Thromb Haemost 2004; 92(03): 583-589
DOI: 10.1160/TH04-03-0099
Blood Coagulation, Fibrinolysis and Cellular Haemostasis
Schattauer GmbH

Prognosis of young ischemic stroke in Taiwan: impact of prothrombotic genetic polymorphisms

Poh-Shiow Yeh
1   Department of Neurology, Chi-Mei Medical Center, Tainan, Taiwan
,
Huey-Juan Lin
1   Department of Neurology, Chi-Mei Medical Center, Tainan, Taiwan
,
Yi-Heng Li
2   Department of Internal Medicine, College of Medicine, National Cheng Kung University, Tainan, Taiwan
,
Kao-Chang Lin
1   Department of Neurology, Chi-Mei Medical Center, Tainan, Taiwan
,
Tain-Junn Cheng
1   Department of Neurology, Chi-Mei Medical Center, Tainan, Taiwan
,
Chia-Yu Chang
1   Department of Neurology, Chi-Mei Medical Center, Tainan, Taiwan
,
Der-Shin Ke
1   Department of Neurology, Chi-Mei Medical Center, Tainan, Taiwan
› Institutsangaben
Financial support: This study was supported by grant 91-B-FA09-2-4 of the MOE Program for Promoting Academic Excellence of Universities from the Ministry of Education, Taipei, Taiwan and grant NSC-90-2314-B-006-089 from the National Science Council, Taipei, Taiwan.
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Publikationsverlauf

Received 16. Februar 2004

Accepted after revision 21. Mai 2004

Publikationsdatum:
02. Dezember 2017 (online)

Summary

We investigated the effects of genetic factors on the prognosis of cerebral infarction in young adults in Taiwan. Because ischemic stroke with arterial occlusion or undetermined etiology is more likely to be related to a genetic prothrombotic state, 231 patients younger than 50 years (mean age 44.6 years, range 25 to 49 years) with acute ischemic stroke due to large artery atherosclerosis (n=90), small artery occlusion (n=114) or undetermined cause (n=27) were recruited and prospectively followed up for pre-determined outcome. On each patient, we screened the PlA1/PlA2 polymorphism of the platelet glycoprotein IIIa gene, 4G/5G polymorphism of the plasminogen activator inhibitor-1 gene, G10976A polymorphism of the factor VII gene, C677T polymorphism of the methylenetetrahydrofolate reductase gene, and 27 base-pair repeat polymorphism of the endothelial nitric oxide synthase gene. End points were the composite outcome events of stroke, myocardial infarction, and death from all causes. During a mean duration follow-up of 29 months, composite outcome events occurred in 33 patients. There was a higher annual incidence rate of composite outcome events during the first year (9.1%, 95% CI 5.9-13.9%) than in the subsequent 2 years (2.6%, 95% CI 1.2-5.6%, p=0.038). None of the genetic polymorphism was associated with the composite outcome events. Past history of coronary artery disease or cerebrovascular disease was the only independent predictor of the composite outcome events (HR 3.71, 95% CI 1.69-8.14, p=0.001) at the Cox regression analysis. Our data indicate that the prothrombotic genetic polymorphisms do not have a significant influence on the prognosis in young ischemic stroke due to arterial occlusion or undetermined causes in Taiwan.

 
  • References

  • 1 Adams HP, Butler MJ, Biller J. et al. Nonhemorrhagic cerebral infarction in young adults. Arch Neurol 1986; 43: 793-6.
  • 2 Hart RG, Miller VT. Cerebral infarction in young adults: a practical approach. Stroke 1983; 14: 110-4.
  • 3 Chang SF, Su CL, Chen ZY. et al. Stroke incidence in Ilan, Taiwan. J Formos Med Assoc 1995; 94: 30-6.
  • 4 Adams Jr HP, Kappelle LJ, Biller J. et al. Ischemic stroke in young adults: experience in 329 patients enrolled in the Iowa registry of stroke in young adults. Arch Neurol 1995; 52: 491-5.
  • 5 Lee TH, Hsu WC, Chen CJ. et al. Etiologic study of young ischemic stroke in Taiwan. Stroke 2002; 33: 1950-5.
  • 6 Kappelle LJ, Adams Jr HP, Heffner MF. et al. Prognosis of young adults with ischemic stroke. A long-term follow-up study assessing recurrent vascular events and functional outcome in the Iowa Registry of stroke in young adults. Stroke 1994; 25: 1360-5.
  • 7 Ferro JM, Crespo M. Prognosis after transient ischemic attack and ischemic stroke in young adults. Stroke 1994; 25: 1611-6.
  • 8 Ko YL, Hsu TS, Wu SM. et al. The G1691A mutation of the coagulation factor V gene (factor V Leiden) is rare in Chinese: an analysis of 618 individuals. Hum Genet 1996; 98: 176-7.
  • 9 Lin JS, Shen MC, Tsay W. The mutation at position 20210 in the 3’-untranslated region of the prothrombin gene is extremely rare in Taiwanese Chinese patients with venous thrombophilia. Thromb Haemost 1998; 80: 343.
  • 10 Gordon DL, Bendixen BH, Adams Jr HP. et al. Interphysician agreement in the diagnosis of subtypes of acute ischemic stroke: implications for clinical trials. The TOAST investigators. Neurology 1993; 43: 1021-7.
  • 11 Li YH, Chen JH, Guo HR. et al. Genetic risk factors associated with the prognosis of myocardial infarction in young patients. Thromb Haemost 2002; 88: 694-7.
  • 12 Anderson JL, King GJ, Bair TL. et al. Associations between a polymorphism in the gene encoding glycoprotein IIIa and myocardial infarction and coronary artery disease. J Am Coll Cardiol 1999; 33: 727-33.
  • 13 Margaglione M, Grandone E, Cappucci G. et al. An alternative method for PAI-1 promoter polymorphism (4G/5G) typing. Thromb Haemost 1997; 77: 605.
  • 14 Green F, Kelleher C, Wilkes H. et al. A common genetic polymorphism associated with lower coagulation factor VII levels in healthy individuals. Arterioscler Thromb 1991; 11: 540-6.
  • 15 Frosst P, Blom HJ, Milos R. et al. A candidate genetic risk factor for vascular disease: a common mutation in methylenetetrahydrofolate reductase. Nat Genet 1995; 10: 111-3.
  • 16 Wang LX, Sim AS, Badenhop RF. et al. A smoking-dependent risk of coronary artery disease associated with a polymorphism of the endothelial nitric oxide synthase gene. Nat Med 1996; 02: 41-5.
  • 17 Leung SY, Ng TH, Yuen ST. et al. Pattern of cerebral atherosclerosis in Hong Kong Chinese: severity in intracranial and extracranial vessels. Stroke 1993; 24: 779-86.
  • 18 Feldmann E, Daneault N, Kwan E. et al. Chinese-white differences in the distribution of occlusive cerebrovascular disease. Neurology 1990; 40: 1541-5.
  • 19 Qureshi AI, Safdar K, Patel M. et al. Stroke in young black patients: risk factors, subtypes, and prognosis. Stroke 1995; 26: 1995-8.
  • 20 Austin H, Chimowitz MI, Hill HA. et al. Cryptogenic stroke in relation to genetic variation in clotting factors and other genetic polymorphisms among young men and women. Stroke 2002; 33: 2762-9.
  • 21 Madonna P, de Stefano V, Coppola A. et al. Hyperhomocysteinemia and other inherited prothrombotic conditions in young adults with a history of ischemic stroke. Stroke 2002; 33: 51-6.
  • 22 Kim RJ, Becker RC. Association between factor V Leiden, prothrombin G20210A, and methylenetetrahydrofolate reductase C677T mutations and events of the arterial circulatory system: A meta-analysis of published studies. Am Heart J 2003; 146: 948-57.
  • 23 Choi BO, Kim NJ, Kim SH. et al. Homozygous C677T mutation in the MTHFR gene as an independent risk factor for multiple small-artery occlusions. Thromb Res 2003; 11: 39-44.
  • 24 Li Z, Sun L, Zhang H. et al. Elevated plasma homocysteine was associated with hemorrhagic and ischemic stroke, but methylenetetrahydrofolate reductase gene C677T polymorphism was a risk factor for thrombotic stroke. Stroke 2003; 34: 2085-90.
  • 25 Carter AM, Catto AJ, Bamford JM. et al. Association of the platelet glycoprotein IIb HPA-3 polymorphism with survival after acute ischemic stroke. Stroke 1999; 30: 2606-11.
  • 26 Heywood DM, Carter AM, Catto AJ. et al. Polymorphisms of the factor VII gene and circulating FVII:C levels in relation to acute cerebrovascular disease and poststroke mortality. Stroke 1997; 28: 816-21.