Fibrinogen-to-albumin ratio and risk of thrombotic diseases incidence

The fibrinogen-to-albumin ratio (FAR) is linked to cardiovascular diseases, but its association with thrombotic diseases in the general population remains unclear. To investigate the relationship between FAR and thrombotic diseases and assess their dose-response association. This prospective cohort study included 18,208 participants (mean age 53.2 years, 41.9% female) from the Xifei community cohort (2011–2021). Participants were categorized into FAR quintiles (Q1–Q5). Restricted cubic spline and Cox regression models were used to assess the associations between FAR and thrombotic risk. Over follow-up of 8 years, 1,373 thrombotic events occurred. Compared to the group of lowest FAR, the group of highest FAR showed significantly increased risks of combined arterial and venous thrombosis (HR = 1.36, 95% CI 1.08–1.70), arterial thrombosis (HR = 1.35, 1.07–1.70), and stroke (HR = 1.36, 1.06–1.76). Risks for acute myocardial infarction, venous thromboembolism, deep venous thrombosis, and pulmonary embolism were not statistically significant. A nonlinear dose-response relationship between FAR and thrombotic risk was observed. Higher baseline FAR was associated with an elevated risk of arterial and venous thrombosis, arterial thrombosis, and stroke, whereas associations with acute myocardial infarction and venous outcomes (VTE, DVT, and PE) were not statistically significant. These findings suggest that FAR may be a useful biomarker for thrombotic risk assessment in the general population. Fibrinogen-to-Albumin Ratio (FAR) has been demonstrated in numerous studies to be associated with various cardiovascular diseases. However, there remains a significant gap in our understanding of the relationship between FAR and the incidence of thrombotic disorders in the general population, particularly in the absence of large-scale prospective clinical research with long-term follow-up. Is baseline FAR associated with the risk of incident thrombotic diseases in a community-based general population? In this prospective community-based cohort study, higher baseline FAR was associated with a modestly increased risk of arterial thrombotic outcomes, particularly arterial thrombosis and stroke. Associations with acute myocardial infarction and venous thromboembolic events were not consistently significant after full adjustment and should be interpreted cautiously. These findings suggest that FAR, as a composite biomarker derived from routine laboratory parameters, may help identify individuals at higher risk of arterial thrombotic events in the general population. Further studies are needed to confirm its potential role in risk stratification and clinical decision-making.