Inherited thrombophilia as a risk factor for the development of ischemic stroke in young adults.
BACKGROUND
Several recent studies have analyzed a possible effect of thrombophilia risk factors such as factor V Leiden, the prothrombin variant (allele 20210 A), and homozygosity for thermolabile methylenetetrahydrofolate reductase (MTHFR-T) on the development of ischemic stroke (IS). In the present study, we determined the role of these prothrombotic polymorphisms in the early onset of arterial IS or cerebral venous thrombosis (CVT) in a group of young Brazilian adults of Caucasian and African descent.


METHODS
We conducted a cross-sectional study of 167 survivors of IS (153 patients with arterial IS and 14 cases of CVT; 66 men: 101 women; 124 of Caucasian and 43 of African origin; median age: 32.6 years; range: 15 to 45 years) and compared the prevalence of inherited thrombophilia risk factors with a control group of 225 sex and age matched individuals of the same ethnic background. To determine the interaction with atherogenic risk factors, the following diagnoses were considered: hypertension, hyperlipoproteinemia, diabetes mellitus, smoking status and use of oral contraceptives.


RESULTS
In the arterial IS group, no significant variation was found between patients and controls of Caucasian origin regarding the prevalence of factor V Leiden (P = 0.92), the prothrombin variant (P = 0.13) or homozygosity for MTHFR-T (P = 0.61). Among Brazilians of African descent, 10.3% were homozygous for MTHFR-T, which was significantly elevated, odds ratio of 5.9 (95% CI: 0.88 to 49.15). In the CVT group, two Caucasian patients (20%) were heterozygous for the prothrombin variant, odds ratio of 9.7 (95% CI: 0.95 to 89.71) and one patient was carrier of factor V Leiden (P = 0.49). No prothrombotic polymorphism was identified in patients with CVT of African descent. All women in the CVT group were in use of oral contraceptives or in the post-partum state.


CONCLUSIONS
Inherited thrombophilia risk factors were not found to increase the risk of arterial IS among young patients of Caucasian descent. However, a potential role of homozygosity for MTHFR-T was observed in a small group of patients of African origin. The analysis of patients with CVT revealed an increased risk due to the prothrombin gene variant or oral contraceptive use. Further studies including all incoming patients with IS are necessary to evaluate the impact of inherited thrombophilia risk factors on early mortality.
Voetsch
B
B
Department of Neurology, State University of Campinas, São Paulo, Brazil.
Damasceno
B P
BP
Camargo
E C
EC
Massaro
A
A
Bacheschi
L A
LA
Scaff
M
M
Annichino-Bizzacchi
J M
JM
Arruda
V R
VR
D000293:Adolescent; D000328:Adult; D000349:Africa / Q000208:ethnology; D000483:Alleles; D001158:Arteries / Q000473:pathology; D001938:Brazil / Q000453:epidemiology; D003276:Contraceptives, Oral / Q000009:adverse effects; D003430:Cross-Sectional Studies; D005165:Factor V / Q000235:genetics; D005192:Family Health; D005260:Female; D005787:Gene Frequency; D014644:Genetic Variation; D006720:Homozygote; D006801:Humans; D007511:Ischemia / Q000453:epidemiology / Q000235:genetics*; D008297:Male; D042965:Methylenetetrahydrofolate Reductase (NADPH2); D008875:Middle Aged; D000587:Oxidoreductases Acting on CH-NH Group Donors / Q000235:genetics; D017354:Point Mutation; D049590:Postpartum Period; D011247:Pregnancy; D015995:Prevalence; D011516:Prothrombin / Q000235:genetics; D012307:Risk Factors; D020521:Stroke / Q000453:epidemiology / Q000235:genetics*; D019851:Thrombophilia / Q000453:epidemiology / Q000235:genetics*; D014652:Vascular Diseases / Q000453:epidemiology / Q000235:genetics; D044465:White People / Q000235:genetics
D003276:Contraceptives, Oral; C095381:factor V Leiden; D005165:Factor V; D011516:Prothrombin; D000587:Oxidoreductases Acting on CH-NH Group Donors; D042965:Methylenetetrahydrofolate Reductase (NADPH2)