Z. Szolnoki et al., Evaluation of the roles of the Leiden V mutation and ACE I/D polymorphism in subtypes of ischaemic stroke, J NEUROL, 248(9), 2001, pp. 756-761
Objective The Leiden V mutation, which causes activated protein C resistanc
e and thrombophilia, has been found to be a risk factor for venous thrombos
is. The angiotensin converting enzyme (ACE) D allele indirectly exerts an u
nfavourable effect on the vasoregulatory system. In this study, the frequen
cy of these mutations was analysed in different subtypes of ischaemic strok
e. Method and material According to the clinical and radiological features
664 Hungarian patients who had suffered acute ischaemic stroke were divided
into 3 subtypes: small and large vessel infarcts and a mixed type. In all
664 patients, the Leiden V mutation and ACE I/D polymorphism were examined
by means of the PCR technique. The frequencies of the different genotypes f
or the Leiden V mutation and ACE I/D polymorphism in the 3 subgroups of str
oke were compared with 199 stroke-free control subjects whose MRI findings
were normal. Results No significant associations were found between the ove
rall group of cerebral infarctions and the Leiden V, ACE I/D and ACE D/D ge
notypes. The ACE D/D genotype was significantly more common in the patients
with small deep infarcts (40.3 010; p < 0.0005; OR 2.31, 95 % CI 1.49-3.57
) than in the control group (22.6 %). The Leiden V mutation was significant
ly more common in patients with large infarcts (13.6 %; p < 0.025; OR 2.25,
CI 1.16-4.34) than in the stroke-free control subjects (6.5 %). Conclusion
s The ACE D/D genotype possibly contributes to the occurrence of small-vess
el infarcts rather than large vessel infarcts. The Leiden V mutation might
predispose to large brain infarcts. Neither the Leiden V factor nor the ACE
D/D genotype has been proved to be a risk factor for ischaemic stroke as a
whole.