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Chen CJ, Brown WM, Moomaw CJ, Langefeld CD, Osborne J, Worrall BB, Woo D, Koch S. Alcohol use and risk of intracerebral hemorrhage. Neurology 2017; 88:2043-2051. [PMID: 28446657 DOI: 10.1212/wnl.0000000000003952] [Citation(s) in RCA: 29] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/01/2016] [Accepted: 03/01/2017] [Indexed: 11/15/2022] Open
Abstract
OBJECTIVE To analyze the dose-risk relationship for alcohol consumption and intracerebral hemorrhage (ICH) in the Ethnic/Racial Variations of Intracerebral Hemorrhage (ERICH) study. METHODS ERICH is a multicenter, prospective, case-control study, designed to recruit 1,000 non-Hispanic white patients, 1,000 non-Hispanic black patients, and 1,000 Hispanic patients with ICH. Cases were matched 1:1 to ICH-free controls by age, sex, race/ethnicity, and geographic area. Comprehensive interviews included questions regarding alcohol consumption. Patterns of alcohol consumption were categorized as none, rare (<1 drink per month), moderate (≥1 drink per month and ≤2 drinks per day), intermediate (>2 drinks per day and <5 drinks per day), and heavy (≥5 drinks per day). ICH risk was calculated using the no-alcohol use category as the reference group. RESULTS Multivariable analyses demonstrated an ordinal trend for alcohol consumption: rare (odds ratio [OR] 0.57, p < 0.0001), moderate (OR 0.65, p < 0.0001), intermediate (OR 0.82, p = 0.2666), and heavy alcohol consumption (OR 1.77, p = 0.0003). Subgroup analyses demonstrated an association of rare and moderate alcohol consumption with decreased risk of both lobar and nonlobar ICH. Heavy alcohol consumption demonstrated a strong association with increased nonlobar ICH risk (OR 2.04, p = 0.0003). Heavy alcohol consumption was associated with significant increase in nonlobar ICH risk in black (OR 2.34, p = 0.0140) and Hispanic participants (OR 12.32, p < 0.0001). A similar association was not found in white participants. CONCLUSIONS This study demonstrated potential protective effects of rare and moderate alcohol consumption on ICH risk. Heavy alcohol consumption was associated with increased ICH risk. Race/ethnicity was a significant factor in alcohol-associated ICH risk; heavy alcohol consumption in black and Hispanic participants poses significant nonlobar ICH risk.
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Affiliation(s)
- Ching-Jen Chen
- From the Departments of Neurosurgery (C.-J.C.), Neurology (B.B.W.), and Public Health Sciences (B.B.W.), University of Virginia Health System, Charlottesville; Center for Public Health Genomics and Department of Biostatistical Sciences (W.M.B., C.D.L.), Wake Forest University School of Medicine, Winston-Salem, NC; Department of Neurology and Rehabilitation Medicine (C.J.M., J.O., D.W.), University of Cincinnati College of Medicine, OH; and Department of Neurology (S.K.), University of Miami Miller School of Medicine, FL. Coinvestigators are listed at Neurology.org
| | - W Mark Brown
- From the Departments of Neurosurgery (C.-J.C.), Neurology (B.B.W.), and Public Health Sciences (B.B.W.), University of Virginia Health System, Charlottesville; Center for Public Health Genomics and Department of Biostatistical Sciences (W.M.B., C.D.L.), Wake Forest University School of Medicine, Winston-Salem, NC; Department of Neurology and Rehabilitation Medicine (C.J.M., J.O., D.W.), University of Cincinnati College of Medicine, OH; and Department of Neurology (S.K.), University of Miami Miller School of Medicine, FL. Coinvestigators are listed at Neurology.org
| | - Charles J Moomaw
- From the Departments of Neurosurgery (C.-J.C.), Neurology (B.B.W.), and Public Health Sciences (B.B.W.), University of Virginia Health System, Charlottesville; Center for Public Health Genomics and Department of Biostatistical Sciences (W.M.B., C.D.L.), Wake Forest University School of Medicine, Winston-Salem, NC; Department of Neurology and Rehabilitation Medicine (C.J.M., J.O., D.W.), University of Cincinnati College of Medicine, OH; and Department of Neurology (S.K.), University of Miami Miller School of Medicine, FL. Coinvestigators are listed at Neurology.org
| | - Carl D Langefeld
- From the Departments of Neurosurgery (C.-J.C.), Neurology (B.B.W.), and Public Health Sciences (B.B.W.), University of Virginia Health System, Charlottesville; Center for Public Health Genomics and Department of Biostatistical Sciences (W.M.B., C.D.L.), Wake Forest University School of Medicine, Winston-Salem, NC; Department of Neurology and Rehabilitation Medicine (C.J.M., J.O., D.W.), University of Cincinnati College of Medicine, OH; and Department of Neurology (S.K.), University of Miami Miller School of Medicine, FL. Coinvestigators are listed at Neurology.org
| | - Jennifer Osborne
- From the Departments of Neurosurgery (C.-J.C.), Neurology (B.B.W.), and Public Health Sciences (B.B.W.), University of Virginia Health System, Charlottesville; Center for Public Health Genomics and Department of Biostatistical Sciences (W.M.B., C.D.L.), Wake Forest University School of Medicine, Winston-Salem, NC; Department of Neurology and Rehabilitation Medicine (C.J.M., J.O., D.W.), University of Cincinnati College of Medicine, OH; and Department of Neurology (S.K.), University of Miami Miller School of Medicine, FL. Coinvestigators are listed at Neurology.org
| | - Bradford B Worrall
- From the Departments of Neurosurgery (C.-J.C.), Neurology (B.B.W.), and Public Health Sciences (B.B.W.), University of Virginia Health System, Charlottesville; Center for Public Health Genomics and Department of Biostatistical Sciences (W.M.B., C.D.L.), Wake Forest University School of Medicine, Winston-Salem, NC; Department of Neurology and Rehabilitation Medicine (C.J.M., J.O., D.W.), University of Cincinnati College of Medicine, OH; and Department of Neurology (S.K.), University of Miami Miller School of Medicine, FL. Coinvestigators are listed at Neurology.org
| | - Daniel Woo
- From the Departments of Neurosurgery (C.-J.C.), Neurology (B.B.W.), and Public Health Sciences (B.B.W.), University of Virginia Health System, Charlottesville; Center for Public Health Genomics and Department of Biostatistical Sciences (W.M.B., C.D.L.), Wake Forest University School of Medicine, Winston-Salem, NC; Department of Neurology and Rehabilitation Medicine (C.J.M., J.O., D.W.), University of Cincinnati College of Medicine, OH; and Department of Neurology (S.K.), University of Miami Miller School of Medicine, FL. Coinvestigators are listed at Neurology.org
| | - Sebastian Koch
- From the Departments of Neurosurgery (C.-J.C.), Neurology (B.B.W.), and Public Health Sciences (B.B.W.), University of Virginia Health System, Charlottesville; Center for Public Health Genomics and Department of Biostatistical Sciences (W.M.B., C.D.L.), Wake Forest University School of Medicine, Winston-Salem, NC; Department of Neurology and Rehabilitation Medicine (C.J.M., J.O., D.W.), University of Cincinnati College of Medicine, OH; and Department of Neurology (S.K.), University of Miami Miller School of Medicine, FL. Coinvestigators are listed at Neurology.org.
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Lee SJ, Cho YJ, Kim JG, Ko Y, Hong KS, Park JM, Kang K, Park TH, Park SS, Lee KB, Cha JK, Kim DH, Lee J, Kim JT, Lee J, Lee JS, Jang MS, Han MK, Gorelick PB, Bae HJ. Moderate alcohol intake reduces risk of ischemic stroke in Korea. Neurology 2015; 85:1950-6. [PMID: 26519539 DOI: 10.1212/wnl.0000000000002165] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/16/2015] [Accepted: 08/03/2015] [Indexed: 11/15/2022] Open
Abstract
OBJECTIVE We undertook a population-based, case-control study to examine a dose-response relationship between alcohol intake and risk of ischemic stroke in Koreans who had different alcoholic beverage type preferences than Western populations and to examine the effect modifications by sex and ischemic stroke subtypes. METHODS Cases (n = 1,848) were recruited from patients aged 20 years or older with first-ever ischemic stroke. Stroke-free controls (n = 3,589) were from the fourth and fifth Korean National Health and Nutrition Examination Survey and were matched to the cases by age (±3 years), sex, and education level. All participants completed an interview using a structured questionnaire about alcohol intake. RESULTS Light to moderate alcohol intake, 3 or 4 drinks (1 drink = 10 g ethanol) per day, was significantly associated with a lower odds of ischemic stroke after adjusting for potential confounders (no drinks: reference; <1 drink: odds ratio 0.38, 95% confidence interval 0.32-0.45; 1-2 drinks: 0.45, 0.36-0.57; and 3-4 drinks: 0.54, 0.39-0.74). The threshold of alcohol effect in women was slightly lower than that in men (up to 1-2 drinks in women vs up to 3-4 drinks in men), but this difference was not statistically significant. There was no statistical interaction between alcohol intake and the subtypes of ischemic stroke (p = 0.50). The most frequently used alcoholic beverage was one native to Korea, soju (78% of the cases), a distilled beverage with 20% ethanol by volume. CONCLUSIONS Our findings suggest that light to moderate distilled alcohol consumption may reduce the risk of ischemic stroke in Koreans.
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Affiliation(s)
- Soo Joo Lee
- From the Department of Neurology (S.J.L., J.G.K., Y.K.), Eulji University Hospital, Daejeon; Department of Neurology (Y.-J.C., K.-S.H.), Inje University Ilsan Paik Hospital, Goyang-si, Gyeonggi-do; Department of Neurology (J.-M.P., K.K.), Eulji General Hospital, Seoul; Department of Neurology (T.H.P., S.-S.P.), Seoul Medical Center; Department of Neurology (K.B.L.), Soonchunhyang University Hospital Seoul; Department of Neurology (J.K.C., D.-H.K.), Dong-A University Hospital, Busan; Department of Neurology (Jun Lee), Yeungnam University Medical Center, Daegu; Department of Neurology (J.-T.K.), Chonnam National University Hospital, Gwangju; Department of Biostatistics (Juneyoung Lee), Korea University College of Medicine, Seoul; Clinical Research Center (J.S.L.), Asan Medical Center, Seoul; Department of Neurology and Cerebrovascular Center (M.S.J., M.-K.H., H.-J.B.), Seoul National University Bundang Hospital, Seongnam-si, Gyeonggi-do, Republic of Korea; and Department of Translational Science & Molecular Medicine (P.B.G.), Michigan State University College of Human Medicine and Medical Director, Mercy Health Hauenstein Neurosciences, Grand Rapids, MI
| | - Yong-Jin Cho
- From the Department of Neurology (S.J.L., J.G.K., Y.K.), Eulji University Hospital, Daejeon; Department of Neurology (Y.-J.C., K.-S.H.), Inje University Ilsan Paik Hospital, Goyang-si, Gyeonggi-do; Department of Neurology (J.-M.P., K.K.), Eulji General Hospital, Seoul; Department of Neurology (T.H.P., S.-S.P.), Seoul Medical Center; Department of Neurology (K.B.L.), Soonchunhyang University Hospital Seoul; Department of Neurology (J.K.C., D.-H.K.), Dong-A University Hospital, Busan; Department of Neurology (Jun Lee), Yeungnam University Medical Center, Daegu; Department of Neurology (J.-T.K.), Chonnam National University Hospital, Gwangju; Department of Biostatistics (Juneyoung Lee), Korea University College of Medicine, Seoul; Clinical Research Center (J.S.L.), Asan Medical Center, Seoul; Department of Neurology and Cerebrovascular Center (M.S.J., M.-K.H., H.-J.B.), Seoul National University Bundang Hospital, Seongnam-si, Gyeonggi-do, Republic of Korea; and Department of Translational Science & Molecular Medicine (P.B.G.), Michigan State University College of Human Medicine and Medical Director, Mercy Health Hauenstein Neurosciences, Grand Rapids, MI
| | - Jae Guk Kim
- From the Department of Neurology (S.J.L., J.G.K., Y.K.), Eulji University Hospital, Daejeon; Department of Neurology (Y.-J.C., K.-S.H.), Inje University Ilsan Paik Hospital, Goyang-si, Gyeonggi-do; Department of Neurology (J.-M.P., K.K.), Eulji General Hospital, Seoul; Department of Neurology (T.H.P., S.-S.P.), Seoul Medical Center; Department of Neurology (K.B.L.), Soonchunhyang University Hospital Seoul; Department of Neurology (J.K.C., D.-H.K.), Dong-A University Hospital, Busan; Department of Neurology (Jun Lee), Yeungnam University Medical Center, Daegu; Department of Neurology (J.-T.K.), Chonnam National University Hospital, Gwangju; Department of Biostatistics (Juneyoung Lee), Korea University College of Medicine, Seoul; Clinical Research Center (J.S.L.), Asan Medical Center, Seoul; Department of Neurology and Cerebrovascular Center (M.S.J., M.-K.H., H.-J.B.), Seoul National University Bundang Hospital, Seongnam-si, Gyeonggi-do, Republic of Korea; and Department of Translational Science & Molecular Medicine (P.B.G.), Michigan State University College of Human Medicine and Medical Director, Mercy Health Hauenstein Neurosciences, Grand Rapids, MI
| | - Youngchai Ko
- From the Department of Neurology (S.J.L., J.G.K., Y.K.), Eulji University Hospital, Daejeon; Department of Neurology (Y.-J.C., K.-S.H.), Inje University Ilsan Paik Hospital, Goyang-si, Gyeonggi-do; Department of Neurology (J.-M.P., K.K.), Eulji General Hospital, Seoul; Department of Neurology (T.H.P., S.-S.P.), Seoul Medical Center; Department of Neurology (K.B.L.), Soonchunhyang University Hospital Seoul; Department of Neurology (J.K.C., D.-H.K.), Dong-A University Hospital, Busan; Department of Neurology (Jun Lee), Yeungnam University Medical Center, Daegu; Department of Neurology (J.-T.K.), Chonnam National University Hospital, Gwangju; Department of Biostatistics (Juneyoung Lee), Korea University College of Medicine, Seoul; Clinical Research Center (J.S.L.), Asan Medical Center, Seoul; Department of Neurology and Cerebrovascular Center (M.S.J., M.-K.H., H.-J.B.), Seoul National University Bundang Hospital, Seongnam-si, Gyeonggi-do, Republic of Korea; and Department of Translational Science & Molecular Medicine (P.B.G.), Michigan State University College of Human Medicine and Medical Director, Mercy Health Hauenstein Neurosciences, Grand Rapids, MI
| | - Keun-Sik Hong
- From the Department of Neurology (S.J.L., J.G.K., Y.K.), Eulji University Hospital, Daejeon; Department of Neurology (Y.-J.C., K.-S.H.), Inje University Ilsan Paik Hospital, Goyang-si, Gyeonggi-do; Department of Neurology (J.-M.P., K.K.), Eulji General Hospital, Seoul; Department of Neurology (T.H.P., S.-S.P.), Seoul Medical Center; Department of Neurology (K.B.L.), Soonchunhyang University Hospital Seoul; Department of Neurology (J.K.C., D.-H.K.), Dong-A University Hospital, Busan; Department of Neurology (Jun Lee), Yeungnam University Medical Center, Daegu; Department of Neurology (J.-T.K.), Chonnam National University Hospital, Gwangju; Department of Biostatistics (Juneyoung Lee), Korea University College of Medicine, Seoul; Clinical Research Center (J.S.L.), Asan Medical Center, Seoul; Department of Neurology and Cerebrovascular Center (M.S.J., M.-K.H., H.-J.B.), Seoul National University Bundang Hospital, Seongnam-si, Gyeonggi-do, Republic of Korea; and Department of Translational Science & Molecular Medicine (P.B.G.), Michigan State University College of Human Medicine and Medical Director, Mercy Health Hauenstein Neurosciences, Grand Rapids, MI
| | - Jong-Moo Park
- From the Department of Neurology (S.J.L., J.G.K., Y.K.), Eulji University Hospital, Daejeon; Department of Neurology (Y.-J.C., K.-S.H.), Inje University Ilsan Paik Hospital, Goyang-si, Gyeonggi-do; Department of Neurology (J.-M.P., K.K.), Eulji General Hospital, Seoul; Department of Neurology (T.H.P., S.-S.P.), Seoul Medical Center; Department of Neurology (K.B.L.), Soonchunhyang University Hospital Seoul; Department of Neurology (J.K.C., D.-H.K.), Dong-A University Hospital, Busan; Department of Neurology (Jun Lee), Yeungnam University Medical Center, Daegu; Department of Neurology (J.-T.K.), Chonnam National University Hospital, Gwangju; Department of Biostatistics (Juneyoung Lee), Korea University College of Medicine, Seoul; Clinical Research Center (J.S.L.), Asan Medical Center, Seoul; Department of Neurology and Cerebrovascular Center (M.S.J., M.-K.H., H.-J.B.), Seoul National University Bundang Hospital, Seongnam-si, Gyeonggi-do, Republic of Korea; and Department of Translational Science & Molecular Medicine (P.B.G.), Michigan State University College of Human Medicine and Medical Director, Mercy Health Hauenstein Neurosciences, Grand Rapids, MI
| | - Kyusik Kang
- From the Department of Neurology (S.J.L., J.G.K., Y.K.), Eulji University Hospital, Daejeon; Department of Neurology (Y.-J.C., K.-S.H.), Inje University Ilsan Paik Hospital, Goyang-si, Gyeonggi-do; Department of Neurology (J.-M.P., K.K.), Eulji General Hospital, Seoul; Department of Neurology (T.H.P., S.-S.P.), Seoul Medical Center; Department of Neurology (K.B.L.), Soonchunhyang University Hospital Seoul; Department of Neurology (J.K.C., D.-H.K.), Dong-A University Hospital, Busan; Department of Neurology (Jun Lee), Yeungnam University Medical Center, Daegu; Department of Neurology (J.-T.K.), Chonnam National University Hospital, Gwangju; Department of Biostatistics (Juneyoung Lee), Korea University College of Medicine, Seoul; Clinical Research Center (J.S.L.), Asan Medical Center, Seoul; Department of Neurology and Cerebrovascular Center (M.S.J., M.-K.H., H.-J.B.), Seoul National University Bundang Hospital, Seongnam-si, Gyeonggi-do, Republic of Korea; and Department of Translational Science & Molecular Medicine (P.B.G.), Michigan State University College of Human Medicine and Medical Director, Mercy Health Hauenstein Neurosciences, Grand Rapids, MI
| | - Tai Hwan Park
- From the Department of Neurology (S.J.L., J.G.K., Y.K.), Eulji University Hospital, Daejeon; Department of Neurology (Y.-J.C., K.-S.H.), Inje University Ilsan Paik Hospital, Goyang-si, Gyeonggi-do; Department of Neurology (J.-M.P., K.K.), Eulji General Hospital, Seoul; Department of Neurology (T.H.P., S.-S.P.), Seoul Medical Center; Department of Neurology (K.B.L.), Soonchunhyang University Hospital Seoul; Department of Neurology (J.K.C., D.-H.K.), Dong-A University Hospital, Busan; Department of Neurology (Jun Lee), Yeungnam University Medical Center, Daegu; Department of Neurology (J.-T.K.), Chonnam National University Hospital, Gwangju; Department of Biostatistics (Juneyoung Lee), Korea University College of Medicine, Seoul; Clinical Research Center (J.S.L.), Asan Medical Center, Seoul; Department of Neurology and Cerebrovascular Center (M.S.J., M.-K.H., H.-J.B.), Seoul National University Bundang Hospital, Seongnam-si, Gyeonggi-do, Republic of Korea; and Department of Translational Science & Molecular Medicine (P.B.G.), Michigan State University College of Human Medicine and Medical Director, Mercy Health Hauenstein Neurosciences, Grand Rapids, MI
| | - Sang-Soon Park
- From the Department of Neurology (S.J.L., J.G.K., Y.K.), Eulji University Hospital, Daejeon; Department of Neurology (Y.-J.C., K.-S.H.), Inje University Ilsan Paik Hospital, Goyang-si, Gyeonggi-do; Department of Neurology (J.-M.P., K.K.), Eulji General Hospital, Seoul; Department of Neurology (T.H.P., S.-S.P.), Seoul Medical Center; Department of Neurology (K.B.L.), Soonchunhyang University Hospital Seoul; Department of Neurology (J.K.C., D.-H.K.), Dong-A University Hospital, Busan; Department of Neurology (Jun Lee), Yeungnam University Medical Center, Daegu; Department of Neurology (J.-T.K.), Chonnam National University Hospital, Gwangju; Department of Biostatistics (Juneyoung Lee), Korea University College of Medicine, Seoul; Clinical Research Center (J.S.L.), Asan Medical Center, Seoul; Department of Neurology and Cerebrovascular Center (M.S.J., M.-K.H., H.-J.B.), Seoul National University Bundang Hospital, Seongnam-si, Gyeonggi-do, Republic of Korea; and Department of Translational Science & Molecular Medicine (P.B.G.), Michigan State University College of Human Medicine and Medical Director, Mercy Health Hauenstein Neurosciences, Grand Rapids, MI
| | - Kyung Bok Lee
- From the Department of Neurology (S.J.L., J.G.K., Y.K.), Eulji University Hospital, Daejeon; Department of Neurology (Y.-J.C., K.-S.H.), Inje University Ilsan Paik Hospital, Goyang-si, Gyeonggi-do; Department of Neurology (J.-M.P., K.K.), Eulji General Hospital, Seoul; Department of Neurology (T.H.P., S.-S.P.), Seoul Medical Center; Department of Neurology (K.B.L.), Soonchunhyang University Hospital Seoul; Department of Neurology (J.K.C., D.-H.K.), Dong-A University Hospital, Busan; Department of Neurology (Jun Lee), Yeungnam University Medical Center, Daegu; Department of Neurology (J.-T.K.), Chonnam National University Hospital, Gwangju; Department of Biostatistics (Juneyoung Lee), Korea University College of Medicine, Seoul; Clinical Research Center (J.S.L.), Asan Medical Center, Seoul; Department of Neurology and Cerebrovascular Center (M.S.J., M.-K.H., H.-J.B.), Seoul National University Bundang Hospital, Seongnam-si, Gyeonggi-do, Republic of Korea; and Department of Translational Science & Molecular Medicine (P.B.G.), Michigan State University College of Human Medicine and Medical Director, Mercy Health Hauenstein Neurosciences, Grand Rapids, MI
| | - Jae Kwan Cha
- From the Department of Neurology (S.J.L., J.G.K., Y.K.), Eulji University Hospital, Daejeon; Department of Neurology (Y.-J.C., K.-S.H.), Inje University Ilsan Paik Hospital, Goyang-si, Gyeonggi-do; Department of Neurology (J.-M.P., K.K.), Eulji General Hospital, Seoul; Department of Neurology (T.H.P., S.-S.P.), Seoul Medical Center; Department of Neurology (K.B.L.), Soonchunhyang University Hospital Seoul; Department of Neurology (J.K.C., D.-H.K.), Dong-A University Hospital, Busan; Department of Neurology (Jun Lee), Yeungnam University Medical Center, Daegu; Department of Neurology (J.-T.K.), Chonnam National University Hospital, Gwangju; Department of Biostatistics (Juneyoung Lee), Korea University College of Medicine, Seoul; Clinical Research Center (J.S.L.), Asan Medical Center, Seoul; Department of Neurology and Cerebrovascular Center (M.S.J., M.-K.H., H.-J.B.), Seoul National University Bundang Hospital, Seongnam-si, Gyeonggi-do, Republic of Korea; and Department of Translational Science & Molecular Medicine (P.B.G.), Michigan State University College of Human Medicine and Medical Director, Mercy Health Hauenstein Neurosciences, Grand Rapids, MI
| | - Dae-Hyun Kim
- From the Department of Neurology (S.J.L., J.G.K., Y.K.), Eulji University Hospital, Daejeon; Department of Neurology (Y.-J.C., K.-S.H.), Inje University Ilsan Paik Hospital, Goyang-si, Gyeonggi-do; Department of Neurology (J.-M.P., K.K.), Eulji General Hospital, Seoul; Department of Neurology (T.H.P., S.-S.P.), Seoul Medical Center; Department of Neurology (K.B.L.), Soonchunhyang University Hospital Seoul; Department of Neurology (J.K.C., D.-H.K.), Dong-A University Hospital, Busan; Department of Neurology (Jun Lee), Yeungnam University Medical Center, Daegu; Department of Neurology (J.-T.K.), Chonnam National University Hospital, Gwangju; Department of Biostatistics (Juneyoung Lee), Korea University College of Medicine, Seoul; Clinical Research Center (J.S.L.), Asan Medical Center, Seoul; Department of Neurology and Cerebrovascular Center (M.S.J., M.-K.H., H.-J.B.), Seoul National University Bundang Hospital, Seongnam-si, Gyeonggi-do, Republic of Korea; and Department of Translational Science & Molecular Medicine (P.B.G.), Michigan State University College of Human Medicine and Medical Director, Mercy Health Hauenstein Neurosciences, Grand Rapids, MI
| | - Jun Lee
- From the Department of Neurology (S.J.L., J.G.K., Y.K.), Eulji University Hospital, Daejeon; Department of Neurology (Y.-J.C., K.-S.H.), Inje University Ilsan Paik Hospital, Goyang-si, Gyeonggi-do; Department of Neurology (J.-M.P., K.K.), Eulji General Hospital, Seoul; Department of Neurology (T.H.P., S.-S.P.), Seoul Medical Center; Department of Neurology (K.B.L.), Soonchunhyang University Hospital Seoul; Department of Neurology (J.K.C., D.-H.K.), Dong-A University Hospital, Busan; Department of Neurology (Jun Lee), Yeungnam University Medical Center, Daegu; Department of Neurology (J.-T.K.), Chonnam National University Hospital, Gwangju; Department of Biostatistics (Juneyoung Lee), Korea University College of Medicine, Seoul; Clinical Research Center (J.S.L.), Asan Medical Center, Seoul; Department of Neurology and Cerebrovascular Center (M.S.J., M.-K.H., H.-J.B.), Seoul National University Bundang Hospital, Seongnam-si, Gyeonggi-do, Republic of Korea; and Department of Translational Science & Molecular Medicine (P.B.G.), Michigan State University College of Human Medicine and Medical Director, Mercy Health Hauenstein Neurosciences, Grand Rapids, MI
| | - Joon-Tae Kim
- From the Department of Neurology (S.J.L., J.G.K., Y.K.), Eulji University Hospital, Daejeon; Department of Neurology (Y.-J.C., K.-S.H.), Inje University Ilsan Paik Hospital, Goyang-si, Gyeonggi-do; Department of Neurology (J.-M.P., K.K.), Eulji General Hospital, Seoul; Department of Neurology (T.H.P., S.-S.P.), Seoul Medical Center; Department of Neurology (K.B.L.), Soonchunhyang University Hospital Seoul; Department of Neurology (J.K.C., D.-H.K.), Dong-A University Hospital, Busan; Department of Neurology (Jun Lee), Yeungnam University Medical Center, Daegu; Department of Neurology (J.-T.K.), Chonnam National University Hospital, Gwangju; Department of Biostatistics (Juneyoung Lee), Korea University College of Medicine, Seoul; Clinical Research Center (J.S.L.), Asan Medical Center, Seoul; Department of Neurology and Cerebrovascular Center (M.S.J., M.-K.H., H.-J.B.), Seoul National University Bundang Hospital, Seongnam-si, Gyeonggi-do, Republic of Korea; and Department of Translational Science & Molecular Medicine (P.B.G.), Michigan State University College of Human Medicine and Medical Director, Mercy Health Hauenstein Neurosciences, Grand Rapids, MI
| | - Juneyoung Lee
- From the Department of Neurology (S.J.L., J.G.K., Y.K.), Eulji University Hospital, Daejeon; Department of Neurology (Y.-J.C., K.-S.H.), Inje University Ilsan Paik Hospital, Goyang-si, Gyeonggi-do; Department of Neurology (J.-M.P., K.K.), Eulji General Hospital, Seoul; Department of Neurology (T.H.P., S.-S.P.), Seoul Medical Center; Department of Neurology (K.B.L.), Soonchunhyang University Hospital Seoul; Department of Neurology (J.K.C., D.-H.K.), Dong-A University Hospital, Busan; Department of Neurology (Jun Lee), Yeungnam University Medical Center, Daegu; Department of Neurology (J.-T.K.), Chonnam National University Hospital, Gwangju; Department of Biostatistics (Juneyoung Lee), Korea University College of Medicine, Seoul; Clinical Research Center (J.S.L.), Asan Medical Center, Seoul; Department of Neurology and Cerebrovascular Center (M.S.J., M.-K.H., H.-J.B.), Seoul National University Bundang Hospital, Seongnam-si, Gyeonggi-do, Republic of Korea; and Department of Translational Science & Molecular Medicine (P.B.G.), Michigan State University College of Human Medicine and Medical Director, Mercy Health Hauenstein Neurosciences, Grand Rapids, MI
| | - Ji Sung Lee
- From the Department of Neurology (S.J.L., J.G.K., Y.K.), Eulji University Hospital, Daejeon; Department of Neurology (Y.-J.C., K.-S.H.), Inje University Ilsan Paik Hospital, Goyang-si, Gyeonggi-do; Department of Neurology (J.-M.P., K.K.), Eulji General Hospital, Seoul; Department of Neurology (T.H.P., S.-S.P.), Seoul Medical Center; Department of Neurology (K.B.L.), Soonchunhyang University Hospital Seoul; Department of Neurology (J.K.C., D.-H.K.), Dong-A University Hospital, Busan; Department of Neurology (Jun Lee), Yeungnam University Medical Center, Daegu; Department of Neurology (J.-T.K.), Chonnam National University Hospital, Gwangju; Department of Biostatistics (Juneyoung Lee), Korea University College of Medicine, Seoul; Clinical Research Center (J.S.L.), Asan Medical Center, Seoul; Department of Neurology and Cerebrovascular Center (M.S.J., M.-K.H., H.-J.B.), Seoul National University Bundang Hospital, Seongnam-si, Gyeonggi-do, Republic of Korea; and Department of Translational Science & Molecular Medicine (P.B.G.), Michigan State University College of Human Medicine and Medical Director, Mercy Health Hauenstein Neurosciences, Grand Rapids, MI
| | - Myung Suk Jang
- From the Department of Neurology (S.J.L., J.G.K., Y.K.), Eulji University Hospital, Daejeon; Department of Neurology (Y.-J.C., K.-S.H.), Inje University Ilsan Paik Hospital, Goyang-si, Gyeonggi-do; Department of Neurology (J.-M.P., K.K.), Eulji General Hospital, Seoul; Department of Neurology (T.H.P., S.-S.P.), Seoul Medical Center; Department of Neurology (K.B.L.), Soonchunhyang University Hospital Seoul; Department of Neurology (J.K.C., D.-H.K.), Dong-A University Hospital, Busan; Department of Neurology (Jun Lee), Yeungnam University Medical Center, Daegu; Department of Neurology (J.-T.K.), Chonnam National University Hospital, Gwangju; Department of Biostatistics (Juneyoung Lee), Korea University College of Medicine, Seoul; Clinical Research Center (J.S.L.), Asan Medical Center, Seoul; Department of Neurology and Cerebrovascular Center (M.S.J., M.-K.H., H.-J.B.), Seoul National University Bundang Hospital, Seongnam-si, Gyeonggi-do, Republic of Korea; and Department of Translational Science & Molecular Medicine (P.B.G.), Michigan State University College of Human Medicine and Medical Director, Mercy Health Hauenstein Neurosciences, Grand Rapids, MI
| | - Moon-Ku Han
- From the Department of Neurology (S.J.L., J.G.K., Y.K.), Eulji University Hospital, Daejeon; Department of Neurology (Y.-J.C., K.-S.H.), Inje University Ilsan Paik Hospital, Goyang-si, Gyeonggi-do; Department of Neurology (J.-M.P., K.K.), Eulji General Hospital, Seoul; Department of Neurology (T.H.P., S.-S.P.), Seoul Medical Center; Department of Neurology (K.B.L.), Soonchunhyang University Hospital Seoul; Department of Neurology (J.K.C., D.-H.K.), Dong-A University Hospital, Busan; Department of Neurology (Jun Lee), Yeungnam University Medical Center, Daegu; Department of Neurology (J.-T.K.), Chonnam National University Hospital, Gwangju; Department of Biostatistics (Juneyoung Lee), Korea University College of Medicine, Seoul; Clinical Research Center (J.S.L.), Asan Medical Center, Seoul; Department of Neurology and Cerebrovascular Center (M.S.J., M.-K.H., H.-J.B.), Seoul National University Bundang Hospital, Seongnam-si, Gyeonggi-do, Republic of Korea; and Department of Translational Science & Molecular Medicine (P.B.G.), Michigan State University College of Human Medicine and Medical Director, Mercy Health Hauenstein Neurosciences, Grand Rapids, MI
| | - Philip B Gorelick
- From the Department of Neurology (S.J.L., J.G.K., Y.K.), Eulji University Hospital, Daejeon; Department of Neurology (Y.-J.C., K.-S.H.), Inje University Ilsan Paik Hospital, Goyang-si, Gyeonggi-do; Department of Neurology (J.-M.P., K.K.), Eulji General Hospital, Seoul; Department of Neurology (T.H.P., S.-S.P.), Seoul Medical Center; Department of Neurology (K.B.L.), Soonchunhyang University Hospital Seoul; Department of Neurology (J.K.C., D.-H.K.), Dong-A University Hospital, Busan; Department of Neurology (Jun Lee), Yeungnam University Medical Center, Daegu; Department of Neurology (J.-T.K.), Chonnam National University Hospital, Gwangju; Department of Biostatistics (Juneyoung Lee), Korea University College of Medicine, Seoul; Clinical Research Center (J.S.L.), Asan Medical Center, Seoul; Department of Neurology and Cerebrovascular Center (M.S.J., M.-K.H., H.-J.B.), Seoul National University Bundang Hospital, Seongnam-si, Gyeonggi-do, Republic of Korea; and Department of Translational Science & Molecular Medicine (P.B.G.), Michigan State University College of Human Medicine and Medical Director, Mercy Health Hauenstein Neurosciences, Grand Rapids, MI
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