Reduced response to activated protein C is associated with increased risk for cerebrovascular disease.
BACKGROUND
Resistance to activated protein C (APC), which results from various factors, including a mutation in the gene for coagulant factor V, has been associated with increased risk for venous thrombosis. However, its relation to arterial disease is still not well defined.


OBJECTIVE
To investigate the association of both response to APC and the factor V Leiden mutation with arterial disease.


METHODS
Population-based case-control study.


METHODS
A district of Rotterdam, the Netherlands.


METHODS
115 patients with a history of myocardial infarction; 112 patients with a history of stroke, transient ischemic attack, or both; and 222 age-matched controls without arterial disease chosen from among 7983 persons in the Rotterdam Study cohort. Patients using anticoagulant drugs were excluded.


METHODS
Response to APC was determined in double-centrifuged platelet-poor plasma. Patients were genotyped for the Arg 506 to Gln mutation in the gene for coagulant factor V.


RESULTS
The prevalence of cerebrovascular disease increased gradually and corresponded to a decreasing response to APC (odds ratio per 1-unit decrease of response to APC, 1.43 [95% CI, 1.12 to 1.81], adjusted for age and sex). Adjustment for the factor V mutation did not change the findings. We found no association between response to APC and myocardial infarction or between factor V mutation and cerebrovascular disease or myocardial infarction.


CONCLUSIONS
Low response to APC is associated with an increased risk for cerebrovascular disease but not with an increased risk for myocardial infarction, independent of the factor V Leiden mutation. The association between the factor V Leiden mutation and cerebrovascular disease or myocardial infarction remains to be determined.
van der Bom
J G
JG
Department of Epidemiology and Biostatistics Erasmus University Medical School, Rotterdam, The Netherlands.
Bots
M L
ML
Haverkate
F
F
Slagboom
P E
PE
Meijer
P
P
de Jong
P T
PT
Hofman
A
A
Grobbee
D E
DE
Kluft
C
C
D000368:Aged; D000925:Anticoagulants / Q000494:pharmacology*; D016022:Case-Control Studies; D002561:Cerebrovascular Disorders / Q000209:etiology / Q000235:genetics* / Q000503:physiopathology*; D005165:Factor V / Q000235:genetics*; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D009154:Mutation; D009203:Myocardial Infarction / Q000235:genetics / Q000503:physiopathology; D016017:Odds Ratio; D011486:Protein C / Q000502:physiology*; D012306:Risk
D000925:Anticoagulants; D011486:Protein C; D005165:Factor V