Journal Article

Relationship of vitamin D, fibrinogen and their ratio with acute coronary syndrome: A comparative analysis of unstable angina, NSTEMI, and STEMI

Huma, Sarwat, Abdelraouf, Mahmoud Ezzat, Muharram, Mohamed Ahmed, Farahat, Ali Hosni, Hassan, Tamer Ahmed Fouad Mohammed, Mohamed, Reda Fakhry, Lashin, Hesham El Sayed, Metwally, Abdelrahman E., Tahir, Nafisa, Shabana, Hossam, Yasin, Ghulam, Ahmed, Marwan Sayed Mohamed, Aggour, Essam Yehia Ali, Ewis Alhawy, Ahmed Mohamed, Imam, Mohammed S., Yunus, Mohammed, Alsayyad, Mohammad Mossaad Abd Allah, Elbwab, Ahmed Farag Abd Elkader, Ashraf, Muhammad, Shalaby, Abdulrahman H., Ayoub, Hazem Sayed Ahmed, Abdelaziz, Ahmed Saeed, Ahmed, Ayman Mohamed Salem, Abotaha, Ahmed Ahmed Mohamed, Mahmoud, Mohamed Elwan Mohamed, Mahmoud, Mahmoud Saeed, Said, Ashraf Mohammed, Ali, Ahmed Ali Hassan, Ibrahim, Ahmed Mahrous Ahmed, Aladl, Hossam Aladl Aladl, Ullah, Himayat, Tayee, Kazem Mohamed, Shawky, Taiseer Ahmed

2025

Overview

There is emerging evidence suggesting that vitamin D and fibrinogen play contrasting roles in ACS pathophysiology and their combined impact, expressed as the vitamin D/fibrinogen ratio, can be a potential biomarker for ACS severity. This study aimed to investigate the relationship between vitamin D, fibrinogen, and their ratio with ACS types, and assess their potential as risk stratification biomarkers. This multicenter observational study was conducted in tertiary care hospitals in Afghanistan, Egypt, and Pakistan, including 300 ACS patients. Serum vitamin D and fibrinogen levels were measured using electrochemiluminescence immunoassay and the Clauss method, respectively. Statistical analyses included ANOVA, Kruskal-Wallis, post-hoc Games-Howell tests, Spearman's correlation, Fisher's Z-test, and multivariable logistic regression. Vitamin D levels were significantly lower (p < 0.001) and fibrinogen levels significantly higher (p < 0.001) in STEMI patients compared to NSTEMI and UA. The vitamin D/fibrinogen ratio showed a stronger correlation with ACS severity (Spearman's rho = -0.45, p = 0.01) than vitamin D alone (-0.41, p = 0.01), but this difference was not statistically significant (Fisher Z = 0.34, p = 0.73). Logistic regression revealed that a 1 nmol/L increase in vitamin D reduced ACS severity by 7.1% (p = 0.043), while a unit increase in the vitamin D/fibrinogen ratio reduced severity by 6.2% (p = 0.048). The contrasting effects of vitamin D and fibrinogen can prove useful biomarkers and modifiable risk factors for ACS. The superiority of the vitamin D/fibrinogen ratio over vitamin D only, however, needs further validation in larger studies.

• Publisher: Public Library of Science,Public Library of Science (PLoS)
• Subject: Acute coronary syndrome / Acute Coronary Syndrome - blood / Acute coronary syndromes / Aged / Alfacalcidol / Analysis / Angina / Angina, Unstable - blood / Biomarkers / Biomarkers - blood / Calcifediol / Calciferol / Care and treatment / Comparative analysis / Diagnosis / Electrochemiluminescence / Female / Fibrinogen / Fibrinogen - analysis / Fibrinogen - metabolism / Health aspects / Heart attack / Humans / Immunoassay / Male / Middle Aged / Non-ST Elevated Myocardial Infarction - blood / Observational studies / Risk factors / ST Elevation Myocardial Infarction - blood / Statistical analysis / Unstable angina / Variance analysis / Vein & artery diseases / Vitamin D / Vitamin D - blood