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(Circulation. 2000;101:e207.)
© 2000 American Heart Association, Inc.

Circulation Electronic Pages

The G20210A Prothrombin Mutation and the Physicians’ Health Study

Felicita Andreotti, MD, PhD; Francesco Burzotta, MD; Valerio De Stefano, MD; Attilio Maseri, MD

Institute of Cardiology and Division of Hematology, Catholic University, 00168 Rome, Italy, felicita.andreotti@iol.it

Licia Iacoviello, MD, PhD

Department of Vascular Medicine and Pharmacology Consorzio Mario Negri Sud, 66030 S. Maria Imbaro, Italy

	Introduction

 
To the Editor:

We would like to offer our interpretation of the recent article by Ridker et al,¹ which was derived from the Physicians’ Health Study (PHS). To our knowledge, this is the only report that does not confirm the association between the G20210A prothrombin mutation and deep vein thrombosis. In this report, the mutation was also unrelated to myocardial infarction and stroke.¹

The G20210A allele is associated with increased prothrombin levels in blood and, since 1996, it has been reported concordantly as a moderate and significant risk factor for deep vein thrombosis by 12 different case-control studies (published in extenso) involving 2657 patients and 4070 healthy controls (for partial review see Reference 2).

The PHS was conceived as a randomized trial to investigate the effects of aspirin versus placebo on cardiovascular mortality during a 5- to 10-year follow-up period.^{1 3} Enrolled subjects constituted a special group: American male physicians, 41 to 84 years of age, who were selected according to the absence of previous thrombotic events (ie, with a low cardiovascular risk profile, which was reduced even further by the intake of aspirin).^{1 3} The extremely low risk of the PHS population is supported by the participants’ initial healthy conditions, despite a mean age at enrollment of 60 years, and by the authors’ own statement at follow-up, that "cardiovascular death rates in this trial were exceptionally low... only 15% of that expected for a general population of white men with the same age distribution over a similar period."³ Thus, the PHS . . . [Full Text of this Article]

Paul M. Ridker, MD; Charles H. Hennekens, MD

Brigham and Women’s Hospital, Boston, Mass

Joseph P. Miletich, MD

Washington University St. Louis, Mo