Prothrombotic coagulation defects and cardiovascular risk factors in young women with acute myocardial infarction

Abstract

Summary. We investigated the effect of prothrombotic coagulation defects in combination with smoking and other conventional risk factors on the risk of myocardial infarction in young women. In 217 women with a first myocardial infarction before the age of 50 years and 763 healthy control women from a population-based case-control study, factor V Leiden and prothrombin 20210A status were determined. Data on major cardiovascular risk factors and oral contraceptive use were combined with the presence or absence of these prothrombotic mutations, and compared between patients and controls. The overall odds ratio for myocardial infarction in the presence of a coagulation defect was 1AE1 [95% confidence interval (CI) 0AE6-1AE9]. The combination of a prothrombotic mutation and current smoking increased the risk of myocardial infarction 12-fold (95% CI 5AE7-27) compared with non-smokers without a coagulation defect. Among women who smoked cigarettes, factor V Leiden presence versus absence increased the risk of myocardial infarction by 2AE0 (95% CI 0AE9-4AE6), and prothrombin 20210A presence versus absence had an odds ratio of 1AE0 (95% CI 0AE3-3AE5). We conclude that factor V Leiden and prothrombin 20210A do not add substantially to the overall risk of myocardial infarction in young women. However, in women who smoke, the presence of factor V Leiden increased the risk of myocardial infarction twofold.

Matched Case-Control Study on Factor V Leiden and the Prothrombin G20210A Mutation in Patients With Ischemic Stroke/Transient Ischemic Attack Up to the Age of 60 Years

“…In a study by Rosendaal et al, a particularly high risk of myocardial infarction was described in young women who smoked and had the FVL mutation. 16,17 A relationship between the FII G20210A mutation and stroke risk in younger individuals has also been reported. In some studies in which gender-specific calculations were performed, the prevalence of the mutation was similar in male and female patients, 11,14 and other studies did not separate the patient cohorts according to gender.…”

“…4 -15 Interactions of these mutations with exogenous vascular risk factors, particularly smoking, probably modulate the risk of arterial vascular events. 16,17 In the present study, we investigated the prevalence of the FVL and the FII G20210A mutation in a large population of patients with ischemic cerebrovascular events (ischemic stroke or transient ischemic attack [TIA]) before the age of 60 years. We compared the occurrence of these variants in patients to healthy controls individually matched for age and gender.…”

Myocardial Infarction With Nonobstructive Coronary Arteries (MINOCA): It's Time to Face Reality!

“…The extent of required testing in patients with a presumptive diagnosis of MINOCA depends on the patient's clinical presentation. In a young female smoker, for example, with a family history of factor V Leiden deficiency,21 a hypercoagulable state is the most likely diagnosis, and one should focus on thrombophilia testing as the first diagnostic step. Although additional testing should always be considered, it may not be feasible because of costs, availability, and other considerations.…”

Acute Myocardial Infarction in a Young Man Complicated With Left Ventricular Thrombi

“…[1][2][3][4][5][6] Additionally, the unique etiologies of premature CAD should be considered in cases of young AMI, including congenital coronary abnormality, Kawasaki's disease, and systemic lupus erythematosus (Table I). [8][9][10][11] The ecchymosed tissue around the LAD in this patient might hint at the trauma caused by the basketball even without direct evidence. The slightly elevated homocysteine and depressed protein-C in this patient also require follow-up despite the lack of evidence of a family history of premature coronary disease.…”