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Background  Elevated levels of fibrinogen may contribute to a prothrombotic state. Cross-sectional studies suggest fibrinogen possibly linked with MetS/its components, while results of cohort studies remain controversial. Thus, this study was designed to identify the association of plasma fibrinogen with metabolic syndrome (MetS) and further to clarify the role of fibrinogen in the development of MetS.    Methods  A large-scale prospective cohort study was conducted in routine health check-up population. 6209 participants free of MetS at baseline were included in the original cohort, with annually routine health check-up for incident MetS from 2005 to 2011. Then, 4 pre-MetS sub-cohorts, with overweight, hypertension, hyperglycemia and dyslipidemia at baseline respectively, were also created from the original cohort. Various strategies of Cox model analysis were performed for attempting to confirm the role of fibrinogen in the development of MetS.    Results  Total MetS incidence density was 75.58 per 1000 person-years. Cox regression analysis by adjusting for potential confounders as well as four MetS components showed a significant effect of fibrinogen on MetS just in female, with risk ratio (RR) (95 % CI) of 1.48 (1.02, 2.13) for Q4 vs. Q1. Further analysis in the 4 pre-MetS female sub-cohorts revealed this significant effect only in overweight sub-cohort, with RR (95 % CI) of 1.97 (1.20, 3.23), but no significant interaction of overweight with fibrinogen on MetS was revealed in original female cohort. Then, stratification analysis among the 4 sub-groups of fibrinogen quartiles showed that effects of overweight on MetS were different among the 4 sub-groups of fibrinogen quartiles, with RR of 2.98 for Q1, 4.40 for Q2, 3.93 for Q3, and 4.82 for Q4 respectively.    Conclusions  Fibrinogen was associated with MetS just in overweight sub-cohort of female individuals, and fibrinogen might be a potential modifier in the pathway from overweight to MetS.    Electronic supplementary material  The online version of this article (doi:10.1186/s13098-015-0103-7) contains supplementary material, which is available to authorized users.

diabetology and metabolic syndrome

A new insight into the role of plasma fibrinogen in the development of metabolic syndrome from a prospective cohort study in urban Han Chinese population