Objective-Recent studies have implicated the potential importance of peroxisome proliferator-activated receptors as a molecular mechanism involved in atherothrombosis. A common alanine (A) for proline (P) substitution at codon 12 in the peroxisome proliferator activated receptor gamma-2 gene (PPARG2) has been associated with reduced risk of developing type 2 diabetes mellitus. Because diabetes and atherothrombosis share common antecedents, we sought evidence that this polymorphism might also be associated with reduced risk of myocardial infarction. Methods and Results-Using DNA samples collected at baseline in a prospective cohort of 14 916 initially healthy American men, we evaluated a P12A polymorphism in the PPARG2 among 523 individuals who subsequently developed myocardial infarction and among 2092 individuals who remained free of reported cardiovascular disease over a mean follow-up period of 13.2 years. As hypothesized, presence of the A12 allele was associated with significantly reduced risk of myocardial infarction (odds ratio in an age-and smoking-adjusted dominant model of inheritance, 0.77; 95% CI, 0.60 to 0.98; Pϭ0.034). This protective effect remained statistically significant in analyses controlling for traditional cardiovascular risk factors, was present among nondiabetic study participants, was observed to be of similar magnitude in analyses assuming codominant or dominant modes of inheritance, and was seen in fully adjusted post hoc analyses in which we limited our control group to those individuals specifically matched to myocardial infarction cases (OR, 0.71; 95% CI, 0.53 to 0.96; Pϭ0.024). Key Words: genetics Ⅲ epidemiology Ⅲ myocardial infarction Ⅲ risk prediction Ⅲ polymorphism R ecent data suggest that a common alanine for proline substitution at codon 12 (P12A) in the peroxisome proliferator-activated receptor gamma-2 gene (PPARG2) is associated with reduced incidence of type 2 diabetes. [1][2][3][4] This observation is of considerable interest because patients with diabetes have accelerated atherosclerosis and insulin resistance is now recognized as a risk factor for myocardial infarction (MI). Recent experimental work has implicated that PPARG may act directly on local vasculature in several critical aspects of atherothrombosis, including lipid metabolism, foam cell responses, and inflammation, additionally suggesting that PPARG may be an important determinant of gene expression during atherogenesis. 5,6 We therefore hypothesized that the P12A polymorphism in the PPARG2 might also be a determinant of incident myocardial infarction (MI).
Conclusions-In
Methods
Patient Selection and Clinical InvestigationWe sought evidence of association between a common P12A polymorphism in the PPARG2 and risk of incident MI as part of an ongoing genetic epidemiology evaluation of incident cardiovascular events being performed within the Physicians' Health Study. 7 In brief, of 22 071 American men aged 40 to 84 years who were free of prior MI, stroke, transient ischemic attack, and cancer, 14 916 provide...