Centre for Haematology, Faculty of Medicine, Imperial College London, London, United Kingdom.
Blood. 2012 Feb 9;119(6):1555-60. doi: 10.1182/blood-2011-09-380618. Epub 2011 Nov 22.
VWF and ADAMTS13 are major determinants of platelet adhesion after vessel injury. In the present study, we aimed to determine whether VWF or ADAMTS13 plasma antigen levels influence the risks of ischemic stroke (IS) or myocardial infarction (MI) in young women and how these risks are affected by oral contraceptive (OC) use. VWF and ADAMTS13 plasma antigen levels were measured in a frequency-matched case-control study of 1018 young (18-49 years) women including 175 IS patients and 205 MI patients. Increasing levels of VWF and decreasing levels of ADAMTS13 were associated with the risk of IS and MI in a dose-dependent manner. Having both high VWF and low ADAMTS13 resulted in an odds ratio (OR) of 6.9 (95% confidence interval [95% CI], 2.0-23.0) for IS and 11.3 (95% CI, 3.6-35.2) for MI. Use of OCs increased the risk of IS and MI associated with high VWF (OR = 12; 95% CI, 5.5-26.2 and OR = 7.5, 95% CI, 3.6-15.7, respectively) and the risk of IS associated with low ADAMTS13 (OR = 5.8, 95% CI, 2.7-12.4). We conclude that high VWF and low ADAMTS13 plasma levels both increase the risk of IS and MI. The risks associated with high VWF or low ADAMTS13 levels are further increased by the use of OCs.
血管性血友病因子（VWF）和血管性血友病因子裂解蛋白酶（ADAMTS13）是血管损伤后血小板黏附的主要决定因素。在本研究中，我们旨在确定 VWF 或 ADAMTS13 血浆抗原水平是否影响年轻女性发生缺血性卒中（IS）或心肌梗死（MI）的风险，以及这些风险如何受到口服避孕药（OC）使用的影响。在一项频率匹配的病例对照研究中，我们测量了 1018 名年轻（18-49 岁）女性（包括 175 名 IS 患者和 205 名 MI 患者）的 VWF 和 ADAMTS13 血浆抗原水平。VWF 水平升高和 ADAMTS13 水平降低与 IS 和 MI 的风险呈剂量依赖性相关。同时存在高 VWF 和低 ADAMTS13 会导致 IS 的比值比（OR）为 6.9（95%置信区间[95%CI]，2.0-23.0），MI 的 OR 为 11.3（95%CI，3.6-35.2）。OC 的使用增加了与高 VWF（OR=12；95%CI，5.5-26.2 和 OR=7.5，95%CI，3.6-15.7）相关的 IS 和 MI 风险，以及与低 ADAMTS13（OR=5.8，95%CI，2.7-12.4）相关的 IS 风险。我们得出结论，高 VWF 和低 ADAMTS13 血浆水平均增加 IS 和 MI 的风险。OC 的使用进一步增加了与高 VWF 或低 ADAMTS13 水平相关的风险。
