A 1-U decrease in response to activated protein C was associated with an increased risk of carotid stenosis (OR 1.6; 95% CI 1.2-2.2), femoral artery stenosis, and prevalent cardiovascular disease.
Cross-Sectional (n=826)
Does poor response to activated protein C predict advanced atherosclerosis and arterial disease in the general population?
Poor response to activated protein C is independently associated with advanced atherosclerosis and prevalent cardiovascular disease, regardless of factor V Leiden mutation status.
Effect estimate: OR 1.6 (95% CI 1.2-2.2)
BACKGROUND: The potential role of activated protein C (APC) resistance in arterial thrombosis and disease is a matter of ongoing controversy. METHODS AND RESULTS: In the present population-based survey, a random sample of 826 men and women underwent high-resolution duplex ultrasound scanning of the carotid and femoral arteries. Response to APC was expressed in APC ratios. Subjects were tested for the factor V Leiden mutation. The risk of carotid stenosis increased gradually with decreasing response to APC (adjusted OR 95% CI for a 1-U decrease of response to APC, 1.6 1. 2 to 2.2), as did the risk of femoral artery stenosis (1.7 1.3 to 2.3) and prevalent cardiovascular disease (1.4 1.1 to 2.0). The association between low APC ratio and atherosclerotic vascular disease applied equally to subjects with the factor V Leiden mutation and those without. Our study identified various nongenetic determinants of poor response to APC in the general population, including behavioral, hormonal, and environmental factors. CONCLUSIONS: The present study revealed an independent and gradual association between low response to APC and both advanced atherosclerosis (stenosis) and arterial disease. Resistance to APC due to factor V Leiden mutation was only one facet of this relationship.
Kiechl et al. (Tue,) conducted a cross-sectional in Atherosclerosis and arterial disease (n=826). Decreasing response to activated protein C (APC) was evaluated on Carotid stenosis (OR 1.6, 95% CI 1.2-2.2). A 1-U decrease in response to activated protein C was associated with an increased risk of carotid stenosis (OR 1.6; 95% CI 1.2-2.2), femoral artery stenosis, and prevalent cardiovascular disease.