Objective-Tissue factor (TF) has, among other factors, a prominent role in acute coronary syndrome (ACS). Our goal was to investigate whether single nucleotide polymorphisms (SNP) in the TF gene (F3) are associated with plasma TF, risk, and outcome in patients with ACS. Moreover, we wanted to investigate the impact of associated TF SNPs on mRNA production in human monocytes.
Methods and Results-In 725 patients with ACS [Fragmin and Fast Revascularization during Instability in CoronaryArtery Disease II (FRISC-II) study] and 376 controls, 13 SNPs were genotyped and plasma TF measured. Thereafter, the 5466 AϾG and the Ϫ1812 CϾT were genotyped among all of the FRISC-II participants (nϭ3143) and assessed concerning clinical outcome. Associated SNPs were genotyped in 92 healthy blood donors for comparison of TF activity and TF mRNA expression. None of the SNPs were associated with patient/control status. The 5466 AϾG SNP was associated with cardiovascular death (odds ratio, 1.8; Pϭ0.025). The CG haplotype by Ϫ1812 CϾT and 5466 AϾG was associated with a 3-fold increased risk of death (PϽ0.001). TF mRNA and basal TF activity was significantly lower among 5466 AG carriers, whereas the increase in monocyte TF activity on lipopolysaccharide stimulation was significantly stronger (Pϭ0.04). Key Words: acute coronary syndrome Ⅲ tissue factor Ⅲ single nucleotide polymorphism Ⅲ outcome Ⅲ mRNA A cute coronary syndrome (ACS) is a multifactorial disease in which a multitude of lifestyle and genetic factors contribute to the development and outcome of the disease. 1 The genetic component of ACS seems to be relatively high, because family history is a strong risk factor, and heritability studies have shown a large genetic contribution to cardiac disease. 2,3 Single nucleotide polymorphisms (SNPs) are the most common genetic variations in the genome and may influence factors involved in atherosclerosis, plaque destabilization, and thrombosis, all of which are fundamental aspects of ACS etiology. 3 Variations in genes that encode for hemostatic factors are considered to be likely candidates for modifiers of the procoagulant phenotype, usually observed in patients with myocardial infarction (MI). 4 A procoagulant phenotype may have a substantial effect on ACS outcome, because a larger sized superimposed thrombus is directly related to the severity of myocardial ischemia. 5 A major player in this respect is tissue factor (TF), which rapidly initiates blood coagulation and is generally recognized as an important thrombogenic factor in atherosclerotic lesions. 6 TF is present as a membrane-bound molecule in different cell types in the vessel wall and within plaques, including endothelial cells, smooth muscle cells monocytes/macrophages, and foam cells. 7 Proteolytic cleavage of TF results in a soluble form of TF (plasma TF), which only contains the extracellular part of the protein and does not show significant procoagulant activity. 8 Moreover, the presence of an alternatively spliced form of TF has been reported recently. 9 Intravascula...