title: The plasminogen activator inhibitor (PAI-1) 4G/5G promoter polymorphism and PAI-1 levels in ischemic stroke. A case-control study.
abstract: High levels of plasminogen activator inhibitor type 1 (PAI-1) have been implicated as a risk factor for cardiovascular disease, but its precise role remains controversial. The 4G allele of the PAI-1 4G/5G promoter polymorphism is associated with higher levels of PAI-1. We studied the relationship between ischemic stroke and the PAI-1 4G/5G polymorphism and PAI-1 antigen levels. We performed a case-control study among patients aged 18-75 years with first ischemic stroke, confirmed by CT. All patients were screened for cardiovascular risk factors, cardiac disorders and large vessel disease. We excluded patients with a definite non-atherosclerotic cause of the stroke and patients using oral anticoagulants. Population-controls were age -and sex-matched, without a history of stroke, and of the Caucasian race. Venous blood samples were taken for PAI-1 4G/5G polymorphism and PAI-1 level one week after stroke. We included 124 patients and 125 controls. Mean age was 56 yrs (range 18 to 75 yrs). Sixty one patients (50%) and 58 (47%) controls were heterozygous for the PAI-1 4G/5G polymorphism. The homozygous 4G/4G genotype was found in 33 patients (27%) and in 36 controls (29%). The odds ratio of ischemic stroke associated with 4G-carriers versus 5G/5G homozygotes was 1.0 (95% CI: 0.6-1.8). The relative risk of ischemic stroke associated with the level of PAI-1 in the upper quartile was 0.73 (95%CI: 0.4 to 1.4). Neither the PAI-1 4G/5G polymorphism nor the PAI-1 antigen level is a strong risk factor for ischemic stroke.
authors.affiliation: Erasmus Medical Center Rotterdam, Department of Neurology, PO Box 2040, 3000 CA Rotterdam, The Netherlands. m.vangoor@erasmusmc.nl
authors.forename: Mary-Lou
authors.initials: ML
authors.lastname: van Goor
authors.forename: Encarna
authors.initials: E
authors.lastname: Gómez García
authors.forename: Frank
authors.initials: F
authors.lastname: Leebeek
authors.forename: Geert-Jan
authors.initials: GJ
authors.lastname: Brouwers
authors.forename: Peter
authors.initials: P
authors.lastname: Koudstaal
authors.forename: Diederik
authors.initials: D
authors.lastname: Dippel
mesh_terms: D000328:Adult; D000368:Aged; D002545:Brain Ischemia; D016022:Case-Control Studies; D005260:Female; D020022:Genetic Predisposition to Disease; D005838:Genotype; D006801:Humans; D008297:Male; D008875:Middle Aged; D017395:Plasminogen Activator Inhibitor 1 / Q000097:blood / Q000235:genetics*; D011110:Polymorphism, Genetic; D011401:Promoter Regions, Genetic / Q000235:genetics*; D011446:Prospective Studies; D020521:Stroke / Q000097:blood / Q000235:genetics*
chemical_list: D017395:Plasminogen Activator Inhibitor 1