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677TT polymorphism of methylenetetrahydrofolate reductase in combination with low serum vitamin B 12 is associated with coronary in‐stent restenosis
Author(s) -
Chung ShengLiang,
Chiou KuanRau,
Charng MinJi
Publication year - 2006
Publication title -
catheterization and cardiovascular interventions
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 0.988
H-Index - 116
eISSN - 1522-726X
pISSN - 1522-1946
DOI - 10.1002/ccd.20663
Subject(s) - methylenetetrahydrofolate reductase , medicine , restenosis , genotype , homocysteine , gastroenterology , genotyping , vitamin b12 , odds ratio , coronary stent , endocrinology , stent , cardiology , genetics , biology , gene
Background: Recent studies have shown that a common mutation (nucleotide 677 C→T) in the methylenetetrahydrofolate reductase ( MTHFR ) gene may contribute to a mild rise in plasma homocysteine levels and increase the incidence of coronary artery disease. Therefore, this study was designed to further investigate whether the effects of MTHFR 677 C to T mutation, plasma homocysteine, serum vitamin B 12 , and folate can influence restenosis after successful coronary stenting.Methods and Results: We investigated 260 patients each with a lesion after successful coronary stent placement. All patients received a repeated angiography after 6 months, or earlier if clinically indicated. Angiographic in‐stent restenosis (ISR) was defined as ≥50% diameter stenosis at follow‐up. Genotyping for MTHFR was based on a polymerase chain reaction technique. Also fasting plasma homocysteine, vitamin B 12 , and folate levels were measured at the same time. The ISR rate was higher among the patients with the TT genotype than in those with the non‐TT genotypes (64.0% versus 32.9%, P = 0.002). There was no significant difference in plasma homocysteine levels among patients with the TT genotype and patients with the non‐TT genotypes (15.9 ± 7.6 versus 15.5 ± 6.6 μmol/L, P = 0.75). However, among the patients with the TT genotype, those with higher plasma homocysteine levels (≥12 μmol/L) demonstrated a significantly higher ISR rate (75.0% versus 33.5%, P = 0.001). Logistic regression analysis revealed that the combined presence of the MTHFR TT genotype and lower than average serum vitamin B 12 (≥550 pg/mL) resulted in the most significant difference in the risk of ISR (OR = 3.57, CI = 1.51–8.46, P = 0.004; OR = 2.36, CI = 1.35–4.15, P = 0.003).Conclusions: MTHFR 677TT polymorphism and low serum vitamin B 12 each individually increased the risk of coronary ISR. Furthermore, the combination of these parameters resulted in a greater increase in risk. © 2006 Wiley‐Liss, Inc.