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Factor V Leiden and Subsequent Atherothrombotic Risk
Quick Takes
- Factor V Leiden mutation is not associated with atherothrombotic events in patients with known coronary heart disease.
- It is not necessary to screen for factor V Leiden mutations to risk stratify for atherothrombotic risk.
Study Questions:
Is factor V Leiden a risk factor for atherothrombotic events in patients with established coronary heart disease (CHD)?
Methods:
The authors performed an individual-level meta-analysis of 25 prospective studies (18 cohort, three case-cohort, and four randomized trial) from the GENIUS-CHD consortium that involved patients with CHD at baseline. Patients were genotypes for factor V Leiden status. Cox regression models were adjusted for age and set with a primary outcome of myocardial infarction (MI) and CHD death. Secondary outcomes included stroke, coronary revascularization, and all-cause mortality.
Results:
The meta-analysis included 69,681 patients, of whom 3,190 (4.6%) were either heterozygous or homozygous (n = 47) for factor V Leiden. Median follow-up ranged from 1.0-10.6 years across the studies. Factor V Leiden was not associated with the combined primary outcome of MI and CHD death (hazard ratio, 1.03; 95% confidence interval, 0.92-1.16). Similarly, risk of secondary outcomes, including stroke, coronary revascularization, cardiovascular mortality, and all-cause mortality, were not elevated among patients with factor V Leiden.
Conclusions:
The authors concluded that factor V Leiden status was not associated with an increased risk of atherothrombotic events and mortality among patients with baseline CHD.
Perspective:
Factor V Leiden is the most common genetic thrombophilic condition, found in approximately 5% of Caucasian individuals. Its association with incident venous thromboembolism is well established. However, this analysis of approximately 70,000 patients with baseline CHD did not find an association with future atherothrombotic events or all-cause mortality. Therefore, screening for factor V Leiden is unlikely to aid in risk stratification or to guide therapy for patients with known CHD.
Clinical Topics: Acute Coronary Syndromes, Anticoagulation Management, Cardiac Surgery, Cardiovascular Care Team, Invasive Cardiovascular Angiography and Intervention, Prevention, Pulmonary Hypertension and Venous Thromboembolism, Vascular Medicine, Anticoagulation Management and ACS, Anticoagulation Management and Venothromboembolism, Cardiac Surgery and Arrhythmias, Interventions and ACS, Interventions and Vascular Medicine
Keywords: Acute Coronary Syndrome, Anticoagulants, Coronary Disease, Factor V, Genotype, Myocardial Infarction, Myocardial Ischemia, Myocardial Revascularization, Risk Factors, Secondary Prevention, Stroke, Thrombosis, Vascular Diseases, Venous Thromboembolism
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