Plasminogen activator inhibitor 4G polymorphism is associated with decreased risk of cerebrovascular mortality in older women

Background-A common 4G allele of a 4G/5G polymorphism in the promoter regio n of the plasminogen activator inhibitor-1. (PAI-1) gene is associated with increased transcription of the PAI-1 protein, which may lead to decreased fibrinolysis. It has therefore been proposed as a candidate risk factor for myocardial infarction or stroke. Methods and Results-We studied the relationship between PAI-1 4G/5G genotyp e and the risk of cardiovascular mortality in a prospective cohort study am ong 12 239 women initially aged between 52 and 67 years, with a maximum fol low-up time of 18 years (153 732 follow-up years). PAI-1 4G/5G genotype was measured in DNA obtained from urine samples, which were collected at basel ine, of 498 women who died of a cardiovascular disease and a random sample of 512 women from the same cohort who did not die of cardiovascular disease . The PAI-1 4G/5G genotype was not associated with risk of myocardial infar ction or other cardiovascular mortality. However, PAI-1 4G4G homozygotes ha d a markedly reduced risk of cerebrovascular mortality compared with PAI-1 5G5G homozygotes: the relative risk was 0.4, with a 95% CI of 0.2 to 0.7, w hereas the relative risk of cerebrovascular mortality in PAI-1 4G5G heteroz ygotes compared with PAI-1 5G5G homozygotes was 0.7, with a 95% CI of 0.4 t o 1.1. Conclusions-These findings are suggestive of an important contribution of P AI-1 in cerebrovascular pathology, probably via pathways other than fibrino lysis. PAI-1 may protect against destabilization of the atherosclerotic pla que, or it may inhibit neurotoxicity of tissue plasminogen activator in the brain.