ADAMTS13 and Myocardial Infarction: A Literature Review

Abstract

Background: Myocardial infarction (MI) is the most common cause of death worldwide. Important modifiable risk factors have been unraveled and preventive measures established, but the disease burden remains substantial. Von Willebrand Factor (VWF) is a protein involved in hemostasis known to have platelet-recruiting ability according to molecular size. A disintegrin and metalloprotease with thrombospondin motif 13 (ADAMTS13) is responsible for the cleavage of VWF multimers, making it an important regulator of VWF thrombogenicity. As severe deficiency of ADAMTS13 is known to cause thrombosis in microvessels, it has been hypothesized that a slight to moderate decrease in ADAMTS13 levels leads to increased risk of MI. Aim: To perform a literature review of existing case-control and cohort studies assessing the association between ADAMTS13 and MI. Methods: The PubMed database was used to perform a literature search designed to retrieve all case-control and cohort studies on the association between ADAMTS13 and MI. Only studies that investigated ADAMTS13 as exposure and MI as outcome were included. Results: Twelve studies were included, 10 case-control studies and 2 cohort studies. In the acute phase of MI, the vast majority of studies reported lower antigen or activity levels of ADAMTS13 in MI cases compared with control subjects. Findings were somewhat controversial when ADAMTS13 was measured several months/years after MI. A large prospective population-based cohort study found that individuals with low ADAMTS13 activity at baseline had increased risk of MI during 10 years of follow-up. Conclusion: Existing literature suggests an association between ADAMTS13 and MI. In the acute phase of MI, patients have lower levels of ADAMTS13 compared with control subjects. ADAMTS13 activity also appears to be reduced in the years prior to the MI event. However, further research using a prospective study design (e.g., cohorts) is necessary to confirm the association between ADAMTS13 and risk of future MI.