined high fibrinogen levels as 1.3 to 7.0 g/L (126 to 696 mg/dL).
According to UCSF, as of February 2023, normal levels are considered 2.0 to 4.0 g/L (200 to 400 mg/dL), a more narrow range than what was used in the 1987 study.
Therefore, in the study, a fibrinogen level of 1.7 g/L would be considered high, and according to the UCSF information, that level would be regarded as low.
So which is it?
The Optimal DX site uses functional lab test ranges based on research findings. They have updated the functional fibrinogen range and suggest a healthy range of 175-300 mg/dL (5.15-8.82 umol/L) based on research from Ang et al. (2017), Danesh et al. (2005) and Liu et al. (2020).
This range slightly differs from the allopathic range. For instance, if your test result were 399 mg/dL, allopathic medicine would consider this just within the optimal range, but for functional practitioners, this level would be considered elevated.
Even if you are healthy, your fibrinogen level can rise by 25 mg/dL every decade.
An elevated level can suggest not only a cardiovascular risk but also systemic inflammation, IBD, pollution exposure, acute inflammation, stroke, trauma, severe illness, and RA.
While low optimal levels are preferred, our bodies strive for balance, not highs nor lows. Thus, lower than 175 mg/dL may suggest liver disease, malnutrition, or advanced cancer or can be caused by certain medications such as anabolic steroids. Low levels may also be associated with recurrent miscarriages.
The fibrinogen test is called Fibrinogen Activity, Clauss. I can order this for you via Fullscript, and you will get the blood drawn at a Quest Diagnostic location. I am unsure if you have a Fullscript account under my name that you can go into your account and order directly. You can try it.
The test is $12.13 at FS. You can also order the test directly from Direct Labs for $39.00. Fasting is not required.
Stay tuned for Part II of the Fibrinogen post on what to do if your fibrinogen level is elevated, which fibrinolytic enzyme is best, and how to read the ingredient labels of these enzyme products to make the best choice.
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