Inherited Thrombophilia, Hypercoagulability, and Risk Factors for Atherosclerosis

Abstract

We appreciate Dr Onuigbo's comments. The association of hypercoagulable states with thrombosis in different vascular beds instead of the entire vascular tree is a well-known phenom enon.1Rosenberg RD Aird WC Vascular-bcd-specific hemostasis and hypercoagulable states.N Engl J Med. 1999; 340: 1555-1564Crossref PubMed Scopus (14) Google Scholar The majority of thrombotic events associated with the factor V Leiden mutation and deficiencies of antithrombin III, protein C, and protein S are venous.?2Demcrs C Ginsberg JS Hirsh J Henderson P Blajchman MA Thrombosis in antithrombin-II-deficient persons: report of a large kindred and literature review.Ann Intern Med. 1992; 116: 754-761Crossref PubMed Scopus (159) Google Scholar, 3De Stefano V Leone G Mastrangelo S et al.Clinical manifestations and management of inherited thrombophilia: retrospective analysis and follow-up after diagnosis of 238 patients with congenital deficiency of antithrombin III, protein C, protein S.Thromb Haemost. 1994; 72: 352-358PubMed Google Scholar, 4De Stefano V Finazzi G Mannucci PM Inherited thrombophilia: pathogencsis, clinical syndromes, and management.Blood. 1996; 87: 3531-3544PubMed Google Scholar To cite just 1 example, the Physicians' Health Study demonstrated that the factor V Leiden mutation was associated with increased risk of venous thrombosis.5Ridker PM Milctich JP Stampfer MJ Goldhaber SZ Lindpaintner K Hennekens CH Factor V Leiden and risks of recurrent idiopathic venous thrombocmbolism.Circulation. 1995; 92: 2800-2802Crossref PubMed Scopus (273) Google Scholar In contrast, the mutation was not associated with a higher risk of myocardial infarction or stroke.6Ridker PM Hennckens CH Lindpaintner K Stampfer MJ Eisenbcrg PR Milctich JP Mutation in the gene coding for coagulation factor V and the risk of myoeardial infarction, stroke, and venous thrombosis in apparently healthy men.N Engl J Med. 1995; 332: 912-917Crossref PubMed Scopus (1039) Google Scholar Arterial thrombotic events in the above-mentioned conditions can occur as Onuigbo points out. However; these seem to be the exception rather than the rule.1Rosenberg RD Aird WC Vascular-bcd-specific hemostasis and hypercoagulable states.N Engl J Med. 1999; 340: 1555-1564Crossref PubMed Scopus (14) Google Scholar, 7Thomas Dl Roberts JR Hypercoagulability in venous and arterial thrombosis.Ann Intern Med. 1997; 126: 638-644Crossref PubMed Scopus (109) Google Scholar Furthermore, a possible role in atherogenesis for the hypercoagulable states has yet to be conclusively established. The association of hypercoagulable states with vascular bedspecific thrombosis is an intriguing phenomenon and possibly related to differential regulation of thrombosis and fibrinolysis in various vascular beds.1Rosenberg RD Aird WC Vascular-bcd-specific hemostasis and hypercoagulable states.N Engl J Med. 1999; 340: 1555-1564Crossref PubMed Scopus (14) Google Scholar Further studies are needed to elucidate the molecular basis of this phenomenon and the possible link to atherogenesis. Inherited Thrombophilia, Hypercoagulability, and Risk Factors for AtherosclerosisMayo Clinic ProceedingsVol. 75Issue 8PreviewTo the Editor: Recently, Kullo and colleagues1 presented a detailed review of novel risk factors for atherosclerosis. They covered such risk factors as the role of homocysteine, fibrinogen, impaired fibrinolysis, increased platelet reactivity, hypercoagulability, lipoprotein(a), and small dense lipoprotein cholesterol. The place of inflammation markers such as C-reactive protein as a predictor of vascular disease and the possible role for infectious agents in the pathogenesis of atherosclerosis were also discussed. Full-Text PDF