Risk of venous thromboembolism and myocardial infarction associated with factor V Leiden and prothrombin mutations and blood type

Abstract

Background: ABO blood type locus has been reported to be an important genetic determinant of venous and arterial thrombosis in genome-wide association studies. We tested the hypothesis that ABO blood type alone and in combination with mutations in factor V Leiden R506Q and prothrombin G20210A is associated with the risk of venous thromboembolism and myocardial infarction in the general population.

Methods: We used data from 2 Danish studies that followed members of the general public from 1977 through 2010. We obtained the genotype of 66 001 white participants for ABO blood type, factor V Leiden R506Q and prothrombin G20210A. We calculated hazard ratios (HRs) and population attributable risk. Our main outcome measures were venous thromboembolism and myocardial infarction.

Results: The multivariable adjusted HR for venous thromboembolism was 1.4 (95% confidence interval [CI] 1.3-1.5) for non-O blood type (v. O blood type). For the factor V Leiden R506Q mutation, the adjusted HR was 2.2 (95% CI 2.0-2.5) for heterozygous participants and 7.0 (95%CI 4.8-10) for homozygous participants (v. participants without the mutation). For prothrombin G20210A, the adjusted HR was 1.5 (95%CI 1.2-1.9) for heterozygous participants and 11 (95% CI 2.8-44) for homozygous participants (v. participants without the mutation). When we combined ABO blood type and factor V Leiden R506Q or prothrombin G20210A genotype, there was a stepwise increase in the risk of venous thromboembolism (trend, p<0.001). The population attributable risk of venous thromboembolism was 20% for ABO blood type, 10% for factor V Leiden R506Q and 1% for prothrombin G20210A. Multivariable adjusted HRs for myocardial infarction by genotypes did not differ from 1.0.

Interpretation: ABO blood type had an additive effect on the risk of venous thromboembolism when combined with factor V Leiden R506Q and prothrombin G20210A mutations; blood type was the most important risk factor for venous thromboembolism in the general population.

Figure 1:

Risk of venous thromboembolism by ABO blood type, factor V Leiden R506Q and prothrombin G20210A mutations among 66 001 individuals in the Copenhagen General Population Study and the Copenhagen City Heart Study. Hazard ratios (HR) with 95% confidence intervals (CIs) were adjusted for age, sex, current smoking status, body mass index, systolic blood pressure and diabetes mellitus. p values are for trend across genotype combinations coded 0 through 6 or 0 through 8, depending on the number of genotype combinations.

Figure 2:

Risk of myocardial infarction by ABO blood type, factor V Leiden R506Q and prothrombin G20210A mutations among 66 001 individuals in the Copenhagen General Population Study and the Copenhagen City Heart Study. Hazard ratios (HR) with 95% confidence intervals (CIs) were adjusted for age, sex, current smoking status, body mass index, systolic blood pressure and diabetes mellitus. p values are for trend across genotype combinations coded 0 through 6 or 0 through 8, depending on the number of genotype combinations.

Figure 3:

Ranking of risk factors for venous thromboembolism by population attributable risk in the general population. The results are based on 66 001 participants in the Copenhagen General Population Study and the Copenhagen City Heart Study. All risk factors were dichotomized before analysis. Hazard ratios (HR) with 95% confidence intervals (CIs) were calculated using Cox regression models with age as the underlying time scale. Only significant HRs were included in the model; sex, hypertension and diabetes mellitus were considered but were not statistically significant.