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Genetic polymorphisms modify the response of factor VII to oral contraceptive use: an example of gene-environment
Kitty W M Bloemenkamp1, Moniek P M de Maat, Marianne C Dersjant-Roorda
1Department of Obstetrics, Gynaecology and Reproductive Medicine, Leiden University Medical Center, Building 1, H-3-P, P.O. Box 9600, Leiden 2300 RC, The Netherlands.
Abstract:
Elevated plasma levels of factor VII and fibrinogen are risk factors for cardiovascular disease, especially arterial thrombosis. Oral contraceptive use increases factor VII and fibrinogen plasma levels. It has been described that DNA polymorphisms are associated with the plasma levels of hemostatic variables and their regulation. The R/Q353 polymorphism in the factor VII gene and the -455G/A polymorphism in the fibrinogen beta-gene are associated with plasma levels of factor VII and fibrinogen, respectively. We analysed data of a randomised study (n = 95) in which two types of oral contraceptives were compared with regard to their effect on factor VII and fibrinogen, in which we also determined R/Q353 and -455G/A polymorphisms. Women were allocated randomly to either receiving a monophasic oral contraceptive containing 75 micrograms of gestodene and 20 micrograms of ethinyl estradiol, or 150 micrograms of desogestrel and 20 micrograms of ethinyl estradiol. Blood was taken before treatment and after 3 and 6 months of oral contraceptive use. Factor VII and fibrinogen increased significantly after 3 and 6 months of oral contraceptive use; the increase in factor VII was higher in the desogestrel group than in the gestodene group at 3 and 6 months. For fibrinogen, there were no intergroup differences at 3 and 6 months. At baseline, an association between genotype and plasma factor VII and fibrinogen levels was observed. In multivariate analysis, the R/Q353 polymorphism and the type of oral contraceptive were determinants of the effect on the change in factor VII, with the highest increase in women carrying the Q allele and using the desogestrel-containing oral contraceptive, and the lowest increase in women with the RR genotype who use the gestodene-containing oral contraceptive. For fibrinogen, no interaction among type of oral contraceptive, -455G/A polymorphism, and change in plasma levels was observed. We conclude that an individual's genetic variation may contribute to the response of plasma factor VII to oral contraceptive use.