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Antiphospholipid antibodies and risk of myocardial infarction and ischaemic stroke in young women in the RATIO study
The Lancet Neurology, 10/16/09

Urbanus RT et al. – Arterial thrombosis is a major clinical manifestation of the antiphospholipid syndrome, which is an autoimmune disease found mostly in young women. Although the presence of circulating antiphospholipid antibodies in individuals who have a thrombotic event is a prerequisite for the diagnosis of the antiphospholipid syndrome, the risk of arterial thrombosis associated with antiphospholipid antibodies in the general population is unclear.Our results suggest that lupus anticoagulant is a major risk factor for arterial thrombotic events in young women, and the presence of other cardiovascular risk factors increases the risk even further.

• RATIO (Risk of Arterial Thrombosis In relation to Oral contraceptives), a large multicentre population-based case-control study
• Women aged under 50 years who were admitted to hospital at 16 centres with first ischaemic stroke or myocardial infarction between January, 1990, and October enrolled
• Additional 59 women who presented with ischaemic stroke at University Medical Centre Utrecht between 1996 and 2001 also enrolled
• Information on cardiovascular risk factors (such as oral contraceptive use, smoking, and hypertension) assessed with standard questionnaire
• During the second phase (1998—2002), blood samples taken to measure antiphospholipid antibody profiles (lupus anticoagulant, anticardiolipin IgG, anti-?2-glycoprotein I IgG, and antiprothrombin IgG) and determine genetic prothrombotic risk factors (factor V G1691A variant, prothrombin G20210A variant, and factor XIII 204Phe allele)

• 175 patients with ischaemic stroke, 203 patients with myocardial infarction, and 628 healthy controls included
• Lupus anticoagulant found in 30 (17%) patients with ischaemic stroke, 6 (3%) patients with myocardial infarction, and 4 (0·7%) in control group
• Odds ratio for MI 5·3 (95% CI 1·4—20·8), which increased to 21·6 (1·9—242·0) in oral contraceptive users and 33·7 (6·0—189·0) in smokers
• Odds ratio for ischaemic stroke 43·1 (12·2—152·0), which increased to 201·0 (22·1—1828·0) in oral contraceptive users and 87·0 (14·5—523·0) in smokers
• In women who had anti-?2-glycoprotein I antibodies, risk of ischaemic stroke 2·3 (1·4—3·7), but risk of MI not increased (0·9, 0·5—1·6)
• Neither anticardiolipin nor antiprothrombin antibodies affected risk of MI or ischaemic stroke

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