{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,14]],"date-time":"2026-09-14T01:34:40Z","timestamp":1789349680274,"version":"build-2803163510"},"reference-count":28,"publisher":"Public Library of Science (PLoS)","issue":"9","license":[{"start":{"date-parts":[[2025,9,5]],"date-time":"2025-09-05T00:00:00Z","timestamp":1757030400000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":["www.plosone.org"],"crossmark-restriction":false},"short-container-title":["PLoS One"],"abstract":"<jats:sec id=\"sec001\">\n<jats:title>Background<\/jats:title>\n<jats:p>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.<\/jats:p>\n<jats:p>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.<\/jats:p>\n<\/jats:sec>\n<jats:sec id=\"sec002\">\n<jats:title>Methods<\/jats:title>\n<jats:p>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\u2019s correlation, Fisher\u2019s Z-test, and multivariable logistic regression.<\/jats:p>\n<\/jats:sec>\n<jats:sec id=\"sec003\">\n<jats:title>Results<\/jats:title>\n<jats:p>Vitamin D levels were significantly lower (p\u2009&lt;\u20090.001) and fibrinogen levels significantly higher (p\u2009&lt;\u20090.001) in STEMI patients compared to NSTEMI and UA. The vitamin D\/fibrinogen ratio showed a stronger correlation with ACS severity (Spearman\u2019s rho\u2009=\u2009\u22120.45, p\u2009=\u20090.01) than vitamin D alone (\u22120.41, p\u2009=\u20090.01), but this difference was not statistically significant (Fisher Z\u2009=\u20090.34, p\u2009=\u20090.73). Logistic regression revealed that a 1 nmol\/L increase in vitamin D reduced ACS severity by 7.1% (p\u2009=\u20090.043), while a unit increase in the vitamin D\/fibrinogen ratio reduced severity by 6.2% (p\u2009=\u20090.048).<\/jats:p>\n<\/jats:sec>\n<jats:sec id=\"sec004\">\n<jats:title>Conclusion<\/jats:title>\n<jats:p>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.<\/jats:p>\n<\/jats:sec>","DOI":"10.1371\/journal.pone.0331853","type":"journal-article","created":{"date-parts":[[2025,9,5]],"date-time":"2025-09-05T17:35:25Z","timestamp":1757093725000},"page":"e0331853","update-policy":"https:\/\/doi.org\/10.1371\/journal.pone.corrections_policy","source":"Crossref","is-referenced-by-count":1,"title":["Relationship of vitamin D, fibrinogen and their ratio with acute coronary syndrome: A comparative analysis of unstable angina, NSTEMI, and 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