title: Genetic variants of coagulation factor XIII, postmenopausal estrogen therapy, and risk of nonfatal myocardial infarction.
abstract: We hypothesized that possession of either of 2 functional coagulation factor XIII polymorphisms, one within subunit A (Val34Leu) and one within subunit B (His95Arg), might modulate the prothrombotic effects of estrogen and help to explain the variation in incidence of arterial thrombotic events among postmenopausal women using hormone replacement therapy. In a population-based case-control study of 955 postmenopausal women, we assessed the associations of factor XIII genotypes and their interactions with estrogen therapy on risk of nonfatal myocardial infarction (MI). The presence of the factor XIIIA Leu34 allele was associated with a reduced risk of MI (odds ratio [OR] = 0.70, 95% confidence interval [95% CI] = 0.51-0.95). The presence of the factor XIIIB Arg95 allele had little association with MI risk. Neither factor XIII polymorphism alone significantly modified the association between the risk of MI and current estrogen use. In exploratory analyses, however, there was a significant factor XIII subunit gene-gene interaction. Compared to women homozygous for both common factor XIII alleles, the Arg95 variant was associated with a reduced risk of MI in the presence of the Leu34 variant (OR = 0.36, 95% CI = 0.17-0.75) but not in the absence of the Leu34 variant (OR = 1.11, 95% CI = 0.69-1.79). Moreover, among women who had at least 2 copies of the variant factor XIII alleles and were current estrogen users, the risk of MI was reduced by 70% relative to estrogen nonusers with fewer than 2 factor XIII variant alleles (P value for interaction =.03). If confirmed, these findings may permit a better assessment of the cardiovascular risks and benefits associated with postmenopausal estrogen therapy.
authors.affiliation: Cardiovascular Health Research Unit, Department of Epidemiology, University of Washington, 1730 Minor Ave, Suite 1360, Seattle, WA 98101-1448, USA. apreiner@u.washington.edu
authors.forename: Alexander P
authors.initials: AP
authors.lastname: Reiner
authors.forename: Susan R
authors.initials: SR
authors.lastname: Heckbert
authors.forename: Hans L
authors.initials: HL
authors.lastname: Vos
authors.forename: Robert A S
authors.initials: RA
authors.lastname: Ariëns
authors.forename: Rozenn N
authors.initials: RN
authors.lastname: Lemaitre
authors.forename: Nicholas L
authors.initials: NL
authors.lastname: Smith
authors.forename: Thomas
authors.initials: T
authors.lastname: Lumley
authors.forename: Thomas D
authors.initials: TD
authors.lastname: Rea
authors.forename: Lucia A
authors.initials: LA
authors.lastname: Hindorff
authors.forename: Gina D
authors.initials: GD
authors.lastname: Schellenbaum
authors.forename: Frits R
authors.initials: FR
authors.lastname: Rosendaal
authors.forename: David S
authors.initials: DS
authors.lastname: Siscovick
authors.forename: Bruce M
authors.initials: BM
authors.lastname: Psaty
mesh_terms: D000328:Adult; D000368:Aged; D016022:Case-Control Studies; D015914:Estrogen Replacement Therapy; D004967:Estrogens / Q000494:pharmacology / Q000627:therapeutic use; D005176:Factor XIII / Q000235:genetics*; D005260:Female; D005838:Genotype; D006801:Humans; D008875:Middle Aged; D009203:Myocardial Infarction / Q000209:etiology* / Q000235:genetics; D016017:Odds Ratio; D011110:Polymorphism, Genetic; D021122:Protein Subunits / Q000235:genetics; D012307:Risk Factors
chemical_list: D004967:Estrogens; D021122:Protein Subunits; D005176:Factor XIII