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Blood, Vol. 94 No. 1 (July 1), 1999:
pp. 46-51
Prothrombotic Genetic Risk Factors in Young Survivors of Myocardial
Infarction
D. Ardissino,
P.M. Mannucci,
P.A. Merlini,
F. Duca,
R. Fetiveau,
L. Tagliabue,
M. Tubaro,
M. Galvani,
F. Ottani,
M. Ferrario,
J. Corral, and
M. Margaglione
From the Division of Cardiology, IRCCS Policlinico San Matteo and
University of Pavia, Pavia; the Angelo Bianchi Bonomi Hemophilia and
Thrombosis Centre and the Department of Internal Medicine, IRCCS
Maggiore Hospital, University of Milan, Milan, Italy; Niguarda Hospital
Ca' Granda, Milan; San Camillo Hospital, Rome; Gian Battista Morgagni
Hospital, Forli'; Bentivoglio Hospital, Bentivoglio; Regional
Transfusion Centre, Murcia, Spain; and IRCCS Casa Sollievo della
Sofferenza, S. Giovanni Rotondo, Italy.
It has long been thought that an individual thrombotic tendency
increases the risk of myocardial infarction, especially in young
adults. Several "prothrombotic" genetic factors that may influence the individual thrombotic risk have been identified. To
investigate the association between the risk of myocardial infarction
at a young age and genetic factors thought to be associated with an
increased tendency to thrombosis (the polymorphisms 4G/5G of the PAI-1
gene, PIA1/PIA2 of the platelet glycoprotein IIIa, C3550T of the
platelet glycoprotein Ib gene, G10976A of the factor VII gene, C677T of
the methylenetetrahydrofolate reductase gene, G1691A of the factor V
gene, and G20210A of the prothrombin gene), we performed a case-control
study evaluating 200 survivors (185 men, 15 women) of myocardial
infarction who had experienced the event before the age of 45 years and
200 healthy subjects with a negative exercise test, individually
matched for sex, age, and geographic origin with the cases. The
presence of the PIA2 polymorphic allele was the only prothrombotic
genetic factor associated with the risk of myocardial infarction at a
young age. The odds ratio for carriers of the PIA2 allele compared with
those of the PIA1 allele was 1.84 (95% confidence intervals (CI) 1.12 to 3.03). There was a significant interaction between the presence of
the PIA2 allele and smoking: with their simultaneous presence, 46% (95% confidence intervals 11% to 81%) of premature myocardial infarctions were attributable to the interaction between the two factors. In conclusion, carrying the PIA2 polymorphic allele of platelet glycoprotein IIIa was the only genetic prothrombotic factor
associated with the risk of developing myocardial infarction at a young
age. The clinical expression of this genetic predisposition seems to be
enhanced by smoking.

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