A polymorphism in the cyclooxygenase 2 gene as an inherited protective factor against myocardial infarction and stroke.
BACKGROUND
Myocardial infarction (MI) and ischemic stroke are thought to be caused by matrix digestion by metalloproteinases (MMPs) leading to rupture of atherosclerotic plaques. Production of macrophage MMP-2 and MMP-9 is induced by cyclooxygenase 2 (COX-2) and prostaglandin E(2) synthesis. Although COX-2 expression may be genetically determined, the relation between COX-2 polymorphisms and the risk of MI and stroke is unclear.


OBJECTIVE
To investigate the relationship between the -765G-->C polymorphism of the COX-2 gene and clinically evident plaque rupture.


METHODS
Prospective, matched case-control study conducted between March 2002 and October 2003 among 864 patients with first MI or atherothrombotic ischemic stroke and 864 hospitalized controls. The groups were matched for age, sex, body mass index, smoking, hypertension, hypercholesterolemia, and diabetes. The -765G-->C variant of the COX-2 gene was genotyped by restriction endonuclease digestion of polymerase chain reaction products.


METHODS
Presence of the -765G-->C polymorphism of the COX-2 gene; COX-2, MMP-2, and MMP-9 expression and activity in plaques and in peripheral monocytes; urinary 6-keto PGF1alpha (marker of endothelial prostacyclin); and endothelium-dependent and -independent forearm blood flow vasodilation.


RESULTS
The prevalence of -765GC was 2.41 times higher among controls than among cases (43.3% vs 17.9%; P<.001). The prevalence of -765CC homozygosity was 5.81 times higher (6.4% vs 1.1%; P =.04). Among participants carrying the -765GC and -765CC genotypes, the prevalence ratios for MI or stroke were 0.48 (95% CI, 0.36-0.68) and 0.33 (95% CI, 0.24-0.55), respectively. Expression of COX-2 and MMPs was significantly lower in atherosclerotic plaques from participants carrying the -765C allele, while the -765G-->C polymorphism did not affect endothelial prostacyclin biosynthesis or endothelium-dependent vasodilation in vivo. In subgroup analyses (n = 224 cases), serum high-sensitivity C-reactive protein was significantly lower in patients carrying the -765C allele (mean [SD], 0.78 [0.1] vs 2.56 [0.4] mg/L; P =.04).


CONCLUSIONS
We found that the -765G-->C polymorphism of the COX-2 gene is associated with a decreased risk of MI and stroke. Detection of this genotype may be useful for predicting genetic risk of MI and stroke.
Cipollone
Francesco
F
G. d'Annunzio University of Chieti and G. d'Annunzio University Foundation, Chieti, Italy.
Toniato
Elena
E
Martinotti
Stefano
S
Fazia
Maria
M
Iezzi
Annalisa
A
Cuccurullo
Chiara
C
Pini
Barbara
B
Ursi
Sebastiano
S
Vitullo
Gianfranco
G
Averna
Maurizio
M
Arca
Marcello
M
Montali
Anna
A
Campagna
Filomena
F
Ucchino
Sante
S
Spigonardo
Francesco
F
Taddei
Stefano
S
Virdis
Agostino
A
Ciabattoni
Giovanni
G
Notarbartolo
Alberto
A
Cuccurullo
Franco
F
Mezzetti
Andrea
A
D001161:Arteriosclerosis / Q000235:genetics / Q000378:metabolism / Q000503:physiopathology; D016893:Carotid Stenosis / Q000235:genetics / Q000378:metabolism / Q000503:physiopathology; D015331:Cohort Studies; D051546:Cyclooxygenase 2; D011464:Epoprostenol / Q000378:metabolism; D005260:Female; D005838:Genotype; D006801:Humans; D007527:Isoenzymes / Q000235:genetics* / Q000378:metabolism; D008297:Male; D020778:Matrix Metalloproteinase 2 / Q000378:metabolism; D020780:Matrix Metalloproteinase 9 / Q000378:metabolism; D008565:Membrane Proteins; D008875:Middle Aged; D009203:Myocardial Infarction / Q000453:epidemiology / Q000235:genetics*; D010641:Phenotype; D011110:Polymorphism, Genetic; D011446:Prospective Studies; D011451:Prostaglandin-Endoperoxide Synthases / Q000235:genetics* / Q000378:metabolism; D012307:Risk Factors; D020521:Stroke / Q000453:epidemiology / Q000235:genetics*
D007527:Isoenzymes; D008565:Membrane Proteins; D011464:Epoprostenol; D051546:Cyclooxygenase 2; C496540:PTGS2 protein, human; D011451:Prostaglandin-Endoperoxide Synthases; D020778:Matrix Metalloproteinase 2; D020780:Matrix Metalloproteinase 9