Determinants of coagulation and myocardial infarction

Abstract

Cardiovascular disease remains the leading cause of mortality and morbidity despite the identification of major risk factors and risk reduction strategies. Malta has been classified as one of the countries with the highest death rates attributed to ischaemic heart disease and the traditional risk factors for myocardial infarction (MI), have a high prevalence in the Maltese population. The development of a first MI is attributed to a large number of contributing factors and is influenced by multiple genetic, environmental and lifestyle factors. Thrombosis is generally accepted as a common pathogenic pathway for the risk of MI and is itself also influenced by several risk factors. In this study, a general assessment of the coagulation pathways of the participants was carried out using the INR and APTT R. Plasma fibrinogen concentration was determined using the Clauss assay and platelet parameters were determined from the complete blood count. Genotyping for the TaqI, BclI, -455G/A and HPA-1 polymorphisms was carried out using PCR and restriction enzyme digest. There were no differences between INR, APTT R and platelet parameters between cases and controls. Age, gender and smoking were found to be the major confounders of plasma fibrinogen levels. Fibrinogen was found to be a risk factor for MI [Females OR 3.3 (95% CI 1.1-8.1) Males OR 1.4 (95% CI 0.9-2.3)] but part of the risk could be explained by the effect of age and smoking on fibrinogen levels. Overall no major increase in risk for MI was contributed by the polymorphisms alone, except for HPA-1 [OR 7.1 (95% CI 1.5-33.4)] but simultaneous effects were observed in the combination of genotypes with smoking.