Plasma fibrinogen is not measured routinely in clinical practice for prediction of cardiovascular disease (CVD) but further modest advances in the research investigating fibrinogen and CVD may make this a reality. First, agreement must be reached on the most appropriate method of measurement in clinical practice taking account of the type of fibrinogen to be assayed, the sources and degree of measurement variability, the development of standards and the financial costs. Secondly, further information is required on the value of plasma fibrinogen as a useful risk marker in the primary and secondary prediction of future cardiovascular events. There is a need to express risks in a format which is useful to the general public and to clinicians, and which takes account of associated risks of cigarette smoking, blood pressure, and serum lipids. Finally, the effectiveness of lowering plasma fibrinogen levels in patients with CVD is not yet established. Fibrate drugs are warranted in patients with high-risk lipid profiles, but their effects on cardiovascular outcome due to lowering of plasma fibrinogen await the results of current randomized trials.