Association between estrogen receptor alpha gene polymorphisms and early restenosis after eversion carotid endarterectomy and carotid stenting.
OBJECTIVE
Our aim was to identify the role of PvuII and XbaI polymorphisms of the ESR1 (estrogen receptor alpha) gene in the occurrence of early restenosis after carotid endarterectomy and carotid artery stenting.


METHODS
In a non-randomized prospective study we analysed blood samples from 172 patients (105 men) with severe stenosis of the internal carotid artery, using the PCR-RFLP method. Patients were treated either by carotid endarterectomy (n=82) or carotid artery stenting (n=90), and were followed-up by ultrasonography with a median follow-up time of 12 months (7.32-14.65 months). Conventional laboratory parameters were also recorded. Restenosis (>50%) rates were compared between patients carrying different genotypes and risk factors were calculated by using multivariate logistic regression.


RESULTS
Allelic frequencies were similar between sexes (C/T allele, 0.40/0.60 and 0.43/0.57; p=0.67; G/A allele, 0.35/0.65 and 0.32/0.68; p=0.65; in men and women, respectively). Significantly higher restenosis rate was observed in patients homozygous for the A-allele of the XbaI polymorphism as compared to carriers of AG and GG genotypes (23.4% vs. 10.5%, p=0.02). TT and TC genotypes of the PvuII polymorphism were also associated with greater restenosis rate, as compared with genotype CC (19.3% vs. 3.1%, p=0.02). Associations for both polymorphisms were more expressed in women and in CEA patients. At multivariate analysis, T-A haplotype was a predictor of restenosis in the whole patient cohort (adjusted odds ratio, 7.85; 95% CI, 1.01-60.98).


CONCLUSIONS
Presence of A and T alleles (of the XbaI and PvuII polymorphisms, respectively) were associated with higher incidence of carotid restenosis, while the presence of G and C alleles (of the XbaI and PvuII polymorphisms, respectively) were associated with lower incidence of carotid restenosis.
Hirschberg
Kristóf
K
Department of Cardiovascular Surgery, Semmelweis University, Városmajor utca 68, Budapest, Hungary. hirschbergkristof@gmail.com
Gombos
Tímea
T
Dósa
Edit
E
Somorjai
Attila
A
Szilágyi
Agnes
A
Szabó
Gábor
G
Füst
George
G
Entz
László
L
D000368:Aged; D000369:Aged, 80 and over; D016893:Carotid Stenosis / Q000235:genetics / Q000601:surgery; D015252:Deoxyribonucleases, Type II Site-Specific / Q000235:genetics; D016894:Endarterectomy, Carotid; D047628:Estrogen Receptor alpha / Q000235:genetics*; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D011110:Polymorphism, Genetic; D011446:Prospective Studies; D012008:Recurrence; D015607:Stents
C506487:ESR1 protein, human; D047628:Estrogen Receptor alpha; C025580:endodeoxyribonuclease XBAI; D015252:Deoxyribonucleases, Type II Site-Specific