Polymorphisms in the genes for coagulation factors II, V, and VII in patients with ischemic heart disease

Background.--Cardiovascular disease remains the leading cause of mortality in the United States, accounting for approximately 33% of all deaths in thi s country. Of these deaths, most are due to acute myocardial infarctions (A MIs), which are associated with thrombotic coronary artery obstruction and/ or occlusion. These events could potentially be due to alterations in genes coding for coagulation factors. Several polymorphisms have been described in the factor II, V, and VII genes, which may predispose one to increased r isk for ischemic heart disease (IHD). Objective.--To determine if mutations in 3 coagulation factor genes could p redispose an individual to increased risk for arterial thrombosis as a mech anism for developing unstable angina (UA) or AMI. Methods.--We examined 125 hospitalized patients (mean age, 53 +/- 6 years, 79 men and 46 women), including 32 with AMI, 68 with UA, and 25 noncardiac controls, for a genetic predisposition for increased risk of IHD. EDTA-anti coagulated whole blood was collected at the time of hospital admission. DNA was extracted, and the polymorphisms were detected by polymerase chain rea ction amplification of these genes with subsequent restriction enzyme diges tion and gel electrophoresis. Results.--Our results showed that 3 (9.4%), 3 (4.4%), and 1 (4%) individual s were heterozygous for prothrombin G20210A and 3 (9.4%), 5 (7.4%), and 1 ( 4%) individuals were heterozygous for factor V Leiden in the AMI, UA, and c ontrol groups, respectively. The following genotype frequencies for the fac tor VII R353Q polymorphism were identified: 25 (78.1%), 56 (82.4%), and 18 (72%) with RR and 7 (21.9%), 12 (17.6%), and 7 (28%) with RQ in the AMI, UA , and control groups, respectively. No QQ homozygotes were identified. For the HVR4 size polymorphism, the following genotypes were identified: 3 (9.4 %), 4 (5.9%), and 5 (20%) individuals with H7H7; 11 (34.4%), 33 (48.5%), an d 12 (48%) with H6H7; and 18 (56.2%), 31 (45.6%), and 8 (32%) with H6H6 gen otypes in the AMI, UA, and control groups, respectively There were no H7H5 and H6H5 genotypes found in this study. Conclusions.--Although the frequency differences of these polymorphisms in patients with AMI and UA were not statistically significant from those in c ontrols, several trends are consistent with what has been reported in the l iterature. Although any of these or other undefined genetic abnormalities m ay result in IHD, it is possible that phenotypic predisposition to IHD init ially presents as UA. A larger population study addressing the significance of these polymorphisms in the sequence of events that lead to IHD, includi ng cases of UA, is warranted.