Associations of estradiol levels and genetic polymorphisms of inflammatory genes with the risk of ischemic stroke

Genetic loci, rs17817449 and rs6567160, known for obesity and the risk of stroke events among middle-aged and older Chinese people

BACKGROUND

Fat Mass and Obesity-Associated (FTO) and the Melanocortin-4 Receptor (MC4R) genes are strongly associated with obesity, an established risk factor for stroke. We aimed to assess the associations between rs17817449 at the FTO and rs6567160 at the MC4R and the risk of stroke events in middle-aged and older Chinese people.

MATERIALS AND METHODS

Study data were obtained from the Guangzhou Biobank Cohort Study; a total of 148 participants with a self-reported history of stroke and an equal volume of age- and sex-matched participants were selected as the cases and the controls in a case-control study; a total of 13,967 participants at the first follow-up and all participants with fatal stroke (up to April 2021) were included in a retrospective cohort study. Conditional logistic regression and the Cox proportional hazards regression analyses were used to assess the associations of the two genetic loci with the risk of stroke events.

RESULTS

After adjusting for age, sex, education, job, smoking, alcohol consumption, body mass index, physical activity, hypertension, diabetes, and dyslipidemia, rs17817449 and rs6567160 shared minor alleles G and C, respectively, in the case-control analyses. The genotypes GG+GT of rs17817449 at the FTO were significantly associated with a decreased risk of fatal stroke occurrence, with fatal all strokes having an adjusted hazard ratio (aHR) of 0.71 (95% confidence intervals (CI) 0.52-0.97, P = 0.04) and fatal ischemic stroke having an aHR of 0.64 (95% CI 0.41-1.00, P = 0.05), when the genotype TT was taken as a reference and a series of multiplicities were adjusted; the risk of fatal all strokes was lowered by dyslipidemia (aHR = 0.63, 95% CI 0.39-1.00, P = 0.05) and non-diabetes (aHR = 0.68, 95% CI 0.46-0.99, P = 0.049) in the retrospective cohort analyses. Significances were observed neither in the associations between rs6567160 and the risk of stroke events nor in an interaction between rs17817449 and rs6567160 in the two-stage analyses.

CONCLUSION

The G allele of rs17817449 at the FTO, not rs6567160 at the MC4R, was associated with a decreased risk of fatal stroke occurrence; its functional role in stroke should be explored in relatively healthy middle-aged to older Chinese people.

Conjugated equine estrogen used in postmenopausal women associated with a higher risk of stroke than estradiol

This study aimed to evaluate the risk of ischemic stroke (IS) in hormone therapy (HT) with oral conjugated equine estrogen (CEE) and estradiol (E2) in postmenopausal women in Taiwan. A retrospective cohort study was conducted using the Taiwan National Health Insurance Research Database, a population-based healthcare claims dataset. Eligible women, aged 40-65 years, who received HT with E2 and CEE orally were enrolled. The primary outcome was IS. Propensity score matching with menopausal age and comorbidities was used. Cox proportional hazard regression models were used to calculate the incidence and hazard ratios (HRs) for IS. The mean menopausal ages of the E2 and CEE groups were 50.31 ± 4.99 and 50.45 ± 5.31 years, respectively. After adjusting for age and comorbidities, the incidence of IS was 1.17-fold higher in the women treated with CEE than in those treated with E2 (4.24 vs. 3.61/1000 person-years), with an adjusted HR (aHR) of 1.23 (95% confidence interval [CI] 1.05-1.44). Moreover, HT with CEE initiated within 5 years of menopause had a higher HR than E2 (aHR = 1.20; 95% CI 1.02-1.42). In conclusion, HT with oral CEE might be associated with a higher risk of IS than E2 in postmenopausal Taiwanese women. The use of HT with CEE should be cautioned with the risk of IS.

Associations between neutrophil/lymphocyte ratio, platelet/lymphocyte ratio, albuminuria and uric acid and the estimated glomerular filtration rate in hypertensive patients with chronic kidney disease stages 1-3

INTRODUCTION

The neutrophil/lymphocyte ratio (NLR), platelet/lymphocyte ratio (PLR), albuminuria and uric acid are known to be independent predictors of hypertension and cardiovascular mortality. However, to date, no study has been conducted describing the relationships between the NLR, PLR and estimated glomerular filtration rate (eGFR) in hypertensive patients with chronic kidney disease (CKD) who do not require renal replacement therapy.

MATERIAL AND METHODS

This prospective study included 271 patients with essential hypertension and eGFR ≥ 30 ml/min/1.73 m². The patients were divided into two groups: those with CKD stages 1 and 2 and those with stage 3. We used the complete blood count to calculate the NLR and PLR, and we measured the albuminuria and uric acid levels. Then, we studied their associations with the eGFR and their potential uses as independent risk factors for renal damage.

RESULTS

The NLR, albuminuria and uric acid were higher in patients with CKD stage 3 than in those with stages 1 and 2 (p = 0.013, p = 0.001 and p = 0.001, respectively). However, no significant difference was detected in the PLR. In stage 3 patients, albuminuria and uric acid were found to be independent risk factors affecting the eGFR (p = 0.042 and p = 0.001, respectively). However, the effects of the NLR and PLR on the eGFR were not significant (p = 0.104 and p = 0.578, respectively).

CONCLUSIONS

The NLR, similar to albuminuria and uric acid, the NLR was found to be a specific marker for CKD stage 3 patients. However, the NLR and PLR did not act as independent risk factors affecting the eGFR.