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(Circulation. 1999;99:457-460.)
© 1999 American Heart Association, Inc.

Correspondence

Factor V Leiden, Prothrombin 20210 Gene Variant, and Risk of Myocardial Infarction

Mae B. Hultin, MD

Professor of Medicine and Pathology

Roger C. Grimson, PhD

Associate Professor of Preventive Medicine University Medical Center, State University of New York, Stony Brook, NY

To The Editor:

Doggen et al¹ reported a case-control study assessing the effect of factor V Leiden and the prothrombin 20210 gene variant on the risk of myocardial infarction in men. The authors stated in their conclusions that "the 20210 GA variant of prothrombin is associated with an increased risk of myocardial infarction" and that "the combined presence of major cardiovascular risk factors and carriership of a coagulation defect increases the risk considerably." A review of their data in Tables 1 through 4 leads us to conclude that neither claim is supported by statistical significance. In Table 2, the prevalence of the prothrombin variant in cases (1.8%) is not significantly different from the prevalence in controls (1.2%) by the ² test, with an OR of 1.5 and a CI (0.6–3.8) that includes unity. A larger study would be required to prove that an OR of 1.5 is truly increased. The likelihood that this OR of 1.5 is not significantly different from 1.0 is also suggested by the fact that it is based on the unexpected finding of a lower prevalence of the variant in the controls (1.2%) than in the general population(2%) rather than a higher prevalence in the cases.

The second conclusion, that a coagulation defect added to the effect of a metabolic defect, also does not stand up to scrutiny of the data. In Table 3, the ORs of 6.1 and 3.3, with their overlapping CIs of 3.0–12.5 and 2.5–4.2, respectively, indicate that smoking increased the risk of . . . [Full Text of this Article]

Carine J.M. Doggen, MSc; Frits R. Rosendaal, MD, Professor; Volker Manger Cats, MD; Rogier M. Bertina, PhD

Department of Clinical Epidemiology, Department of Cardiology, Hemostasis and Thrombosis Research Center, Leiden University Hospital, Leiden, Netherlands