Inherited and Acquired Thrombophilic Risk Factors in Atherosclerotic Disease

Abstract number: P1123

Marcucci R, Sofi F, Gori AM, Coppo M, Comeglio M, Lombardi A, Margheri M, Prisco D, Abbate R, Gensini GF

Thrombophilia has been investigated in different atherosclerotic localization, but its role has not yet been defined. Aim of our study was to evaluate the weight of the most common inherited and acquired thrombophilic risk factors – factor V Leiden, prothrombin polymorphism, homocysteine (Hcy) and lipoprotein (a)[Lp(a)]– in a large cohort of Italian patients with different clinical manifestation of atherosclerotic disease. We studied 1014 patients with coronary artery disease (CAD) (group 1) (724 m/272 F; age: 65 ± 11.8 yrs), 615 patients with severe carotid atherosclerosis undergone a carotid endarterectomy (group 2) (410 m/205 F; age: 72 ± 12.1 yrs) and 280 patients with peripheral artery disease (PAD) (group 3) (216 m/64 F; age: 68.5 ± 9.4 yrs). Prothrombin polymorphism showed a different prevalence in the three groups investigated with a significant higher prevalence in group 2 and 3 than in group 1 (4.7% and 5.4% vs 3.1%), whereas the prevalence of FV Leiden was similar (group 1: 3.1%; group 2: 3.3%; group 3: 2.4%). Totally, high levels of Hcy and Lp(a) were present in about 30% of patients (group 1: 30.3% and 39.3%; group 2: 29.4% and 36.4% and group 3: 32.8% and 34.1%). At the multivariate analysis adjusted for age, sex and the classical cardiovascular risk factors independent risk factors for CAD were high levels of Hcy [OR = 7.2 (4.4–11.8), P < 0.000] and Lp(a) [OR = 2.1 (1.4–3.0), P < 0.000]. Independent risk factors for PAD were: high levels of Hcy [OR = 14.4 (6.5–31.8), P < 0.000] and Lp(a) [OR = 3.8 (1.9–7.5), P < 0.000] and heterozygosity for prothrombin polymorphism [OR = 9.4 (2.0–44.1), P < 0.005]. In patients with severe carotid atherosclerosis, in addition to hyperhomocysteinemia [OR = 11.02 (5.3–22.9), P < 0.000] and high levels of Lp(a) [OR = 3.16 (1.93–5.17), P < 0.000], prothrombin polymorphism was an independent risk factor only in the subgroup of men. In conclusion, our data on a total number of 1355 Italian patients with atherosclerotic disease, demonstrate that hyperHcy and high levels of Lp(a) are common risk factors for atherosclerosis, with no differences in the different manifestation of the disease. Prothrombin polymorphism is an independent risk factor in patients with PAD and severe carotid atherosclerosis, whereas it does not play a role as risk factor in coronary artery disease.