Genetic variation in coagulation and fibrinolytic proteins and their relation with acute myocardial infarction: a systematic review.
BACKGROUND
It is pathophysiologically conceivable that genetic variations in coagulation and fibrinolytic proteins are associated with the risk of myocardial infarction. Methods and Results- We performed a literature search to identify published case-control studies correlating the factor V Leiden or prothrombin G20210A mutations or fibrinogen G-455A or plasminogen activator inhibitor-1 (PAI-1) 4G/5G polymorphisms with the risk of myocardial infarction. Studies were included only if they used solid diagnostic criteria and complied with published methodological criteria. A common OR with corresponding 95% CI was calculated for the risk of myocardial infarction in a fixed-effect model according to Mantel-Haenszel. The factor V Leiden and prothrombin G20201A mutations did not significantly correlate with myocardial infarction (OR 1.26, 95% CI 0.94 to 1.67, P=0.12 and OR 0.89, 95% CI 0.59 to 1.35, P=0.6, respectively). Inclusion of the studies that investigated young patients (<55 years) made the association significant for factor V Leiden (OR 1.29, 95% CI 1.03 to 1.61, P=0.02). Homozygosity for the fibrinogen -455A allele was significantly associated with a decreased risk of myocardial infarction (OR 0.66, 95% CI 0.44 to 0.99, P=0.04), whereas the PAI-1 4G4G genotype was significantly associated with increased risk (OR 1.20, 95% CI 1.04 to 1.39, P=0.04).


CONCLUSIONS
Associations between these genetic variations and myocardial infarction were weak or absent. In the absence of clinical implications, our results indicate that screening of patients with myocardial infarction for these genetic variations is not warranted.
Boekholdt
S M
SM
Department of Cardiology, Academic Medical Center, Amsterdam, Netherlands.
Bijsterveld
N R
NR
Moons
A H
AH
Levi
M
M
Büller
H R
HR
Peters
R J
RJ
D006801:Humans; D001779:Blood Coagulation Factors / Q000235:genetics; D005165:Factor V / Q000235:genetics; D005340:Fibrinogen / Q000235:genetics; D014644:Genetic Variation; D009154:Mutation; D009203:Myocardial Infarction / Q000097:blood / Q000235:genetics / Q000473:pathology; D017395:Plasminogen Activator Inhibitor 1 / Q000235:genetics; D011110:Polymorphism, Genetic; D021122:Protein Subunits; D011516:Prothrombin / Q000235:genetics
D001779:Blood Coagulation Factors; D005165:Factor V; C095381:factor V Leiden; D005340:Fibrinogen; D017395:Plasminogen Activator Inhibitor 1; D021122:Protein Subunits; D011516:Prothrombin