Rosendaal F R, Siscovick D S, Schwartz S M, Beverly R K, Psaty B M, Longstreth W T, Raghunathan T E, Koepsell T D, Reitsma P H
Department of Epidemiology, University of Washington, Seattle, USA.
Blood. 1997 Apr 15;89(8):2817-21.
Factor V Leiden (factor V Arg506Gln), the genetic defect underlying resistance to activated protein C, is the most common risk factor for venous thrombosis. The relationship between this genetic abnormality and arterial disease is still unresolved. To assess whether factor V Leiden increases the risk of myocardial infarction (MI), we conducted a population-based case-control study among women 18 to 44 years of age in western Washington state. We included 84 women with first MI and 388 control women, ie, women residing in the same area in the same age range without MI (n = 388). The control women were contacted by random digit dialing. Data on risk factor status were collected via personal interview, and data on the factor V genotype via polymerase chain reaction techniques. The factor V Leiden mutation was found more often in women with MI (10%) than among controls (4%). The odds ratio for MI was 2.4 [95% confidence interval (CI) 1.0 to 5.9]. The risk was increased fourfold (CIgs 1.2 to 12.1) when adjusted for major cardiovascular risk factors. Among nonsmokers the factor V Leiden mutation had little effect (odds ratio 1.1, CI95 0.1 to 8.5), whereas it had a large effect among smokers (odds ratio 3.6, CI95 0.9 to 14.4), which, because smoking was itself a strong risk factor for MI, led to an odds ratio for smoking carriers of the mutation that was 32-fold increased compared with nonsmoking noncarriers. We conclude that factor V Leiden increases the risk of MI in young women. This effect seems to be confined largely to current smokers.
因子V莱顿突变（因子V Arg506Gln）是导致对活化蛋白C产生抵抗的遗传缺陷，是静脉血栓形成最常见的危险因素。这种基因异常与动脉疾病之间的关系仍未明确。为了评估因子V莱顿突变是否会增加心肌梗死（MI）的风险，我们在华盛顿州西部对18至44岁的女性进行了一项基于人群的病例对照研究。我们纳入了84例首次发生心肌梗死的女性和388例对照女性，即居住在同一地区、年龄范围相同且无心肌梗死的女性（n = 388）。通过随机数字拨号联系对照女性。通过个人访谈收集危险因素状态数据，通过聚合酶链反应技术收集因子V基因型数据。在心肌梗死女性中发现因子V莱顿突变的频率（10%）高于对照组（4%）。心肌梗死的比值比为2.4 [95%置信区间（CI）1.0至5.9]。在调整主要心血管危险因素后，风险增加了四倍（CI范围1.2至12.1）。在不吸烟者中，因子V莱顿突变影响较小（比值比1.1，CI95 0.1至8.5），而在吸烟者中影响较大（比值比3.6，CI95 0.9至14.4），由于吸烟本身就是心肌梗死的一个强危险因素，这导致携带突变的吸烟者的比值比与不吸烟的非携带者相比增加了32倍。我们得出结论，因子V莱顿突变会增加年轻女性患心肌梗死的风险。这种影响似乎主要局限于目前的吸烟者。
