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Huang K, Jia J, Liang F, Li J, Niu X, Yang X, Chen S, Cao J, Shen C, Liu X, Yu L, Lu F, Wu X, Zhao L, Li Y, Hu D, Huang J, Liu Y, Gu D, Liu F, Lu X. Fine Particulate Matter Exposure, Genetic Susceptibility, and the Risk of Incident Stroke: A Prospective Cohort Study. Stroke 2024; 55:92-100. [PMID: 38018834 DOI: 10.1161/strokeaha.123.043812] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/09/2023] [Accepted: 10/12/2023] [Indexed: 11/30/2023]
Abstract
BACKGROUND Both genetic factors and environmental air pollution contribute to the risk of stroke. However, it is unknown whether the association between air pollution and stroke risk is influenced by the genetic susceptibilities of stroke and its risk factors. METHODS This prospective cohort study included 40 827 Chinese adults without stroke history. Satellite-based monthly fine particulate matter (PM2.5) estimation at 1-km resolution was used for exposure assessment. Based on 534 identified genetic variants from genome-wide association studies in East Asians, we constructed 6 polygenic risk scores for stroke and its risk factors, including atrial fibrillation, blood pressure, type 2 diabetes, body mass index, and triglyceride. The Cox proportional hazards model was applied to evaluate the hazard ratios and 95% CIs for the associations of PM2.5 and polygenic risk score with incident stroke and the potential effect modifications. RESULTS Over a median follow-up of 12.06 years, 3147 incident stroke cases were documented. Compared with the lowest quartile of PM2.5 exposure, the hazard ratio (95% CI) for stroke in the highest quartile group was 2.72 (2.42-3.06). Among individuals at high genetic risk, the relative risk of stroke was 57% (1.57; 1.40-1.76) higher than those at low genetic risk. Although no statistically significant interaction was found, participants with both the highest PM2.5 and high genetic risk showed the highest risk of stroke, with ≈4× that of the lowest PM2.5 and low genetic risk group (hazard ratio, 3.55 [95% CI, 2.84-4.44]). Similar upward gradients were observed in the risk of stroke when assessing the joint effects of PM2.5 and genetic risks of blood pressure, type 2 diabetes, body mass index, atrial fibrillation, and triglyceride. CONCLUSIONS Long-term exposure to PM2.5 was associated with a higher risk of incident stroke across different genetic susceptibilities. Our findings highlighted the great importance of comprehensive assessment of air pollution and genetic risk in the prevention of stroke.
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Affiliation(s)
- Keyong Huang
- Department of Epidemiology, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China (K.H., J.J., J.L., X.N., S.C., J.C., L.Z., Y. Li, J.H., D.G., F. Liu, X. Lu)
- Key Laboratory of Cardiovascular Epidemiology (K.H., J.J., J.L., S.C., J.C., L.Z., Y. Li, J.H., D.G., F. Liu, X. Lu), Chinese Academy of Medical Sciences, Beijing, China
| | - Jiajing Jia
- Department of Epidemiology, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China (K.H., J.J., J.L., X.N., S.C., J.C., L.Z., Y. Li, J.H., D.G., F. Liu, X. Lu)
- Key Laboratory of Cardiovascular Epidemiology (K.H., J.J., J.L., S.C., J.C., L.Z., Y. Li, J.H., D.G., F. Liu, X. Lu), Chinese Academy of Medical Sciences, Beijing, China
| | - Fengchao Liang
- School of Public Health and Emergency Management (F. Liang), Southern University of Science and Technology, Shenzhen, China
| | - Jianxin Li
- Department of Epidemiology, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China (K.H., J.J., J.L., X.N., S.C., J.C., L.Z., Y. Li, J.H., D.G., F. Liu, X. Lu)
- Key Laboratory of Cardiovascular Epidemiology (K.H., J.J., J.L., S.C., J.C., L.Z., Y. Li, J.H., D.G., F. Liu, X. Lu), Chinese Academy of Medical Sciences, Beijing, China
| | - Xiaoge Niu
- Department of Epidemiology, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China (K.H., J.J., J.L., X.N., S.C., J.C., L.Z., Y. Li, J.H., D.G., F. Liu, X. Lu)
- Key Laboratory of Cardiovascular Epidemiology (K.H., J.J., J.L., S.C., J.C., L.Z., Y. Li, J.H., D.G., F. Liu, X. Lu), Chinese Academy of Medical Sciences, Beijing, China
- Department of Nephrology, Henan Provincial Key Laboratory of Kidney Disease and Immunology, Henan Provincial Clinical Research Center for Kidney Disease, Henan Provincial People's Hospital and People's Hospital of Zhengzhou University, China (X.N.)
| | - Xueli Yang
- Tianjin Key Laboratory of Environment, Nutrition and Public Health, Department of Occupational and Environmental Health, School of Public Health, Tianjin Medical University, China (X.Y.)
| | - Shufeng Chen
- Department of Epidemiology, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China (K.H., J.J., J.L., X.N., S.C., J.C., L.Z., Y. Li, J.H., D.G., F. Liu, X. Lu)
- Key Laboratory of Cardiovascular Epidemiology (K.H., J.J., J.L., S.C., J.C., L.Z., Y. Li, J.H., D.G., F. Liu, X. Lu), Chinese Academy of Medical Sciences, Beijing, China
| | - Jie Cao
- Department of Epidemiology, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China (K.H., J.J., J.L., X.N., S.C., J.C., L.Z., Y. Li, J.H., D.G., F. Liu, X. Lu)
- Key Laboratory of Cardiovascular Epidemiology (K.H., J.J., J.L., S.C., J.C., L.Z., Y. Li, J.H., D.G., F. Liu, X. Lu), Chinese Academy of Medical Sciences, Beijing, China
| | - Chong Shen
- Research Units of Cohort Study on Cardiovascular Diseases and Cancers (C.S.), Chinese Academy of Medical Sciences, Beijing, China
- Department of Epidemiology and Biostatistics, School of Public Health, Nanjing Medical University, China (C.S.)
| | - Xiaoqing Liu
- Division of Epidemiology, Guangdong Provincial People's Hospital and Cardiovascular Institute, Guangzhou, China (X. Liu)
| | - Ling Yu
- Department of Cardiology, Fujian Provincial People's Hospital, Fuzhou, China (L.Y.)
| | - Fanghong Lu
- Cardio-Cerebrovascular Control and Research Center, Institute of Basic Medicine, Shandong Academy of Medical Sciences, Jinan, China (F. Lu)
| | - Xianping Wu
- Sichuan Center for Disease Control and Prevention, Chengdu, China (X.W.)
| | - Liancheng Zhao
- Department of Epidemiology, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China (K.H., J.J., J.L., X.N., S.C., J.C., L.Z., Y. Li, J.H., D.G., F. Liu, X. Lu)
- Key Laboratory of Cardiovascular Epidemiology (K.H., J.J., J.L., S.C., J.C., L.Z., Y. Li, J.H., D.G., F. Liu, X. Lu), Chinese Academy of Medical Sciences, Beijing, China
| | - Ying Li
- Department of Epidemiology, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China (K.H., J.J., J.L., X.N., S.C., J.C., L.Z., Y. Li, J.H., D.G., F. Liu, X. Lu)
- Key Laboratory of Cardiovascular Epidemiology (K.H., J.J., J.L., S.C., J.C., L.Z., Y. Li, J.H., D.G., F. Liu, X. Lu), Chinese Academy of Medical Sciences, Beijing, China
| | - Dongsheng Hu
- Department of Epidemiology, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China (K.H., J.J., J.L., X.N., S.C., J.C., L.Z., Y. Li, J.H., D.G., F. Liu, X. Lu)
- Department of Epidemiology and Health Statistics, College of Public Health, Zhengzhou University, China (D.H.)
- Department of Biostatistics and Epidemiology, School of Public Health, Shenzhen University Health Science Center, China (D.H.)
| | - Jianfeng Huang
- Department of Epidemiology, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China (K.H., J.J., J.L., X.N., S.C., J.C., L.Z., Y. Li, J.H., D.G., F. Liu, X. Lu)
- Key Laboratory of Cardiovascular Epidemiology (K.H., J.J., J.L., S.C., J.C., L.Z., Y. Li, J.H., D.G., F. Liu, X. Lu), Chinese Academy of Medical Sciences, Beijing, China
| | - Yang Liu
- Gangarosa Department of Environmental Health, Rollins School of Public Health, Emory University, Atlanta, GA (Y. Liu)
| | - Dongfeng Gu
- Key Laboratory of Cardiovascular Epidemiology (K.H., J.J., J.L., S.C., J.C., L.Z., Y. Li, J.H., D.G., F. Liu, X. Lu), Chinese Academy of Medical Sciences, Beijing, China
- School of Medicine (D.G), Southern University of Science and Technology, Shenzhen, China
| | - Fangchao Liu
- Department of Epidemiology, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China (K.H., J.J., J.L., X.N., S.C., J.C., L.Z., Y. Li, J.H., D.G., F. Liu, X. Lu)
- Key Laboratory of Cardiovascular Epidemiology (K.H., J.J., J.L., S.C., J.C., L.Z., Y. Li, J.H., D.G., F. Liu, X. Lu), Chinese Academy of Medical Sciences, Beijing, China
| | - Xiangfeng Lu
- Department of Epidemiology, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China (K.H., J.J., J.L., X.N., S.C., J.C., L.Z., Y. Li, J.H., D.G., F. Liu, X. Lu)
- Key Laboratory of Cardiovascular Epidemiology (K.H., J.J., J.L., S.C., J.C., L.Z., Y. Li, J.H., D.G., F. Liu, X. Lu), Chinese Academy of Medical Sciences, Beijing, China
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Mayerhofer E, Parodi L, Prapiadou S, Malik R, Rosand J, Georgakis MK, Anderson CD. Genetic Risk Score Improves Risk Stratification for Anticoagulation-Related Intracerebral Hemorrhage. Stroke 2023; 54:791-799. [PMID: 36756894 PMCID: PMC9992221 DOI: 10.1161/strokeaha.122.041764] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/25/2022] [Accepted: 01/19/2023] [Indexed: 02/10/2023]
Abstract
BACKGROUND Intracerebral hemorrhage (ICH) is the most devastating adverse outcome for patients on anticoagulants. Clinical risk scores that quantify bleeding risk can guide decision-making in situations when indication or duration for anticoagulation is uncertain. We investigated whether integration of a genetic risk score into an existing risk factor-based CRS could improve risk stratification for anticoagulation-related ICH. METHODS We constructed 153 genetic risk scores from genome-wide association data of 1545 ICH cases and 1481 controls and validated them in 431 ICH cases and 431 matched controls from the population-based UK Biobank. The score that explained the largest variance in ICH risk was selected and tested for prediction of incident ICH in an independent cohort of 5530 anticoagulant users. A CRS for major anticoagulation-related hemorrhage, based on 8/9 components of the HAS-BLED score, was compared with a combined clinical and genetic risk score incorporating an additional point for high genetic risk for ICH. RESULTS Among anticoagulated individuals, 94 ICH occurred over a mean follow-up of 11.9 years. Compared with the lowest genetic risk score tertile, being in the highest tertile was associated with a two-fold increased risk for incident ICH (hazard ratio, 2.08 [95% CI, 1.22-3.56]). Although the CRS predicted incident ICH with a hazard ratio of 1.24 per 1-point increase (95% CI [1.01-1.53]), adding a point for high genetic ICH risk led to a stronger association (hazard ratio of 1.33 per 1-point increase [95% CI, 1.11-1.59]) with improved risk stratification (C index 0.57 versus 0.53) and maintained calibration (integrated calibration index 0.001 for both). The new clinical and genetic risk score showed 19% improvement in high-risk classification among individuals with ICH and a net reclassification improvement of 0.10. CONCLUSIONS Among anticoagulant users, a prediction score incorporating genomic information is superior to a clinical risk score alone for ICH risk stratification and could serve in clinical decision-making.
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Affiliation(s)
- Ernst Mayerhofer
- Center for Genomic Medicine, Massachusetts General Hospital, Boston, USA
- Henry and Allison McCance Center for Brain Health, Massachusetts General Hospital, Boston, USA
- Program in Medical and Population Genetics, Broad Institute of Harvard and the Massachusetts Institute of Technology, Cambridge, USA
| | - Livia Parodi
- Center for Genomic Medicine, Massachusetts General Hospital, Boston, USA
- Henry and Allison McCance Center for Brain Health, Massachusetts General Hospital, Boston, USA
- Program in Medical and Population Genetics, Broad Institute of Harvard and the Massachusetts Institute of Technology, Cambridge, USA
- Department of Neurology, Brigham and Women’s Hospital, Boston, USA
| | - Savvina Prapiadou
- Center for Genomic Medicine, Massachusetts General Hospital, Boston, USA
- Henry and Allison McCance Center for Brain Health, Massachusetts General Hospital, Boston, USA
- Program in Medical and Population Genetics, Broad Institute of Harvard and the Massachusetts Institute of Technology, Cambridge, USA
| | - Rainer Malik
- Institute for Stroke and Dementia Research (ISD), University Hospital, Ludwig-Maximilians-University (LMU) Munich, Germany
| | - Jonathan Rosand
- Center for Genomic Medicine, Massachusetts General Hospital, Boston, USA
- Henry and Allison McCance Center for Brain Health, Massachusetts General Hospital, Boston, USA
- Program in Medical and Population Genetics, Broad Institute of Harvard and the Massachusetts Institute of Technology, Cambridge, USA
| | - Marios K Georgakis
- Center for Genomic Medicine, Massachusetts General Hospital, Boston, USA
- Henry and Allison McCance Center for Brain Health, Massachusetts General Hospital, Boston, USA
- Program in Medical and Population Genetics, Broad Institute of Harvard and the Massachusetts Institute of Technology, Cambridge, USA
- Institute for Stroke and Dementia Research (ISD), University Hospital, Ludwig-Maximilians-University (LMU) Munich, Germany
| | - Christopher D Anderson
- Center for Genomic Medicine, Massachusetts General Hospital, Boston, USA
- Henry and Allison McCance Center for Brain Health, Massachusetts General Hospital, Boston, USA
- Program in Medical and Population Genetics, Broad Institute of Harvard and the Massachusetts Institute of Technology, Cambridge, USA
- Department of Neurology, Brigham and Women’s Hospital, Boston, USA
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