title: High VWF, low ADAMTS13, and oral contraceptives increase the risk of ischemic stroke and myocardial infarction in young women.
abstract: VWF and ADAMTS13 are major determinants of platelet adhesion after vessel injury. In the present study, we aimed to determine whether VWF or ADAMTS13 plasma antigen levels influence the risks of ischemic stroke (IS) or myocardial infarction (MI) in young women and how these risks are affected by oral contraceptive (OC) use. VWF and ADAMTS13 plasma antigen levels were measured in a frequency-matched case-control study of 1018 young (18-49 years) women including 175 IS patients and 205 MI patients. Increasing levels of VWF and decreasing levels of ADAMTS13 were associated with the risk of IS and MI in a dose-dependent manner. Having both high VWF and low ADAMTS13 resulted in an odds ratio (OR) of 6.9 (95% confidence interval [95% CI], 2.0-23.0) for IS and 11.3 (95% CI, 3.6-35.2) for MI. Use of OCs increased the risk of IS and MI associated with high VWF (OR = 12; 95% CI, 5.5-26.2 and OR = 7.5, 95% CI, 3.6-15.7, respectively) and the risk of IS associated with low ADAMTS13 (OR = 5.8, 95% CI, 2.7-12.4). We conclude that high VWF and low ADAMTS13 plasma levels both increase the risk of IS and MI. The risks associated with high VWF or low ADAMTS13 levels are further increased by the use of OCs.
authors: Centre for Haematology, Faculty of Medicine, Imperial College London, London, United Kingdom.
authors: Helena M
authors: HM
authors: Andersson
authors: Bob
authors: B
authors: Siegerink
authors: Brenda M
authors: BM
authors: Luken
authors: James T B
authors: JT
authors: Crawley
authors: Ale
authors: A
authors: Algra
authors: David A
authors: DA
authors: Lane
authors: Frits R
authors: FR
authors: Rosendaal
mesh_terms: D051722:ADAM Proteins / Q000097:blood*; D000071120:ADAMTS13 Protein; D000293:Adolescent; D000328:Adult; D002545:Brain Ischemia / Q000150:complications; D016022:Case-Control Studies; D003276:Contraceptives, Oral / Q000009:adverse effects*; D005260:Female; D006801:Humans; D008875:Middle Aged; D009203:Myocardial Infarction / Q000097:blood* / Q000209:etiology; D016017:Odds Ratio; D018570:Risk Assessment; D012307:Risk Factors; D020521:Stroke / Q000097:blood* / Q000209:etiology; D055815:Young Adult; D014841:von Willebrand Factor / Q000378:metabolism*
chemical_list: D003276:Contraceptives, Oral; D014841:von Willebrand Factor; D051722:ADAM Proteins; D000071120:ADAMTS13 Protein; C099604:ADAMTS13 protein, human