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Whittaker E, Thrippleton S, Chong LYW, Collins VG, Ferguson AC, Henshall DE, Lancastle E, Wilkinson T, Wilson B, Wilson K, Sudlow C, Wardlaw J, Rannikmäe K. Systematic Review of Cerebral Phenotypes Associated With Monogenic Cerebral Small-Vessel Disease. J Am Heart Assoc 2022; 11:e025629. [PMID: 35699195 PMCID: PMC9238640 DOI: 10.1161/jaha.121.025629] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/01/2022] [Accepted: 04/19/2022] [Indexed: 11/16/2022]
Abstract
Background Cerebral small-vessel disease (cSVD) is an important cause of stroke and vascular dementia. Most cases are multifactorial, but an emerging minority have a monogenic cause. While NOTCH3 is the best-known gene, several others have been reported. We aimed to summarize the cerebral phenotypes associated with these more recent cSVD genes. Methods and Results We performed a systematic review (PROSPERO [International Prospective Register of Systematic Reviews]: CRD42020196720), searching Medline/Embase (conception to July 2020) for any language publications describing COL4A1/2, TREX1, HTRA1, ADA2, or CTSA pathogenic variant carriers. We extracted data about individuals' characteristics and clinical and vascular radiological cerebral phenotypes. We summarized phenotype frequencies per gene, comparing patterns across genes. We screened 6485 publications including 402, and extracted data on 390 individuals with COL4A1, 123 with TREX1, 44 with HTRA1 homozygous, 41 with COL4A2, 346 with ADA2, 82 with HTRA1 heterozygous, and 14 with CTSA. Mean age ranged from 15 (ADA2) to 59 years (HTRA1 heterozygotes). Clinical phenotype frequencies varied widely: stroke, 9% (TREX1) to 52% (HTRA1 heterozygotes); cognitive features, 0% (ADA2) to 64% (HTRA1 homozygotes); and psychiatric features, 0% (COL4A2; ADA2) to 57% (CTSA). Among individuals with neuroimaging, vascular radiological phenotypes appeared common, ranging from 62% (ADA2) to 100% (HTRA1 homozygotes; CTSA). White matter lesions were the most common pathology, except in ADA2 and COL4A2 cases, where ischemic and hemorrhagic lesions dominated, respectively. Conclusions There appear to be differences in cerebral manifestations across cSVD genes. Vascular radiological changes were more common than clinical neurological phenotypes, and present in the majority of individuals with reported neuroimaging. However, these results may be affected by age and biases inherent to case reports. In the future, better characterization of associated phenotypes, as well as insights from population-based studies, should improve our understanding of monogenic cSVD to inform genetic testing, guide clinical management, and help unravel underlying disease mechanisms.
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Affiliation(s)
- Ed Whittaker
- Medical SchoolUniversity of EdinburghEdinburghUnited Kingdom
| | | | | | | | - Amy C. Ferguson
- Centre for Medical InformaticsUsher InstituteUniversity of EdinburghEdinburghUnited Kingdom
| | - David E. Henshall
- Centre for Medical InformaticsUsher InstituteUniversity of EdinburghEdinburghUnited Kingdom
| | - Emily Lancastle
- Medical SchoolUniversity of EdinburghEdinburghUnited Kingdom
| | - Tim Wilkinson
- Centre for Medical InformaticsUsher InstituteUniversity of EdinburghEdinburghUnited Kingdom
- Centre for Clinical Brain SciencesUniversity of EdinburghEdinburghUnited Kingdom
| | - Blair Wilson
- NHS Greater Glasgow and ClydeGlasgowUnited Kingdom
| | | | - Cathie Sudlow
- Centre for Medical InformaticsUsher InstituteUniversity of EdinburghEdinburghUnited Kingdom
- BHF Data Science CentreLondonUnited Kingdom
| | - Joanna Wardlaw
- Centre for Clinical Brain SciencesUniversity of EdinburghEdinburghUnited Kingdom
- UK Dementia Research Institute CentreUniversity of EdinburghEdinburghUnited Kingdom
| | - Kristiina Rannikmäe
- Centre for Medical InformaticsUsher InstituteUniversity of EdinburghEdinburghUnited Kingdom
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2
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Wilkinson T, Schnier C, Bush K, Rannikmäe K, Lyons RA, McTaggart S, Bennie M, Sudlow CL. Drug prescriptions and dementia incidence: a medication-wide association study of 17000 dementia cases among half a million participants. J Epidemiol Community Health 2022; 76:223-229. [PMID: 34706926 PMCID: PMC8862053 DOI: 10.1136/jech-2021-217090] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/29/2021] [Accepted: 08/30/2021] [Indexed: 11/24/2022]
Abstract
BACKGROUND Previous studies have suggested that some medications may influence dementia risk. We conducted a hypothesis-generating medication-wide association study to investigate systematically the association between all prescription medications and incident dementia. METHODS We used a population-based cohort within the Secure Anonymised Information Linkage (SAIL) databank, comprising routinely-collected primary care, hospital admissions and mortality data from Wales, UK. We included all participants born after 1910 and registered with a SAIL general practice at ≤60 years old. Follow-up was from each participant's 60th birthday to the earliest of dementia diagnosis, deregistration from a SAIL general practice, death or the end of 2018. We considered participants exposed to a medication if they received ≥1 prescription for any of 744 medications before or during follow-up. We adjusted for sex, smoking and socioeconomic status. The outcome was any all-cause dementia code in primary care, hospital or mortality data during follow-up. We used Cox regression to calculate hazard ratios and Bonferroni-corrected p values. RESULTS Of 551 344 participants, 16 998 (3%) developed dementia (median follow-up was 17 years for people who developed dementia, 10 years for those without dementia). Of 744 medications, 221 (30%) were associated with dementia. Of these, 217 (98%) were associated with increased dementia incidence, many clustering around certain indications. Four medications (all vaccines) were associated with a lower dementia incidence. CONCLUSIONS Almost a third of medications were associated with dementia. The clustering of many drugs around certain indications may provide insights into early manifestations of dementia. We encourage further investigation of hypotheses generated by these results.
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Affiliation(s)
- Tim Wilkinson
- Centre for Clinical Brain Sciences, University of Edinburgh, Edinburgh, UK .,Usher Institute, The University of Edinburgh, Edinburgh, UK
| | | | - Kathryn Bush
- Usher Institute, The University of Edinburgh, Edinburgh, UK
| | | | - Ronan A Lyons
- National Centre for Population Health and Wellbeing Research, Swansea University, Swansea, UK.,HDR UK Wales and Northern Ireland, Health Data Research UK, London, UK
| | - Stuart McTaggart
- Public Health and Intelligence Strategic Business Unit, NHS National Services Scotland, Edinburgh, UK
| | - Marion Bennie
- Public Health and Intelligence Strategic Business Unit, NHS National Services Scotland, Edinburgh, UK.,Strathclyde Institute of Pharmacy and Biomedical Sciences, University of Strathclyde, Glasgow, UK
| | - Cathie Lm Sudlow
- Usher Institute, The University of Edinburgh, Edinburgh, UK.,HDR UK Scotland, Health Data Research UK, London, UK
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Rannikmäe K, Rawlik K, Ferguson AC, Avramidis N, Jiang M, Pirastu N, Shen X, Davidson E, Woodfield R, Malik R, Dichgans M, Tenesa A, Sudlow C. Physician-Confirmed and Administrative Definitions of Stroke in UK Biobank Reflect the Same Underlying Genetic Trait. Front Neurol 2022; 12:787107. [PMID: 35185750 PMCID: PMC8847736 DOI: 10.3389/fneur.2021.787107] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/01/2021] [Accepted: 12/13/2021] [Indexed: 11/15/2022] Open
Abstract
Background Stroke in UK Biobank (UKB) is ascertained via linkages to coded administrative datasets and self-report. We studied the accuracy of these codes using genetic validation. Methods We compiled stroke-specific and broad cerebrovascular disease (CVD) code lists (Read V2/V3, ICD-9/-10) for medical settings (hospital, death record, primary care) and self-report. Among 408,210 UKB participants, we identified all with a relevant code, creating 12 stroke definitions based on the code type and source. We performed genome-wide association studies (GWASs) for each definition, comparing summary results against the largest published stroke GWAS (MEGASTROKE), assessing genetic correlations, and replicating 32 stroke-associated loci. Results The stroke case numbers identified varied widely from 3,976 (primary care stroke-specific codes) to 19,449 (all codes, all sources). All 12 UKB stroke definitions were significantly correlated with the MEGASTROKE summary GWAS results (rg.81-1) and each other (rg.4-1). However, Bonferroni-corrected confidence intervals were wide, suggesting limited precision of some results. Six previously reported stroke-associated loci were replicated using ≥1 UKB stroke definition. Conclusions Stroke case numbers in UKB depend on the code source and type used, with a 5-fold difference in the maximum case-sample size. All stroke definitions are significantly genetically correlated with the largest stroke GWAS to date.
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Affiliation(s)
- Kristiina Rannikmäe
- Centre for Medical Informatics, Usher Institute, University of Edinburgh, Edinburgh, United Kingdom
- *Correspondence: Kristiina Rannikmäe
| | - Konrad Rawlik
- Roslin Institute, University of Edinburgh, Edinburgh, United Kingdom
| | - Amy C. Ferguson
- Centre for Medical Informatics, Usher Institute, University of Edinburgh, Edinburgh, United Kingdom
| | - Nikos Avramidis
- School of Biological Sciences, University of Edinburgh, Edinburgh, United Kingdom
| | - Muchen Jiang
- Medical School, University of Edinburgh, Edinburgh, United Kingdom
| | - Nicola Pirastu
- Usher Institute, University of Edinburgh, Edinburgh, United Kingdom
| | - Xia Shen
- Usher Institute, University of Edinburgh, Edinburgh, United Kingdom
- Biostatistics Group, Greater Bay Area Institute of Precision Medicine (Guangzhou), Fudan University, Guangzhou, China
- Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden
| | - Emma Davidson
- Centre for Clinical Brain Sciences, University of Edinburgh, Edinburgh, United Kingdom
| | - Rebecca Woodfield
- Department of Medicine for the Elderly, Western General Hospital, Edinburgh, United Kingdom
| | - Rainer Malik
- Institute for Stroke and Dementia Research (ISD), University Hospital, LMU Munich, Munich, Germany
| | - Martin Dichgans
- Institute for Stroke and Dementia Research (ISD), University Hospital, LMU Munich, Munich, Germany
- Munich Cluster for Systems Neurology, Munich, Germany
- German Center for Neurodegenerative Diseases (DZNE), Munich, Germany
| | - Albert Tenesa
- Centre for Medical Informatics, Usher Institute, University of Edinburgh, Edinburgh, United Kingdom
- Roslin Institute, University of Edinburgh, Edinburgh, United Kingdom
- MRC Human Genetics Unit, Institute of Genetics and Cancer, University of Edinburgh, Western General Hospital, Edinburgh, United Kingdom
| | - Cathie Sudlow
- Centre for Medical Informatics, Usher Institute, University of Edinburgh, Edinburgh, United Kingdom
- BHF Data Science Centre, Health Data Research UK, London, United Kingdom
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4
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Malik R, Beaufort N, Frerich S, Gesierich B, Georgakis MK, Rannikmäe K, Ferguson AC, Haffner C, Traylor M, Ehrmann M, Sudlow CLM, Dichgans M. Whole-exome sequencing reveals a role of HTRA1 and EGFL8 in brain white matter hyperintensities. Brain 2021; 144:2670-2682. [PMID: 34626176 PMCID: PMC8557338 DOI: 10.1093/brain/awab253] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/30/2021] [Revised: 06/01/2021] [Accepted: 06/19/2021] [Indexed: 11/13/2022] Open
Abstract
White matter hyperintensities (WMH) are among the most common radiological abnormalities in the ageing population and an established risk factor for stroke and dementia. While common variant association studies have revealed multiple genetic loci with an influence on their volume, the contribution of rare variants to the WMH burden in the general population remains largely unexplored. We conducted a comprehensive analysis of this burden in the UK Biobank using publicly available whole-exome sequencing data (n up to 17 830) and found a splice-site variant in GBE1, encoding 1,4-alpha-glucan branching enzyme 1, to be associated with lower white matter burden on an exome-wide level [c.691+2T>C, β = -0.74, standard error (SE) = 0.13, P = 9.7 × 10-9]. Applying whole-exome gene-based burden tests, we found damaging missense and loss-of-function variants in HTRA1 (frequency of 1 in 275 in the UK Biobank population) to associate with an increased WMH volume (P = 5.5 × 10-6, false discovery rate = 0.04). HTRA1 encodes a secreted serine protease implicated in familial forms of small vessel disease. Domain-specific burden tests revealed that the association with WMH volume was restricted to rare variants in the protease domain (amino acids 204-364; β = 0.79, SE = 0.14, P = 9.4 × 10-8). The frequency of such variants in the UK Biobank population was 1 in 450. The WMH volume was brought forward by ∼11 years in carriers of a rare protease domain variant. A comparison with the effect size of established risk factors for WMH burden revealed that the presence of a rare variant in the HTRA1 protease domain corresponded to a larger effect than meeting the criteria for hypertension (β = 0.26, SE = 0.02, P = 2.9 × 10-59) or being in the upper 99.8% percentile of the distribution of a polygenic risk score based on common genetic variants (β = 0.44, SE = 0.14, P = 0.002). In biochemical experiments, most (6/9) of the identified protease domain variants resulted in markedly reduced protease activity. We further found EGFL8, which showed suggestive evidence for association with WMH volume (P = 1.5 × 10-4, false discovery rate = 0.22) in gene burden tests, to be a direct substrate of HTRA1 and to be preferentially expressed in cerebral arterioles and arteries. In a phenome-wide association study mapping ICD-10 diagnoses to 741 standardized Phecodes, rare variants in the HTRA1 protease domain were associated with multiple neurological and non-neurological conditions including migraine with aura (odds ratio = 12.24, 95%CI: 2.54-35.25; P = 8.3 × 10-5]. Collectively, these findings highlight an important role of rare genetic variation and the HTRA1 protease in determining WMH burden in the general population.
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Affiliation(s)
- Rainer Malik
- Institute for Stroke and Dementia Research (ISD), University Hospital, LMU Munich, 81377 Munich, Germany
| | - Nathalie Beaufort
- Institute for Stroke and Dementia Research (ISD), University Hospital, LMU Munich, 81377 Munich, Germany
| | - Simon Frerich
- Institute for Stroke and Dementia Research (ISD), University Hospital, LMU Munich, 81377 Munich, Germany
| | - Benno Gesierich
- Institute for Stroke and Dementia Research (ISD), University Hospital, LMU Munich, 81377 Munich, Germany
| | - Marios K Georgakis
- Institute for Stroke and Dementia Research (ISD), University Hospital, LMU Munich, 81377 Munich, Germany
| | - Kristiina Rannikmäe
- Centre for Medical Informatics, Usher Institute, University of Edinburgh, Edinburgh EH16 4TL, UK
| | - Amy C Ferguson
- Centre for Medical Informatics, Usher Institute, University of Edinburgh, Edinburgh EH16 4TL, UK
| | - Christof Haffner
- Institute for Stroke and Dementia Research (ISD), University Hospital, LMU Munich, 81377 Munich, Germany
| | - Matthew Traylor
- Clinical Pharmacology, William Harvey Research Institute, Queen Mary University of London, London EC1M 6BQ, UK
- The Barts Heart Centre and NIHR Barts Biomedical Research Centre - Barts Health NHS Trust, The William Harvey Research Institute, Queen Mary University of London, London, UK
| | - Michael Ehrmann
- Center of Medical Biotechnology, Faculty of Biology, University Duisburg-Essen, Essen 45141, Germany
- School of Biosciences, Cardiff University, Cardiff CF10 3AX, UK
| | - Cathie L M Sudlow
- Centre for Medical Informatics, Usher Institute, University of Edinburgh, Edinburgh EH16 4TL, UK
- Centre for Clinical Brain Sciences, University of Edinburgh, Edinburgh EH16 4TL, UK
- Health Data Research UK Scotland, University of Edinburgh, Edinburgh EH16 4TL, UK
| | - Martin Dichgans
- Institute for Stroke and Dementia Research (ISD), University Hospital, LMU Munich, 81377 Munich, Germany
- Munich Cluster for Systems Neurology, Munich 81377, Germany
- German Center for Neurodegenerative Diseases (DZNE), Munich 81377, Germany
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5
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Rannikmäe K, Wu H, Tominey S, Whiteley W, Allen N, Sudlow C. Developing automated methods for disease subtyping in UK Biobank: an exemplar study on stroke. BMC Med Inform Decis Mak 2021; 21:191. [PMID: 34130677 PMCID: PMC8204419 DOI: 10.1186/s12911-021-01556-0] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/25/2021] [Accepted: 06/08/2021] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND Better phenotyping of routinely collected coded data would be useful for research and health improvement. For example, the precision of coded data for hemorrhagic stroke (intracerebral hemorrhage [ICH] and subarachnoid hemorrhage [SAH]) may be as poor as < 50%. This work aimed to investigate the feasibility and added value of automated methods applied to clinical radiology reports to improve stroke subtyping. METHODS From a sub-population of 17,249 Scottish UK Biobank participants, we ascertained those with an incident stroke code in hospital, death record or primary care administrative data by September 2015, and ≥ 1 clinical brain scan report. We used a combination of natural language processing and clinical knowledge inference on brain scan reports to assign a stroke subtype (ischemic vs ICH vs SAH) for each participant and assessed performance by precision and recall at entity and patient levels. RESULTS Of 225 participants with an incident stroke code, 207 had a relevant brain scan report and were included in this study. Entity level precision and recall ranged from 78 to 100%. Automated methods showed precision and recall at patient level that were very good for ICH (both 89%), good for SAH (both 82%), but, as expected, lower for ischemic stroke (73%, and 64%, respectively), suggesting coded data remains the preferred method for identifying the latter stroke subtype. CONCLUSIONS Our automated method applied to radiology reports provides a feasible, scalable and accurate solution to improve disease subtyping when used in conjunction with administrative coded health data. Future research should validate these findings in a different population setting.
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Affiliation(s)
- Kristiina Rannikmäe
- Centre for Medical Informatics, University of Edinburgh, NINE Edinburgh BioQuarter, 9 Little France Road, Edinburgh, EH16 4UX, UK.
- Health Data Research UK, London, UK.
| | - Honghan Wu
- Health Data Research UK, London, UK
- Institute of Health Informatics, University College London, London, UK
| | | | - William Whiteley
- Centre for Clinical Brain Sciences, University of Edinburgh, Edinburgh, UK
- Nuffield Department of Population Health, University of Oxford, Oxford, UK
| | - Naomi Allen
- Nuffield Department of Population Health, University of Oxford, Oxford, UK
- UK Biobank, Stockport, UK
| | - Cathie Sudlow
- Centre for Medical Informatics, University of Edinburgh, NINE Edinburgh BioQuarter, 9 Little France Road, Edinburgh, EH16 4UX, UK
- Health Data Research UK, London, UK
- BHF Data Science Centre, London, UK
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6
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Malik R, Georgakis MK, Neitzel J, Rannikmäe K, Ewers M, Seshadri S, Sudlow CLM, Dichgans M. Midlife vascular risk factors and risk of incident dementia: Longitudinal cohort and Mendelian randomization analyses in the UK Biobank. Alzheimers Dement 2021; 17:1422-1431. [PMID: 33749976 DOI: 10.1002/alz.12320] [Citation(s) in RCA: 68] [Impact Index Per Article: 22.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/17/2020] [Revised: 12/18/2020] [Accepted: 02/05/2021] [Indexed: 01/04/2023]
Abstract
INTRODUCTION Midlife clustering of vascular risk factors has been associated with late-life dementia, but causal effects of individual biological and lifestyle factors remain largely unknown. METHODS Among 229,976 individuals (mean follow-up 9 years), we explored whether midlife cardiovascular health measured by Life's Simple 7 (LS7) is associated with incident all-cause dementia and whether the individual components of the score are causally associated with dementia. RESULTS Adherence to the biological metrics of LS7 (blood pressure, cholesterol, glycemic status) was associated with lower incident dementia risk (hazard ratio = 0.93 per 1-point increase, 95% confidence interval [CI; 0.89-0.96]). In contrast, there was no association between the composite LS7 score and the lifestyle subscore (smoking, body mass index, diet, physical activity) and incident dementia. In Mendelian randomization analyses, genetically elevated blood pressure was associated with higher risk of dementia (odds ratio = 1.31 per one-standard deviation increase, 95% CI [1.05-1.60]). DISCUSSION These findings underscore the importance of blood pressure control in midlife to mitigate dementia risk.
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Affiliation(s)
- Rainer Malik
- Institute for Stroke and Dementia Research (ISD), University Hospital, Ludwig-Maximilians-University LMU, Munich, Germany
| | - Marios K Georgakis
- Institute for Stroke and Dementia Research (ISD), University Hospital, Ludwig-Maximilians-University LMU, Munich, Germany
| | - Julia Neitzel
- Institute for Stroke and Dementia Research (ISD), University Hospital, Ludwig-Maximilians-University LMU, Munich, Germany
| | - Kristiina Rannikmäe
- Centre for Medical Informatics, Usher Institute, University of Edinburgh, Edinburgh, UK
| | - Michael Ewers
- Institute for Stroke and Dementia Research (ISD), University Hospital, Ludwig-Maximilians-University LMU, Munich, Germany
| | - Sudha Seshadri
- The Glenn Biggs Institute for Alzheimer's and Neurodegenerative Diseases, University of Texas Health Sciences Center, San Antonio, Texas, USA
| | - Cathie L M Sudlow
- Center for Clinical Brain Sciences, University of Edinburgh, Edinburgh, UK.,Nine Bioquarter, Usher Institute of Population Health Sciences and Informatics, Edinburgh, UK
| | - Martin Dichgans
- Institute for Stroke and Dementia Research (ISD), University Hospital, Ludwig-Maximilians-University LMU, Munich, Germany.,German Center for Neurodegenerative Diseases (DZNE), Munich, Germany.,Munich Cluster for Systems Neurology (SyNergy), Munich, Germany
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7
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Bakker MK, van der Spek RAA, van Rheenen W, Morel S, Bourcier R, Hostettler IC, Alg VS, van Eijk KR, Koido M, Akiyama M, Terao C, Matsuda K, Walters RG, Lin K, Li L, Millwood IY, Chen Z, Rouleau GA, Zhou S, Rannikmäe K, Sudlow CLM, Houlden H, van den Berg LH, Dina C, Naggara O, Gentric JC, Shotar E, Eugène F, Desal H, Winsvold BS, Børte S, Johnsen MB, Brumpton BM, Sandvei MS, Willer CJ, Hveem K, Zwart JA, Verschuren WMM, Friedrich CM, Hirsch S, Schilling S, Dauvillier J, Martin O, Jones GT, Bown MJ, Ko NU, Kim H, Coleman JRI, Breen G, Zaroff JG, Klijn CJM, Malik R, Dichgans M, Sargurupremraj M, Tatlisumak T, Amouyel P, Debette S, Rinkel GJE, Worrall BB, Pera J, Slowik A, Gaál-Paavola EI, Niemelä M, Jääskeläinen JE, von Und Zu Fraunberg M, Lindgren A, Broderick JP, Werring DJ, Woo D, Redon R, Bijlenga P, Kamatani Y, Veldink JH, Ruigrok YM. Author Correction: Genome-wide association study of intracranial aneurysms identifies 17 risk loci and genetic overlap with clinical risk factors. Nat Genet 2021; 53:254. [PMID: 33353957 DOI: 10.1038/s41588-020-00760-4] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Affiliation(s)
- Mark K Bakker
- Department of Neurology and Neurosurgery, University Medical Center Utrecht Brain Center, Utrecht University, Utrecht, the Netherlands.
| | - Rick A A van der Spek
- Department of Neurology and Neurosurgery, University Medical Center Utrecht Brain Center, Utrecht University, Utrecht, the Netherlands
| | - Wouter van Rheenen
- Department of Neurology and Neurosurgery, University Medical Center Utrecht Brain Center, Utrecht University, Utrecht, the Netherlands
| | - Sandrine Morel
- Department of Pathology and Immunology, Faculty of Medicine, University of Geneva, Geneva, Switzerland
- Neurosurgery Division, Department of Clinical Neurosciences, Faculty of Medicine, Geneva University Hospitals, Geneva, Switzerland
| | - Romain Bourcier
- l'institut du thorax Université de Nantes, CHU Nantes, INSERM, CNRS, Nantes, France
- CHU Nantes, Department of Neuroradiology, Nantes, France
| | - Isabel C Hostettler
- Stroke Research Centre, University College London Queen Square Institute of Neurology, London, UK
- Department of Neurosurgery, Klinikum rechts der Isar, Technical University Munich, Munich, Germany
| | - Varinder S Alg
- Stroke Research Centre, University College London Queen Square Institute of Neurology, London, UK
| | - Kristel R van Eijk
- Department of Neurology and Neurosurgery, University Medical Center Utrecht Brain Center, Utrecht University, Utrecht, the Netherlands
| | - Masaru Koido
- Laboratory for Statistical and Translational Genetics, RIKEN Center for Integrative Medical Sciences, Yokohama, Japan
- Department of Cancer Biology, Institute of Medical Science, The University of Tokyo, Tokyo, Japan
| | - Masato Akiyama
- Laboratory for Statistical and Translational Genetics, RIKEN Center for Integrative Medical Sciences, Yokohama, Japan
- Department of Ophthalmology, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan
- Department of Ocular Pathology and Imaging Science, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan
| | - Chikashi Terao
- Laboratory for Statistical and Translational Genetics, RIKEN Center for Integrative Medical Sciences, Yokohama, Japan
| | - Koichi Matsuda
- Graduate School of Frontier Sciences, The University of Tokyo, Tokyo, Japan
- Laboratory of Clinical Genome Sequencing, Graduate School of Frontier Sciences, The University of Tokyo, Tokyo, Japan
| | - Robin G Walters
- Clinical Trial Service Unit and Epidemiological Studies Unit, Nuffield Department of Population Health, University of Oxford, Oxford, UK
- Medical Research Council Population Health Research Unit, University of Oxford, Oxford, UK
| | - Kuang Lin
- Clinical Trial Service Unit and Epidemiological Studies Unit, Nuffield Department of Population Health, University of Oxford, Oxford, UK
| | - Liming Li
- Department of Epidemiology, School of Public Health, Peking University Health Science Center, Beijing, China
| | - Iona Y Millwood
- Clinical Trial Service Unit and Epidemiological Studies Unit, Nuffield Department of Population Health, University of Oxford, Oxford, UK
- Medical Research Council Population Health Research Unit, University of Oxford, Oxford, UK
| | - Zhengming Chen
- Clinical Trial Service Unit and Epidemiological Studies Unit, Nuffield Department of Population Health, University of Oxford, Oxford, UK
- Medical Research Council Population Health Research Unit, University of Oxford, Oxford, UK
| | - Guy A Rouleau
- Montréal Neurological Institute and Hospital, McGill University, Montréal, Québec, Canada
| | - Sirui Zhou
- Lady Davis Institute, Jewish General Hospital, McGill University, Montréal, Québec, Canada
| | - Kristiina Rannikmäe
- Centre for Medical Informatics, Usher Institute, University of Edinburgh, Edinburgh, UK
| | - Cathie L M Sudlow
- Centre for Medical Informatics, Usher Institute, University of Edinburgh, Edinburgh, UK
- UK Biobank, Cheadle, Stockport, UK
| | - Henry Houlden
- Neurogenetics Laboratory, The National Hospital of Neurology and Neurosurgery, London, UK
| | - Leonard H van den Berg
- Department of Neurology and Neurosurgery, University Medical Center Utrecht Brain Center, Utrecht University, Utrecht, the Netherlands
| | - Christian Dina
- l'institut du thorax Université de Nantes, CHU Nantes, INSERM, CNRS, Nantes, France
| | - Olivier Naggara
- Pediatric Radiology, Necker Hospital for Sick Children, Université Paris Descartes, Paris, France
- Department of Neuroradiology, Sainte-Anne Hospital and Université Paris Descartes, INSERM UMR, S894, Paris, France
| | | | - Eimad Shotar
- Department of Neuroradiology, Pitié-Salpêtrière Hospital, Paris, France
| | - François Eugène
- Department of Neuroradiology, University Hospital of Rennes, Rennes, France
| | - Hubert Desal
- l'institut du thorax Université de Nantes, CHU Nantes, INSERM, CNRS, Nantes, France
- CHU Nantes, Department of Neuroradiology, Nantes, France
| | - Bendik S Winsvold
- Department of Research, Innovation and Education, Division of Clinical Neuroscience, Oslo University Hospital, Oslo, Norway
- K. G. Jebsen Center for Genetic Epidemiology, Department of Public Health and Nursing, Faculty of Medicine and Health Sciences, Norwegian University of Science and Technology, Trondheim, Norway
| | - Sigrid Børte
- K. G. Jebsen Center for Genetic Epidemiology, Department of Public Health and Nursing, Faculty of Medicine and Health Sciences, Norwegian University of Science and Technology, Trondheim, Norway
- Research and Communication Unit for Musculoskeletal Health (FORMI), Department of Research, Innovation and Education, Division of Clinical Neuroscience, Oslo University Hospital, Oslo, Norway
- Institute of Clinical Medicine, Faculty of Medicine, University of Oslo, Oslo, Norway
| | - Marianne Bakke Johnsen
- K. G. Jebsen Center for Genetic Epidemiology, Department of Public Health and Nursing, Faculty of Medicine and Health Sciences, Norwegian University of Science and Technology, Trondheim, Norway
- Research and Communication Unit for Musculoskeletal Health (FORMI), Department of Research, Innovation and Education, Division of Clinical Neuroscience, Oslo University Hospital, Oslo, Norway
- Institute of Clinical Medicine, Faculty of Medicine, University of Oslo, Oslo, Norway
| | - Ben M Brumpton
- K. G. Jebsen Center for Genetic Epidemiology, Department of Public Health and Nursing, Faculty of Medicine and Health Sciences, Norwegian University of Science and Technology, Trondheim, Norway
| | - Marie Søfteland Sandvei
- Department of Public Health and Nursing, Faculty of Medicine and Health Sciences, Norwegian University of Science and Technology, Trondheim, Norway
- The Cancer Clinic, St Olavs Hospital, Trondheim University Hospital, Trondheim, Norway
| | - Cristen J Willer
- Department of Internal Medicine, Division of Cardiovascular Medicine, University of Michigan, Ann Arbor, MI, USA
| | - Kristian Hveem
- K. G. Jebsen Center for Genetic Epidemiology, Department of Public Health and Nursing, Faculty of Medicine and Health Sciences, Norwegian University of Science and Technology, Trondheim, Norway
- HUNT Research Center, Department of Public Health and Nursing, Faculty of Medicine and Health Sciences, Norwegian University of Science and Technology, Trondheim, Norway
| | - John-Anker Zwart
- Department of Research, Innovation and Education, Division of Clinical Neuroscience, Oslo University Hospital, Oslo, Norway
- K. G. Jebsen Center for Genetic Epidemiology, Department of Public Health and Nursing, Faculty of Medicine and Health Sciences, Norwegian University of Science and Technology, Trondheim, Norway
- Institute of Clinical Medicine, Faculty of Medicine, University of Oslo, Oslo, Norway
| | - W M Monique Verschuren
- Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht, the Netherlands
- National Institute for Public Health and the Environment, Bilthoven, the Netherlands
| | - Christoph M Friedrich
- Dortmund University of Applied Science and Arts, Dortmund, Germany
- Institute for Medical Informatics, Biometry and Epidemiology (IMIBE), University Hospital Essen, Essen, Germany
| | - Sven Hirsch
- Zurich University of Applied Sciences, School of Life Sciences and Facility Management, Zurich, Switzerland
| | - Sabine Schilling
- Zurich University of Applied Sciences, School of Life Sciences and Facility Management, Zurich, Switzerland
| | | | - Olivier Martin
- SIB Swiss Institute of Bioinformatics, Lausanne, Switzerland
| | - Gregory T Jones
- Department of Surgery, University of Otago, Dunedin, New Zealand
| | - Matthew J Bown
- Department of Cardiovascular Sciences and National Institute for Health Research, University of Leicester, Leicester, UK
- Leicester Biomedical Research Centre, University of Leicester, Glenfield Hospital, Leicester, UK
| | - Nerissa U Ko
- Department of Neurology, University of California at San Francisco, San Francisco, CA, USA
| | - Helen Kim
- Department of Anesthesia and Perioperative Care, Center for Cerebrovascular Research, University of California, San Francisco, CA, USA
- Department of Epidemiology and Biostatistics, University of California, San Francisco, CA, USA
- Institute for Human Genetics, University of California, San Francisco, CA, USA
| | - Jonathan R I Coleman
- Social, Genetic and Developmental Psychiatry Centre, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK
- UK National Institute for Health Research (NIHR) Biomedical Research Centre (BRC), South London and Maudsley NHS Foundation Trust, London, UK
| | - Gerome Breen
- Social, Genetic and Developmental Psychiatry Centre, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK
- UK National Institute for Health Research (NIHR) Biomedical Research Centre (BRC), South London and Maudsley NHS Foundation Trust, London, UK
| | - Jonathan G Zaroff
- Division of Research, Kaiser Permanente of Northern California, Oakland, CA, USA
| | - Catharina J M Klijn
- Department of Neurology, Donders Institute for Brain, Cognition and Behaviour, Radboud University Medical Center, Nijmegen, the Netherlands
| | - Rainer Malik
- Institute for Stroke and Dementia Research, University Hospital, Ludwig-Maximilians-University, Munich, Germany
| | - Martin Dichgans
- Munich Cluster for Systems Neurology (SyNergy), Munich, Germany
- Deutsches Zentrum für Neurodegenerative Erkrankungen (DZNE), Munich, Germany
| | - Muralidharan Sargurupremraj
- INSERM U1219 Bordeaux Population Health Research Center, University of Bordeaux, Bordeaux, France
- Department of Neurology, Institute for Neurodegenerative Disease, Bordeaux University Hospital, Bordeaux, France
| | - Turgut Tatlisumak
- Department of Clinical Neuroscience at Institute of Neuroscience and Physiology, University of Gothenburg, Gothenburg, Sweden
| | - Philippe Amouyel
- Institut Pasteur de Lille, UMR1167 LabEx DISTALZ - RID-AGE Université de Lille, INSERM, Centre Hospitalier Université de Lille Lille, Lille Lille, France
| | - Stéphanie Debette
- INSERM U1219 Bordeaux Population Health Research Center, University of Bordeaux, Bordeaux, France
- Department of Neurology, Institute for Neurodegenerative Disease, Bordeaux University Hospital, Bordeaux, France
| | - Gabriel J E Rinkel
- Department of Neurology and Neurosurgery, University Medical Center Utrecht Brain Center, Utrecht University, Utrecht, the Netherlands
| | - Bradford B Worrall
- Departments of Neurology and Public Health Sciences, University of Virginia School of Medicine, Charlottesville, VA, USA
| | - Joanna Pera
- Department of Neurology, Faculty of Medicine, Jagiellonian University Medical College, Krakow, Poland
| | - Agnieszka Slowik
- Department of Neurology, Faculty of Medicine, Jagiellonian University Medical College, Krakow, Poland
| | - Emília I Gaál-Paavola
- Department of Neurosurgery, Helsinki University Hospital, University of Helsinki, Helsinki, Finland
- Clinical Neurosciences, University of Helsinki, Helsinki, Finland
| | - Mika Niemelä
- Department of Neurosurgery, Helsinki University Hospital, University of Helsinki, Helsinki, Finland
| | - Juha E Jääskeläinen
- Neurosurgery NeuroCenter, Kuopio University Hospital, Kuopio, Finland
- Institute of Clinical Medicine, Faculty of Health Sciences, University of Eastern Finland, Kuopio, Finland
| | - Mikael von Und Zu Fraunberg
- Neurosurgery NeuroCenter, Kuopio University Hospital, Kuopio, Finland
- Institute of Clinical Medicine, Faculty of Health Sciences, University of Eastern Finland, Kuopio, Finland
| | - Antti Lindgren
- Neurosurgery NeuroCenter, Kuopio University Hospital, Kuopio, Finland
- Institute of Clinical Medicine, Faculty of Health Sciences, University of Eastern Finland, Kuopio, Finland
| | | | - David J Werring
- Stroke Research Centre, University College London Queen Square Institute of Neurology, London, UK
| | - Daniel Woo
- University of Cincinnati College of Medicine, Cincinnati, OH, USA
| | - Richard Redon
- l'institut du thorax Université de Nantes, CHU Nantes, INSERM, CNRS, Nantes, France
| | - Philippe Bijlenga
- Neurosurgery Division, Department of Clinical Neurosciences, Faculty of Medicine, Geneva University Hospitals, Geneva, Switzerland
| | - Yoichiro Kamatani
- Laboratory for Statistical and Translational Genetics, RIKEN Center for Integrative Medical Sciences, Yokohama, Japan
- Graduate School of Frontier Sciences, The University of Tokyo, Tokyo, Japan
| | - Jan H Veldink
- Department of Neurology and Neurosurgery, University Medical Center Utrecht Brain Center, Utrecht University, Utrecht, the Netherlands
| | - Ynte M Ruigrok
- Department of Neurology and Neurosurgery, University Medical Center Utrecht Brain Center, Utrecht University, Utrecht, the Netherlands.
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8
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Bakker MK, van der Spek RAA, van Rheenen W, Morel S, Bourcier R, Hostettler IC, Alg VS, van Eijk KR, Koido M, Akiyama M, Terao C, Matsuda K, Walters RG, Lin K, Li L, Millwood IY, Chen Z, Rouleau GA, Zhou S, Rannikmäe K, Sudlow CLM, Houlden H, van den Berg LH, Dina C, Naggara O, Gentric JC, Shotar E, Eugène F, Desal H, Winsvold BS, Børte S, Johnsen MB, Brumpton BM, Sandvei MS, Willer CJ, Hveem K, Zwart JA, Verschuren WMM, Friedrich CM, Hirsch S, Schilling S, Dauvillier J, Martin O, Jones GT, Bown MJ, Ko NU, Kim H, Coleman JRI, Breen G, Zaroff JG, Klijn CJM, Malik R, Dichgans M, Sargurupremraj M, Tatlisumak T, Amouyel P, Debette S, Rinkel GJE, Worrall BB, Pera J, Slowik A, Gaál-Paavola EI, Niemelä M, Jääskeläinen JE, von Und Zu Fraunberg M, Lindgren A, Broderick JP, Werring DJ, Woo D, Redon R, Bijlenga P, Kamatani Y, Veldink JH, Ruigrok YM. Genome-wide association study of intracranial aneurysms identifies 17 risk loci and genetic overlap with clinical risk factors. Nat Genet 2020; 52:1303-1313. [PMID: 33199917 PMCID: PMC7116530 DOI: 10.1038/s41588-020-00725-7] [Citation(s) in RCA: 121] [Impact Index Per Article: 30.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/24/2020] [Accepted: 09/24/2020] [Indexed: 01/16/2023]
Abstract
Rupture of an intracranial aneurysm leads to subarachnoid hemorrhage, a severe type of stroke. To discover new risk loci and the genetic architecture of intracranial aneurysms, we performed a cross-ancestry, genome-wide association study in 10,754 cases and 306,882 controls of European and East Asian ancestry. We discovered 17 risk loci, 11 of which are new. We reveal a polygenic architecture and explain over half of the disease heritability. We show a high genetic correlation between ruptured and unruptured intracranial aneurysms. We also find a suggestive role for endothelial cells by using gene mapping and heritability enrichment. Drug-target enrichment shows pleiotropy between intracranial aneurysms and antiepileptic and sex hormone drugs, providing insights into intracranial aneurysm pathophysiology. Finally, genetic risks for smoking and high blood pressure, the two main clinical risk factors, play important roles in intracranial aneurysm risk, and drive most of the genetic correlation between intracranial aneurysms and other cerebrovascular traits.
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Affiliation(s)
- Mark K Bakker
- Department of Neurology and Neurosurgery, University Medical Center Utrecht Brain Center, Utrecht University, Utrecht, the Netherlands.
| | - Rick A A van der Spek
- Department of Neurology and Neurosurgery, University Medical Center Utrecht Brain Center, Utrecht University, Utrecht, the Netherlands
| | - Wouter van Rheenen
- Department of Neurology and Neurosurgery, University Medical Center Utrecht Brain Center, Utrecht University, Utrecht, the Netherlands
| | - Sandrine Morel
- Department of Pathology and Immunology, Faculty of Medicine, University of Geneva, Geneva, Switzerland
- Neurosurgery Division, Department of Clinical Neurosciences, Faculty of Medicine, Geneva University Hospitals, Geneva, Switzerland
| | - Romain Bourcier
- l'institut du thorax Université de Nantes, CHU Nantes, INSERM, CNRS, Nantes, France
- CHU Nantes, Department of Neuroradiology, Nantes, France
| | - Isabel C Hostettler
- Stroke Research Centre, University College London Queen Square Institute of Neurology, London, UK
- Department of Neurosurgery, Klinikum rechts der Isar, Technical University Munich, Munich, Germany
| | - Varinder S Alg
- Stroke Research Centre, University College London Queen Square Institute of Neurology, London, UK
| | - Kristel R van Eijk
- Department of Neurology and Neurosurgery, University Medical Center Utrecht Brain Center, Utrecht University, Utrecht, the Netherlands
| | - Masaru Koido
- Laboratory for Statistical and Translational Genetics, RIKEN Center for Integrative Medical Sciences, Yokohama, Japan
- Department of Cancer Biology, Institute of Medical Science, The University of Tokyo, Tokyo, Japan
| | - Masato Akiyama
- Laboratory for Statistical and Translational Genetics, RIKEN Center for Integrative Medical Sciences, Yokohama, Japan
- Department of Ophthalmology, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan
- Department of Ocular Pathology and Imaging Science, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan
| | - Chikashi Terao
- Laboratory for Statistical and Translational Genetics, RIKEN Center for Integrative Medical Sciences, Yokohama, Japan
| | - Koichi Matsuda
- Graduate School of Frontier Sciences, The University of Tokyo, Tokyo, Japan
- Laboratory of Clinical Genome Sequencing, Graduate School of Frontier Sciences, The University of Tokyo, Tokyo, Japan
| | - Robin G Walters
- Clinical Trial Service Unit and Epidemiological Studies Unit, Nuffield Department of Population Health, University of Oxford, Oxford, UK
- Medical Research Council Population Health Research Unit, University of Oxford, Oxford, UK
| | - Kuang Lin
- Clinical Trial Service Unit and Epidemiological Studies Unit, Nuffield Department of Population Health, University of Oxford, Oxford, UK
| | - Liming Li
- Department of Epidemiology, School of Public Health, Peking University Health Science Center, Beijing, China
| | - Iona Y Millwood
- Clinical Trial Service Unit and Epidemiological Studies Unit, Nuffield Department of Population Health, University of Oxford, Oxford, UK
- Medical Research Council Population Health Research Unit, University of Oxford, Oxford, UK
| | - Zhengming Chen
- Clinical Trial Service Unit and Epidemiological Studies Unit, Nuffield Department of Population Health, University of Oxford, Oxford, UK
- Medical Research Council Population Health Research Unit, University of Oxford, Oxford, UK
| | - Guy A Rouleau
- Montréal Neurological Institute and Hospital, McGill University, Montréal, QC, Canada
| | - Sirui Zhou
- Lady Davis Institute, Jewish General Hospital, McGill University, Montréal, QC, Canada
| | - Kristiina Rannikmäe
- Centre for Medical Informatics, Usher Institute, University of Edinburgh, Edinburgh, UK
| | - Cathie L M Sudlow
- Centre for Medical Informatics, Usher Institute, University of Edinburgh, Edinburgh, UK
- UK Biobank, Cheadle, Stockport, UK
| | - Henry Houlden
- Neurogenetics Laboratory, The National Hospital of Neurology and Neurosurgery, London, UK
| | - Leonard H van den Berg
- Department of Neurology and Neurosurgery, University Medical Center Utrecht Brain Center, Utrecht University, Utrecht, the Netherlands
| | - Christian Dina
- l'institut du thorax Université de Nantes, CHU Nantes, INSERM, CNRS, Nantes, France
| | - Olivier Naggara
- Pediatric Radiology, Necker Hospital for Sick Children, Université Paris Descartes, Paris, France
- Department of Neuroradiology, Sainte-Anne Hospital and Université Paris Descartes, INSERM UMR, S894, Paris, France
| | | | - Eimad Shotar
- Department of Neuroradiology, Pitié-Salpêtrière Hospital, Paris, France
| | - François Eugène
- Department of Neuroradiology, University Hospital of Rennes, Rennes, France
| | - Hubert Desal
- l'institut du thorax Université de Nantes, CHU Nantes, INSERM, CNRS, Nantes, France
- CHU Nantes, Department of Neuroradiology, Nantes, France
| | - Bendik S Winsvold
- Department of Research, Innovation and Education, Division of Clinical Neuroscience, Oslo University Hospital, Oslo, Norway
- K. G. Jebsen Center for Genetic Epidemiology, Department of Public Health and Nursing, Faculty of Medicine and Health Sciences, Norwegian University of Science and Technology, Trondheim, Norway
| | - Sigrid Børte
- K. G. Jebsen Center for Genetic Epidemiology, Department of Public Health and Nursing, Faculty of Medicine and Health Sciences, Norwegian University of Science and Technology, Trondheim, Norway
- Research and Communication Unit for Musculoskeletal Health (FORMI), Department of Research, Innovation and Education, Division of Clinical Neuroscience, Oslo University Hospital, Oslo, Norway
- Institute of Clinical Medicine, Faculty of Medicine, University of Oslo, Oslo, Norway
| | - Marianne Bakke Johnsen
- K. G. Jebsen Center for Genetic Epidemiology, Department of Public Health and Nursing, Faculty of Medicine and Health Sciences, Norwegian University of Science and Technology, Trondheim, Norway
- Research and Communication Unit for Musculoskeletal Health (FORMI), Department of Research, Innovation and Education, Division of Clinical Neuroscience, Oslo University Hospital, Oslo, Norway
- Institute of Clinical Medicine, Faculty of Medicine, University of Oslo, Oslo, Norway
| | - Ben M Brumpton
- K. G. Jebsen Center for Genetic Epidemiology, Department of Public Health and Nursing, Faculty of Medicine and Health Sciences, Norwegian University of Science and Technology, Trondheim, Norway
| | - Marie Søfteland Sandvei
- Department of Public Health and Nursing, Faculty of Medicine and Health Sciences, Norwegian University of Science and Technology, Trondheim, Norway
- The Cancer Clinic, St Olavs Hospital, Trondheim University Hospital, Trondheim, Norway
| | - Cristen J Willer
- Department of Internal Medicine, Division of Cardiovascular Medicine, University of Michigan, Ann Arbor, MI, USA
| | - Kristian Hveem
- K. G. Jebsen Center for Genetic Epidemiology, Department of Public Health and Nursing, Faculty of Medicine and Health Sciences, Norwegian University of Science and Technology, Trondheim, Norway
- HUNT Research Center, Department of Public Health and Nursing, Faculty of Medicine and Health Sciences, Norwegian University of Science and Technology, Trondheim, Norway
| | - John-Anker Zwart
- Department of Research, Innovation and Education, Division of Clinical Neuroscience, Oslo University Hospital, Oslo, Norway
- K. G. Jebsen Center for Genetic Epidemiology, Department of Public Health and Nursing, Faculty of Medicine and Health Sciences, Norwegian University of Science and Technology, Trondheim, Norway
- Institute of Clinical Medicine, Faculty of Medicine, University of Oslo, Oslo, Norway
| | - W M Monique Verschuren
- Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht, the Netherlands
- National Institute for Public Health and the Environment, Bilthoven, the Netherlands
| | - Christoph M Friedrich
- Dortmund University of Applied Science and Arts, Dortmund, Germany
- Institute for Medical Informatics, Biometry and Epidemiology (IMIBE), University Hospital Essen, Essen, Germany
| | - Sven Hirsch
- Zurich University of Applied Sciences, School of Life Sciences and Facility Management, Zurich, Switzerland
| | - Sabine Schilling
- Zurich University of Applied Sciences, School of Life Sciences and Facility Management, Zurich, Switzerland
| | | | - Olivier Martin
- SIB Swiss Institute of Bioinformatics, Lausanne, Switzerland
| | | | | | | | | | | | | | | | - Gregory T Jones
- Department of Surgery, University of Otago, Dunedin, New Zealand
| | - Matthew J Bown
- Department of Cardiovascular Sciences and National Institute for Health Research, University of Leicester, Leicester, UK
- Leicester Biomedical Research Centre, University of Leicester, Glenfield Hospital, Leicester, UK
| | - Nerissa U Ko
- Department of Neurology, University of California at San Francisco, San Francisco, CA, USA
| | - Helen Kim
- Department of Anesthesia and Perioperative Care, Center for Cerebrovascular Research, University of California, San Francisco, CA, USA
- Department of Epidemiology and Biostatistics, University of California, San Francisco, CA, USA
- Institute for Human Genetics, University of California, San Francisco, CA, USA
| | - Jonathan R I Coleman
- Social, Genetic and Developmental Psychiatry Centre, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK
- UK National Institute for Health Research (NIHR) Biomedical Research Centre (BRC), South London and Maudsley NHS Foundation Trust, London, UK
| | - Gerome Breen
- Social, Genetic and Developmental Psychiatry Centre, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK
- UK National Institute for Health Research (NIHR) Biomedical Research Centre (BRC), South London and Maudsley NHS Foundation Trust, London, UK
| | - Jonathan G Zaroff
- Division of Research, Kaiser Permanente of Northern California, Oakland, CA, USA
| | - Catharina J M Klijn
- Department of Neurology, Donders Institute for Brain, Cognition and Behaviour, Radboud University Medical Center, Nijmegen, the Netherlands
| | - Rainer Malik
- Institute for Stroke and Dementia Research, University Hospital, Ludwig-Maximilians-University, Munich, Germany
| | - Martin Dichgans
- Munich Cluster for Systems Neurology (SyNergy), Munich, Germany
- Deutsches Zentrum für Neurodegenerative Erkrankungen (DZNE), Munich, Germany
| | - Muralidharan Sargurupremraj
- INSERM U1219 Bordeaux Population Health Research Center, University of Bordeaux, Bordeaux, France
- Department of Neurology, Institute for Neurodegenerative Disease, Bordeaux University Hospital, Bordeaux, France
| | - Turgut Tatlisumak
- Department of Clinical Neuroscience at Institute of Neuroscience and Physiology, University of Gothenburg, Gothenburg, Sweden
| | - Philippe Amouyel
- Institut Pasteur de Lille, UMR1167 LabEx DISTALZ - RID-AGE Université de Lille, INSERM, Centre Hospitalier Université de Lille Lille, Lille Lille, France
| | - Stéphanie Debette
- INSERM U1219 Bordeaux Population Health Research Center, University of Bordeaux, Bordeaux, France
- Department of Neurology, Institute for Neurodegenerative Disease, Bordeaux University Hospital, Bordeaux, France
| | - Gabriel J E Rinkel
- Department of Neurology and Neurosurgery, University Medical Center Utrecht Brain Center, Utrecht University, Utrecht, the Netherlands
| | - Bradford B Worrall
- Departments of Neurology and Public Health Sciences, University of Virginia School of Medicine, Charlottesville, VA, USA
| | - Joanna Pera
- Department of Neurology, Faculty of Medicine, Jagiellonian University Medical College, Krakow, Poland
| | - Agnieszka Slowik
- Department of Neurology, Faculty of Medicine, Jagiellonian University Medical College, Krakow, Poland
| | - Emília I Gaál-Paavola
- Department of Neurosurgery, Helsinki University Hospital, University of Helsinki, Helsinki, Finland
- Clinical Neurosciences, University of Helsinki, Helsinki, Finland
| | - Mika Niemelä
- Department of Neurosurgery, Helsinki University Hospital, University of Helsinki, Helsinki, Finland
| | - Juha E Jääskeläinen
- Neurosurgery NeuroCenter, Kuopio University Hospital, Kuopio, Finland
- Institute of Clinical Medicine, Faculty of Health Sciences, University of Eastern Finland, Kuopio, Finland
| | - Mikael von Und Zu Fraunberg
- Neurosurgery NeuroCenter, Kuopio University Hospital, Kuopio, Finland
- Institute of Clinical Medicine, Faculty of Health Sciences, University of Eastern Finland, Kuopio, Finland
| | - Antti Lindgren
- Neurosurgery NeuroCenter, Kuopio University Hospital, Kuopio, Finland
- Institute of Clinical Medicine, Faculty of Health Sciences, University of Eastern Finland, Kuopio, Finland
| | | | - David J Werring
- Stroke Research Centre, University College London Queen Square Institute of Neurology, London, UK
| | - Daniel Woo
- University of Cincinnati College of Medicine, Cincinnati, OH, USA
| | - Richard Redon
- l'institut du thorax Université de Nantes, CHU Nantes, INSERM, CNRS, Nantes, France
| | - Philippe Bijlenga
- Neurosurgery Division, Department of Clinical Neurosciences, Faculty of Medicine, Geneva University Hospitals, Geneva, Switzerland
| | - Yoichiro Kamatani
- Laboratory for Statistical and Translational Genetics, RIKEN Center for Integrative Medical Sciences, Yokohama, Japan
- Graduate School of Frontier Sciences, The University of Tokyo, Tokyo, Japan
| | - Jan H Veldink
- Department of Neurology and Neurosurgery, University Medical Center Utrecht Brain Center, Utrecht University, Utrecht, the Netherlands
| | - Ynte M Ruigrok
- Department of Neurology and Neurosurgery, University Medical Center Utrecht Brain Center, Utrecht University, Utrecht, the Netherlands.
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9
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Rannikmäe K, Henshall DE, Thrippleton S, Ginj Kong Q, Chong M, Grami N, Kuan I, Wilkinson T, Wilson B, Wilson K, Paré G, Sudlow C. Beyond the Brain. Stroke 2020; 51:3007-3017. [DOI: 10.1161/strokeaha.120.029517] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
Background and Purpose:
An important minority of cerebral small vessel disease (cSVD) is monogenic. Many monogenic cSVD genes are recognized to be associated with extracerebral phenotypes. We assessed the frequency of these phenotypes in existing literature.
Methods:
We performed a systematic review following the PRISMA guidelines (Preferred Reporting Items for Systematic Reviews and Meta-Analyses), searching Medline/Embase for publications describing individuals with pathogenic variants in
COL4A1/2
,
TREX1
,
HTRA1
,
ADA2
, and
CTSA
genes (PROSPERO 74804). We included any publication reporting on ≥1 individual with a pathogenic variant and their clinically relevant phenotype. We extracted individuals’ characteristics and information about associated extracerebral phenotypes and stroke/transient ischemic attack. We noted any novel extracerebral phenotypes and looked for shared phenotypes between monogenic cSVDs.
Results:
After screening 6048 publications, we included 96
COL4A1
(350 individuals), 32
TREX1
(115 individuals), 43
HTRA1
(38 homozygous/61 heterozygous individuals), 16
COL4A2
(37 individuals), 119
ADA2
(209 individuals), and 3
CTSA
(14 individuals) publications. The majority of individuals originated from Europe/North America, except for
HTRA1
, where most were from Asia. Age varied widely,
ADA2
individuals being youngest and heterozygous
HTRA1/CTSA
individuals oldest. Sex distribution appeared equal. Extracerebral phenotypes were common: 14% to 100% of individuals with a pathogenic variant manifested at least one extracerebral phenotype (14%
COL4A2
, 43%
HTRA1
heterozygotes, 47%
COL4A1
, 57%
TREX1
, 91%
ADA2
, 94%
HTRA1
homozygotes, and 100%
CTSA
individuals). Indeed, for 4 of 7 genes, an extracerebral phenotype was observed more frequently than stroke/transient ischemic attack. Ocular, renal, hepatic, muscle, and hematologic systems were each involved in more than one monogenic cSVD.
Conclusions:
Extracerebral phenotypes are common in monogenic cSVD with extracerebral system involvement shared between genes. However, inherent biases in the existing literature mean that further data from large-scale population-based longitudinal studies collecting health outcomes in a systematic unbiased way is warranted. The emerging knowledge will help to select patients for testing, inform clinical management, and provide further insights into the underlying mechanisms of cSVD.
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Affiliation(s)
- Kristiina Rannikmäe
- Centre for Medical Informatics, Usher Institute (K.R., D.E.H., T.W., K.W., C.S.), University of Edinburgh, United Kingdom
| | - David E. Henshall
- Centre for Medical Informatics, Usher Institute (K.R., D.E.H., T.W., K.W., C.S.), University of Edinburgh, United Kingdom
| | - Sophie Thrippleton
- Edinburgh Medical School (S.T., Q.G.K., I.K., B.W.), University of Edinburgh, United Kingdom
| | - Qiu Ginj Kong
- Edinburgh Medical School (S.T., Q.G.K., I.K., B.W.), University of Edinburgh, United Kingdom
| | - Mike Chong
- Genetic and Molecular Epidemiology Laboratory, McMaster University, Canada (M.C., N.G., G.P.)
| | - Nickrooz Grami
- Genetic and Molecular Epidemiology Laboratory, McMaster University, Canada (M.C., N.G., G.P.)
| | - Isaac Kuan
- Edinburgh Medical School (S.T., Q.G.K., I.K., B.W.), University of Edinburgh, United Kingdom
| | - Tim Wilkinson
- Centre for Medical Informatics, Usher Institute (K.R., D.E.H., T.W., K.W., C.S.), University of Edinburgh, United Kingdom
| | - Blair Wilson
- Edinburgh Medical School (S.T., Q.G.K., I.K., B.W.), University of Edinburgh, United Kingdom
| | - Kirsty Wilson
- Centre for Medical Informatics, Usher Institute (K.R., D.E.H., T.W., K.W., C.S.), University of Edinburgh, United Kingdom
| | - Guillaume Paré
- Genetic and Molecular Epidemiology Laboratory, McMaster University, Canada (M.C., N.G., G.P.)
| | - Cathie Sudlow
- Centre for Medical Informatics, Usher Institute (K.R., D.E.H., T.W., K.W., C.S.), University of Edinburgh, United Kingdom
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10
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Rannikmäe K, Ngoh K, Bush K, Al-Shahi Salman R, Doubal F, Flaig R, Henshall DE, Hutchison A, Nolan J, Osborne S, Samarasekera N, Schnier C, Whiteley W, Wilkinson T, Wilson K, Woodfield R, Zhang Q, Allen N, Sudlow CLM. Accuracy of identifying incident stroke cases from linked health care data in UK Biobank. Neurology 2020; 95:e697-e707. [PMID: 32616677 PMCID: PMC7455356 DOI: 10.1212/wnl.0000000000009924] [Citation(s) in RCA: 22] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/04/2019] [Accepted: 01/27/2020] [Indexed: 11/15/2022] Open
Abstract
OBJECTIVE In UK Biobank (UKB), a large population-based prospective study, cases of many diseases are ascertained through linkage to routinely collected, coded national health datasets. We assessed the accuracy of these for identifying incident strokes. METHODS In a regional UKB subpopulation (n = 17,249), we identified all participants with ≥1 code signifying a first stroke after recruitment (incident stroke-coded cases) in linked hospital admission, primary care, or death record data. Stroke physicians reviewed their full electronic patient records (EPRs) and generated reference standard diagnoses. We evaluated the number and proportion of cases that were true-positives (i.e., positive predictive value [PPV]) for all codes combined and by code source and type. RESULTS Of 232 incident stroke-coded cases, 97% had EPR information available. Data sources were 30% hospital admission only, 39% primary care only, 28% hospital and primary care, and 3% death records only. While 42% of cases were coded as unspecified stroke type, review of EPRs enabled a pathologic type to be assigned in >99%. PPVs (95% confidence intervals) were 79% (73%-84%) for any stroke (89% for hospital admission codes, 80% for primary care codes) and 83% (74%-90%) for ischemic stroke. PPVs for small numbers of death record and hemorrhagic stroke codes were low but imprecise. CONCLUSIONS Stroke and ischemic stroke cases in UKB can be ascertained through linked health datasets with sufficient accuracy for many research studies. Further work is needed to understand the accuracy of death record and hemorrhagic stroke codes and to develop scalable approaches for better identifying stroke types.
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Affiliation(s)
- Kristiina Rannikmäe
- From the Centre for Medical Informatics, Usher Institute of Population Health Sciences and Informatics (K.R., K.B., R.F., A.H., J.N., C.S., T.W., K.W., Q.Z., C.L.M.S.), and Centre for Clinical Brain Sciences (R.A.-S.S., F.D., N.S., W.W., R.W.), University of Edinburgh; UK Biobank (K.R., K.B., R.F., A.H., J.N., C.S., T.W., K.W., R.W., Q.Z., N.A., C.L.M.S.), Stockport; University of Edinburgh Medical School (K.N., D.E.H., S.O.); and Nuffield Department of Population Health (N.A.), University of Oxford, UK.
| | - Kenneth Ngoh
- From the Centre for Medical Informatics, Usher Institute of Population Health Sciences and Informatics (K.R., K.B., R.F., A.H., J.N., C.S., T.W., K.W., Q.Z., C.L.M.S.), and Centre for Clinical Brain Sciences (R.A.-S.S., F.D., N.S., W.W., R.W.), University of Edinburgh; UK Biobank (K.R., K.B., R.F., A.H., J.N., C.S., T.W., K.W., R.W., Q.Z., N.A., C.L.M.S.), Stockport; University of Edinburgh Medical School (K.N., D.E.H., S.O.); and Nuffield Department of Population Health (N.A.), University of Oxford, UK
| | - Kathryn Bush
- From the Centre for Medical Informatics, Usher Institute of Population Health Sciences and Informatics (K.R., K.B., R.F., A.H., J.N., C.S., T.W., K.W., Q.Z., C.L.M.S.), and Centre for Clinical Brain Sciences (R.A.-S.S., F.D., N.S., W.W., R.W.), University of Edinburgh; UK Biobank (K.R., K.B., R.F., A.H., J.N., C.S., T.W., K.W., R.W., Q.Z., N.A., C.L.M.S.), Stockport; University of Edinburgh Medical School (K.N., D.E.H., S.O.); and Nuffield Department of Population Health (N.A.), University of Oxford, UK
| | - Rustam Al-Shahi Salman
- From the Centre for Medical Informatics, Usher Institute of Population Health Sciences and Informatics (K.R., K.B., R.F., A.H., J.N., C.S., T.W., K.W., Q.Z., C.L.M.S.), and Centre for Clinical Brain Sciences (R.A.-S.S., F.D., N.S., W.W., R.W.), University of Edinburgh; UK Biobank (K.R., K.B., R.F., A.H., J.N., C.S., T.W., K.W., R.W., Q.Z., N.A., C.L.M.S.), Stockport; University of Edinburgh Medical School (K.N., D.E.H., S.O.); and Nuffield Department of Population Health (N.A.), University of Oxford, UK
| | - Fergus Doubal
- From the Centre for Medical Informatics, Usher Institute of Population Health Sciences and Informatics (K.R., K.B., R.F., A.H., J.N., C.S., T.W., K.W., Q.Z., C.L.M.S.), and Centre for Clinical Brain Sciences (R.A.-S.S., F.D., N.S., W.W., R.W.), University of Edinburgh; UK Biobank (K.R., K.B., R.F., A.H., J.N., C.S., T.W., K.W., R.W., Q.Z., N.A., C.L.M.S.), Stockport; University of Edinburgh Medical School (K.N., D.E.H., S.O.); and Nuffield Department of Population Health (N.A.), University of Oxford, UK
| | - Robin Flaig
- From the Centre for Medical Informatics, Usher Institute of Population Health Sciences and Informatics (K.R., K.B., R.F., A.H., J.N., C.S., T.W., K.W., Q.Z., C.L.M.S.), and Centre for Clinical Brain Sciences (R.A.-S.S., F.D., N.S., W.W., R.W.), University of Edinburgh; UK Biobank (K.R., K.B., R.F., A.H., J.N., C.S., T.W., K.W., R.W., Q.Z., N.A., C.L.M.S.), Stockport; University of Edinburgh Medical School (K.N., D.E.H., S.O.); and Nuffield Department of Population Health (N.A.), University of Oxford, UK
| | - David E Henshall
- From the Centre for Medical Informatics, Usher Institute of Population Health Sciences and Informatics (K.R., K.B., R.F., A.H., J.N., C.S., T.W., K.W., Q.Z., C.L.M.S.), and Centre for Clinical Brain Sciences (R.A.-S.S., F.D., N.S., W.W., R.W.), University of Edinburgh; UK Biobank (K.R., K.B., R.F., A.H., J.N., C.S., T.W., K.W., R.W., Q.Z., N.A., C.L.M.S.), Stockport; University of Edinburgh Medical School (K.N., D.E.H., S.O.); and Nuffield Department of Population Health (N.A.), University of Oxford, UK
| | - Aidan Hutchison
- From the Centre for Medical Informatics, Usher Institute of Population Health Sciences and Informatics (K.R., K.B., R.F., A.H., J.N., C.S., T.W., K.W., Q.Z., C.L.M.S.), and Centre for Clinical Brain Sciences (R.A.-S.S., F.D., N.S., W.W., R.W.), University of Edinburgh; UK Biobank (K.R., K.B., R.F., A.H., J.N., C.S., T.W., K.W., R.W., Q.Z., N.A., C.L.M.S.), Stockport; University of Edinburgh Medical School (K.N., D.E.H., S.O.); and Nuffield Department of Population Health (N.A.), University of Oxford, UK
| | - John Nolan
- From the Centre for Medical Informatics, Usher Institute of Population Health Sciences and Informatics (K.R., K.B., R.F., A.H., J.N., C.S., T.W., K.W., Q.Z., C.L.M.S.), and Centre for Clinical Brain Sciences (R.A.-S.S., F.D., N.S., W.W., R.W.), University of Edinburgh; UK Biobank (K.R., K.B., R.F., A.H., J.N., C.S., T.W., K.W., R.W., Q.Z., N.A., C.L.M.S.), Stockport; University of Edinburgh Medical School (K.N., D.E.H., S.O.); and Nuffield Department of Population Health (N.A.), University of Oxford, UK
| | - Scott Osborne
- From the Centre for Medical Informatics, Usher Institute of Population Health Sciences and Informatics (K.R., K.B., R.F., A.H., J.N., C.S., T.W., K.W., Q.Z., C.L.M.S.), and Centre for Clinical Brain Sciences (R.A.-S.S., F.D., N.S., W.W., R.W.), University of Edinburgh; UK Biobank (K.R., K.B., R.F., A.H., J.N., C.S., T.W., K.W., R.W., Q.Z., N.A., C.L.M.S.), Stockport; University of Edinburgh Medical School (K.N., D.E.H., S.O.); and Nuffield Department of Population Health (N.A.), University of Oxford, UK
| | - Neshika Samarasekera
- From the Centre for Medical Informatics, Usher Institute of Population Health Sciences and Informatics (K.R., K.B., R.F., A.H., J.N., C.S., T.W., K.W., Q.Z., C.L.M.S.), and Centre for Clinical Brain Sciences (R.A.-S.S., F.D., N.S., W.W., R.W.), University of Edinburgh; UK Biobank (K.R., K.B., R.F., A.H., J.N., C.S., T.W., K.W., R.W., Q.Z., N.A., C.L.M.S.), Stockport; University of Edinburgh Medical School (K.N., D.E.H., S.O.); and Nuffield Department of Population Health (N.A.), University of Oxford, UK
| | - Christian Schnier
- From the Centre for Medical Informatics, Usher Institute of Population Health Sciences and Informatics (K.R., K.B., R.F., A.H., J.N., C.S., T.W., K.W., Q.Z., C.L.M.S.), and Centre for Clinical Brain Sciences (R.A.-S.S., F.D., N.S., W.W., R.W.), University of Edinburgh; UK Biobank (K.R., K.B., R.F., A.H., J.N., C.S., T.W., K.W., R.W., Q.Z., N.A., C.L.M.S.), Stockport; University of Edinburgh Medical School (K.N., D.E.H., S.O.); and Nuffield Department of Population Health (N.A.), University of Oxford, UK
| | - Will Whiteley
- From the Centre for Medical Informatics, Usher Institute of Population Health Sciences and Informatics (K.R., K.B., R.F., A.H., J.N., C.S., T.W., K.W., Q.Z., C.L.M.S.), and Centre for Clinical Brain Sciences (R.A.-S.S., F.D., N.S., W.W., R.W.), University of Edinburgh; UK Biobank (K.R., K.B., R.F., A.H., J.N., C.S., T.W., K.W., R.W., Q.Z., N.A., C.L.M.S.), Stockport; University of Edinburgh Medical School (K.N., D.E.H., S.O.); and Nuffield Department of Population Health (N.A.), University of Oxford, UK
| | - Tim Wilkinson
- From the Centre for Medical Informatics, Usher Institute of Population Health Sciences and Informatics (K.R., K.B., R.F., A.H., J.N., C.S., T.W., K.W., Q.Z., C.L.M.S.), and Centre for Clinical Brain Sciences (R.A.-S.S., F.D., N.S., W.W., R.W.), University of Edinburgh; UK Biobank (K.R., K.B., R.F., A.H., J.N., C.S., T.W., K.W., R.W., Q.Z., N.A., C.L.M.S.), Stockport; University of Edinburgh Medical School (K.N., D.E.H., S.O.); and Nuffield Department of Population Health (N.A.), University of Oxford, UK
| | - Kirsty Wilson
- From the Centre for Medical Informatics, Usher Institute of Population Health Sciences and Informatics (K.R., K.B., R.F., A.H., J.N., C.S., T.W., K.W., Q.Z., C.L.M.S.), and Centre for Clinical Brain Sciences (R.A.-S.S., F.D., N.S., W.W., R.W.), University of Edinburgh; UK Biobank (K.R., K.B., R.F., A.H., J.N., C.S., T.W., K.W., R.W., Q.Z., N.A., C.L.M.S.), Stockport; University of Edinburgh Medical School (K.N., D.E.H., S.O.); and Nuffield Department of Population Health (N.A.), University of Oxford, UK
| | - Rebecca Woodfield
- From the Centre for Medical Informatics, Usher Institute of Population Health Sciences and Informatics (K.R., K.B., R.F., A.H., J.N., C.S., T.W., K.W., Q.Z., C.L.M.S.), and Centre for Clinical Brain Sciences (R.A.-S.S., F.D., N.S., W.W., R.W.), University of Edinburgh; UK Biobank (K.R., K.B., R.F., A.H., J.N., C.S., T.W., K.W., R.W., Q.Z., N.A., C.L.M.S.), Stockport; University of Edinburgh Medical School (K.N., D.E.H., S.O.); and Nuffield Department of Population Health (N.A.), University of Oxford, UK
| | - Qiuli Zhang
- From the Centre for Medical Informatics, Usher Institute of Population Health Sciences and Informatics (K.R., K.B., R.F., A.H., J.N., C.S., T.W., K.W., Q.Z., C.L.M.S.), and Centre for Clinical Brain Sciences (R.A.-S.S., F.D., N.S., W.W., R.W.), University of Edinburgh; UK Biobank (K.R., K.B., R.F., A.H., J.N., C.S., T.W., K.W., R.W., Q.Z., N.A., C.L.M.S.), Stockport; University of Edinburgh Medical School (K.N., D.E.H., S.O.); and Nuffield Department of Population Health (N.A.), University of Oxford, UK
| | - Naomi Allen
- From the Centre for Medical Informatics, Usher Institute of Population Health Sciences and Informatics (K.R., K.B., R.F., A.H., J.N., C.S., T.W., K.W., Q.Z., C.L.M.S.), and Centre for Clinical Brain Sciences (R.A.-S.S., F.D., N.S., W.W., R.W.), University of Edinburgh; UK Biobank (K.R., K.B., R.F., A.H., J.N., C.S., T.W., K.W., R.W., Q.Z., N.A., C.L.M.S.), Stockport; University of Edinburgh Medical School (K.N., D.E.H., S.O.); and Nuffield Department of Population Health (N.A.), University of Oxford, UK
| | - Cathie L M Sudlow
- From the Centre for Medical Informatics, Usher Institute of Population Health Sciences and Informatics (K.R., K.B., R.F., A.H., J.N., C.S., T.W., K.W., Q.Z., C.L.M.S.), and Centre for Clinical Brain Sciences (R.A.-S.S., F.D., N.S., W.W., R.W.), University of Edinburgh; UK Biobank (K.R., K.B., R.F., A.H., J.N., C.S., T.W., K.W., R.W., Q.Z., N.A., C.L.M.S.), Stockport; University of Edinburgh Medical School (K.N., D.E.H., S.O.); and Nuffield Department of Population Health (N.A.), University of Oxford, UK
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11
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Grami N, Chong M, Lali R, Mohammadi-Shemirani P, Henshall DE, Rannikmäe K, Paré G. Global Assessment of Mendelian Stroke Genetic Prevalence in 101 635 Individuals From 7 Ethnic Groups. Stroke 2020; 51:1290-1293. [PMID: 32106772 DOI: 10.1161/strokeaha.119.028840] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
Abstract
Background and Purpose- Mendelian stroke confers a high lifetime risk for mutation carriers; however, ethnicity-specific prevalence estimates have been difficult to establish. Methods- Eighteen genes responsible for Mendelian stroke were investigated using the Genome Aggregation Database. Genome Aggregation Database participants belonged to 1 of 7 populations: African/African-American, Latino/Admixed American, Ashkenazi Jewish, East Asian, Finnish European, non-Finnish European, and South Asian. Rare nonsynonymous variants from 101 635 participants free of neurological disease were examined for each ethnicity. Mutations were categorized according to 3 nested classes: pathogenic clinical variants, likely damaging variants based on in silico prediction, and all nonsynonymous variants. Results- ABCC6, KRIT1, CECR1, COL3A1, COL4A1, COL4A2, COLGALT1, GLA, HTRA1, NOTCH3, RNF213, and TREX1 harbored pathogenic clinical variants in Genome Aggregation Database. Across all 18 genes, total nonsynonymous carrier frequency was found to be high in 5 ethnicities (African/African-American, Latino/Admixed American, East Asian, non-Finnish European, and South Asian; 28.5%-37.5%) while lower total frequencies were estimated for in silico-predicted likely damaging variants (14.9%-19.7%) and pathogenic clinical variants (0.7%-2.8%). Overall, East Asian exhibited the highest total pathogenic clinical mutation carrier frequency (2.8%). ABCC6 pathogenic clinical variants were most prevalent among East Asian (0.8%). Pathogenic NOTCH3 variants, causal for cerebral autosomal dominant arteriopathy with subcortical infarcts and leukoencephalopathy, were most frequent among East Asian (1.1%) and South Asian (1.2%). East Asian also demonstrated the highest carrier rate for RNF213 (0.8%). Finnish European exhibited the greatest HTRA1 frequency (0.2%), while COL4A1 pathogenic variants were most prevalent in African/African-American (0.3%). Conclusions- Especially, among pathogenic clinical variants, Mendelian stroke genetic prevalence differed significantly between populations. These prevalence estimates may serve as guides for screening and risk profiling in patients worldwide, particularly for understudied non-European populations.
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Affiliation(s)
- Nickrooz Grami
- From the Population Health Research Institute, the Thrombosis & Atherosclerosis Research Institute, McMaster University, Hamilton, Ontario, Canada (N.G., M.C., R.L., P.M.-S., G.P.)
| | - Michael Chong
- From the Population Health Research Institute, the Thrombosis & Atherosclerosis Research Institute, McMaster University, Hamilton, Ontario, Canada (N.G., M.C., R.L., P.M.-S., G.P.)
| | - Ricky Lali
- From the Population Health Research Institute, the Thrombosis & Atherosclerosis Research Institute, McMaster University, Hamilton, Ontario, Canada (N.G., M.C., R.L., P.M.-S., G.P.)
| | - Pedrum Mohammadi-Shemirani
- From the Population Health Research Institute, the Thrombosis & Atherosclerosis Research Institute, McMaster University, Hamilton, Ontario, Canada (N.G., M.C., R.L., P.M.-S., G.P.)
| | - David E Henshall
- the Centre for Medical Informatics, Usher Institute, The University of Edinburgh, United Kingdom (D.E.H., K.R.)
| | - Kristiina Rannikmäe
- the Centre for Medical Informatics, Usher Institute, The University of Edinburgh, United Kingdom (D.E.H., K.R.)
| | - Guillaume Paré
- From the Population Health Research Institute, the Thrombosis & Atherosclerosis Research Institute, McMaster University, Hamilton, Ontario, Canada (N.G., M.C., R.L., P.M.-S., G.P.)
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12
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Georgakis MK, Gill D, Rannikmäe K, Traylor M, Anderson CD, Lee JM, Kamatani Y, Hopewell JC, Worrall BB, Bernhagen J, Sudlow CLM, Malik R, Dichgans M. Genetically Determined Levels of Circulating Cytokines and Risk of Stroke. Circulation 2019; 139:256-268. [PMID: 30586705 DOI: 10.1161/circulationaha.118.035905] [Citation(s) in RCA: 125] [Impact Index Per Article: 25.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
BACKGROUND Cytokines and growth factors have been implicated in the initiation and propagation of vascular disease. Observational studies have shown associations of their circulating levels with stroke. Our objective was to explore whether genetically determined circulating levels of cytokines and growth factors are associated with stroke and its etiologic subtypes by conducting a 2-sample Mendelian randomization (MR) study. METHODS Genetic instruments for 41 cytokines and growth factors were obtained from a genome-wide association study of 8293 healthy adults. Their associations with stroke and stroke subtypes were evaluated in the MEGASTROKE genome-wide association study data set (67 162 cases; 454 450 controls) applying inverse variance-weighted meta-analysis, weighted-median analysis, Mendelian randomization-Egger regression, and multivariable Mendelian randomization. The UK Biobank cohort was used as an independent validation sample (4985 cases; 364 434 controls). Genetic instruments for monocyte chemoattractant protein-1 (MCP-1/CCL2) were further tested for association with etiologically related vascular traits by using publicly available genome-wide association study data. RESULTS Genetic predisposition to higher MCP-1 levels was associated with higher risk of any stroke (odds ratio [OR] per 1 SD increase, 1.06; 95% CI, 1.02-1.09; P=0.0009), any ischemic stroke (OR, 1.06; 95% CI, 1.02-1.10; P=0.002), large-artery stroke (OR, 1.19; 95% CI, 1.09-1.30; P=0.0002), and cardioembolic stroke (OR, 1.14; 95% CI, 1.06-1.23; P=0.0004), but not with small-vessel stroke or intracerebral hemorrhage. The results were stable in sensitivity analyses and remained significant after adjustment for cardiovascular risk factors. Analyses in the UK Biobank showed similar associations for available phenotypes (any stroke: OR, 1.08; 95% CI, 0.99-1.17; P=0.09; any ischemic stroke: OR, 1.07; 95% CI, 0.97-1.18; P=0.17). Genetically determined higher MCP-1 levels were further associated with coronary artery disease (OR, 1.04; 95% CI, 1.00-1.08; P=0.04) and myocardial infarction (OR, 1.05; 95% CI, 1.01-1.09; P=0.02), but not with atrial fibrillation. A meta-analysis of observational studies showed higher circulating MCP-1 levels in patients with stroke in comparison with controls. CONCLUSIONS Genetic predisposition to elevated circulating levels of MCP-1 is associated with higher risk of stroke, in particular with large-artery stroke and cardioembolic stroke. Whether targeting MCP-1 or its receptors can lower stroke incidence requires further study.
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Affiliation(s)
- Marios K Georgakis
- Institute for Stroke and Dementia Research, University Hospital of Ludwig-Maximilians-University, Munich, Germany (M.K.G., J.B., R.M., M.D.).,Graduate School for Systemic Neurosciences, Ludwig-Maximilians-University, Munich, Germany (M.K.G.)
| | - Dipender Gill
- Department of Biostatistics and Epidemiology, School of Public Health, Imperial College London, UK (D.G., C.L.M.S.)
| | | | - Matthew Traylor
- Stroke Research Group, Department of Clinical Neurosciences, University of Cambridge, UK (M.T.)
| | - Christopher D Anderson
- Center for Genomic Medicine (C.D.A.), Massachusetts General Hospital, Boston.,Division of Neurocritical Care and Emergency Neurology, Department of Neurology (C.D.A.), Massachusetts General Hospital, Boston.,Program in Medical and Population Genetics, Broad Institute, Cambridge, MA (C.D.A.)
| | - Jin-Moo Lee
- Department of Neurology, Radiology, and Biomedical Engineering, Washington University School of Medicine, St Louis, MO (J.-M.L.)
| | - Yoichiro Kamatani
- Laboratory for Statistical Analysis, RIKEN Center for Integrative Medical Sciences, Yokohama, Japan (Y.K.)
| | - Jemma C Hopewell
- Clinical Trial Service Unit and Epidemiological Studies Unit, Nuffield Department of Population Health, University of Oxford, UK (J.C.H.)
| | - Bradford B Worrall
- Departments of Neurology and Public Health Sciences, University of Virginia School of Medicine, Charlottesville (B.B.W.)
| | - Jürgen Bernhagen
- Institute for Stroke and Dementia Research, University Hospital of Ludwig-Maximilians-University, Munich, Germany (M.K.G., J.B., R.M., M.D.).,Munich Cluster for Systems Neurology (SyNergy), Munich, Germany (J.B., M.D.)
| | - Cathie L M Sudlow
- Department of Biostatistics and Epidemiology, School of Public Health, Imperial College London, UK (D.G., C.L.M.S.).,Institute for Genetics and Molecular Medicine, University of Edinburgh, UK (C.L.M.S.)
| | - Rainer Malik
- Institute for Stroke and Dementia Research, University Hospital of Ludwig-Maximilians-University, Munich, Germany (M.K.G., J.B., R.M., M.D.)
| | - Martin Dichgans
- Institute for Stroke and Dementia Research, University Hospital of Ludwig-Maximilians-University, Munich, Germany (M.K.G., J.B., R.M., M.D.).,Munich Cluster for Systems Neurology (SyNergy), Munich, Germany (J.B., M.D.).,German Centre for Neurodegenerative Diseases, Munich (M.D.)
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Abstract
Case presentation: A 66-year-old gentleman with metastatic non-small-cell lung cancer developed a wide-based gait following treatment on a clinical trial with cytotoxic chemotherapy and an anti-PD-L1 drug. He had no other significant past medical history of note. Brain imaging, blood tests and lumbar puncture did not reveal a structural, biochemical, paraneoplastic or infective cause. The main differential diagnoses were immune-mediated toxicity or a paraneoplastic syndrome. He was started on prednisolone on the suspicion that his symptoms represented an immune-mediated toxicity. His condition improved following this and his immunotherapy treatment was discontinued. Upon steroid withdrawal, his symptoms recurred and responded to further prednisolone. Conclusions: Immune-mediated toxicities can affect any part of the nervous system and should form part of the differential diagnosis for new neurological symptoms in a patient receiving immunotherapy. Corticosteroids should be the first-line treatment of immune-mediated toxicities. Immunotherapy should be permanently discontinued following severe toxicities.
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Affiliation(s)
- Yun Yi Tan
- Department of Medical Oncology, Beatson West of Scotland Cancer Centre , Glasgow , Scotland
| | | | - Nicola Steele
- Department of Medical Oncology, Beatson West of Scotland Cancer Centre , Glasgow , Scotland
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14
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Wilkinson T, Schnier C, Bush K, Hutchison A, Rannikmäe K, Sudlow C. P1-559: DRUG PRESCRIPTIONS AND DEMENTIA INCIDENCE: A MEDICATION-WIDE ASSOCIATION STUDY. Alzheimers Dement 2019. [DOI: 10.1016/j.jalz.2019.06.1164] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Affiliation(s)
| | | | - Kathryn Bush
- University of Edinburgh; Edinburgh United Kingdom
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Malik R, Chauhan G, Traylor M, Sargurupremraj M, Okada Y, Mishra A, Rutten-Jacobs L, Giese AK, van der Laan SW, Gretarsdottir S, Anderson CD, Chong M, Adams HHH, Ago T, Almgren P, Amouyel P, Ay H, Bartz TM, Benavente OR, Bevan S, Boncoraglio GB, Brown RD, Butterworth AS, Carrera C, Carty CL, Chasman DI, Chen WM, Cole JW, Correa A, Cotlarciuc I, Cruchaga C, Danesh J, de Bakker PIW, DeStefano AL, den Hoed M, Duan Q, Engelter ST, Falcone GJ, Gottesman RF, Grewal RP, Gudnason V, Gustafsson S, Haessler J, Harris TB, Hassan A, Havulinna AS, Heckbert SR, Holliday EG, Howard G, Hsu FC, Hyacinth HI, Ikram MA, Ingelsson E, Irvin MR, Jian X, Jiménez-Conde J, Johnson JA, Jukema JW, Kanai M, Keene KL, Kissela BM, Kleindorfer DO, Kooperberg C, Kubo M, Lange LA, Langefeld CD, Langenberg C, Launer LJ, Lee JM, Lemmens R, Leys D, Lewis CM, Lin WY, Lindgren AG, Lorentzen E, Magnusson PK, Maguire J, Manichaikul A, McArdle PF, Meschia JF, Mitchell BD, Mosley TH, Nalls MA, Ninomiya T, O'Donnell MJ, Psaty BM, Pulit SL, Rannikmäe K, Reiner AP, Rexrode KM, Rice K, Rich SS, Ridker PM, Rost NS, Rothwell PM, Rotter JI, Rundek T, Sacco RL, Sakaue S, Sale MM, Salomaa V, Sapkota BR, Schmidt R, Schmidt CO, Schminke U, Sharma P, Slowik A, Sudlow CLM, Tanislav C, Tatlisumak T, Taylor KD, Thijs VNS, Thorleifsson G, Thorsteinsdottir U, Tiedt S, Trompet S, Tzourio C, van Duijn CM, Walters M, Wareham NJ, Wassertheil-Smoller S, Wilson JG, Wiggins KL, Yang Q, Yusuf S, Bis JC, Pastinen T, Ruusalepp A, Schadt EE, Koplev S, Björkegren JLM, Codoni V, Civelek M, Smith NL, Trégouët DA, Christophersen IE, Roselli C, Lubitz SA, Ellinor PT, Tai ES, Kooner JS, Kato N, He J, van der Harst P, Elliott P, Chambers JC, Takeuchi F, Johnson AD, Sanghera DK, Melander O, Jern C, Strbian D, Fernandez-Cadenas I, Longstreth WT, Rolfs A, Hata J, Woo D, Rosand J, Pare G, Hopewell JC, Saleheen D, Stefansson K, Worrall BB, Kittner SJ, Seshadri S, Fornage M, Markus HS, Howson JMM, Kamatani Y, Debette S, Dichgans M. Publisher Correction: Multiancestry genome-wide association study of 520,000 subjects identifies 32 loci associated with stroke and stroke subtypes. Nat Genet 2019; 51:1192-1193. [PMID: 31160810 DOI: 10.1038/s41588-019-0449-0] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/02/2023]
Abstract
An amendment to this paper has been published and can be accessed via a link at the top of the paper.
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Affiliation(s)
- Rainer Malik
- Institute for Stroke and Dementia Research (ISD), University Hospital, LMU Munich, Munich, Germany
| | - Ganesh Chauhan
- Centre for Brain Research, Indian Institute of Science, Bangalore, India
- INSERM U1219 Bordeaux Population Health Research Center, University of Bordeaux, Bordeaux, France
| | - Matthew Traylor
- Stroke Research Group, Division of Clinical Neurosciences, University of Cambridge, Cambridge, UK
| | - Muralidharan Sargurupremraj
- INSERM U1219 Bordeaux Population Health Research Center, University of Bordeaux, Bordeaux, France
- Department of Neurology, Institute for Neurodegenerative Disease, Bordeaux University Hospital, Bordeaux, France
| | - Yukinori Okada
- Laboratory for Statistical Analysis, RIKEN Center for Integrative Medical Sciences, Yokohama, Japan
- Department of Statistical Genetics, Osaka University Graduate School of Medicine, Osaka, Japan
- Laboratory of Statistical Immunology, Immunology Frontier Research Center (WPI-IFReC), Osaka University, Suita, Japan
| | - Aniket Mishra
- INSERM U1219 Bordeaux Population Health Research Center, University of Bordeaux, Bordeaux, France
- Department of Neurology, Institute for Neurodegenerative Disease, Bordeaux University Hospital, Bordeaux, France
| | - Loes Rutten-Jacobs
- Stroke Research Group, Division of Clinical Neurosciences, University of Cambridge, Cambridge, UK
| | - Anne-Katrin Giese
- Department of Neurology, Massachusetts General Hospital (MGH), Harvard Medical School, Boston, MA, USA
| | - Sander W van der Laan
- Laboratory of Experimental Cardiology, Department of Cardiology, Division of Heart and Lungs, University Medical Center Utrecht, University of Utrecht, Utrecht, the Netherlands
| | | | - Christopher D Anderson
- Center for Genomic Medicine, MGH, Boston, MA, USA
- J. Philip Kistler Stroke Research Center, Department of Neurology, MGH, Boston, MA, USA
- Program in Medical and Population Genetics, Broad Institute, Cambridge, MA, USA
| | - Michael Chong
- Population Health Research Institute, McMaster University, Hamilton, Ontario, Canada
| | - Hieab H H Adams
- Department of Epidemiology, Erasmus University Medical Center, Rotterdam, the Netherlands
- Department of Radiology and Nuclear Medicine, Erasmus University Medical Center, Rotterdam, the Netherlands
| | - Tetsuro Ago
- Department of Medicine and Clinical Science, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan
| | - Peter Almgren
- Department of Clinical Sciences, Lund University, Malmö, Sweden
| | - Philippe Amouyel
- INSERM, Institut Pasteur de Lille, LabEx DISTALZ-UMR1167, Risk Factors and Molecular Determinants of Aging-Related Diseases, Université Lille, Lille, France
- Centre Hospitalier Université Lille, Epidemiology and Public Health Department, Lille, France
| | - Hakan Ay
- J. Philip Kistler Stroke Research Center, Department of Neurology, MGH, Boston, MA, USA
- AA Martinos Center for Biomedical Imaging, Department of Radiology, MGH, Harvard Medical School, Boston, MA, USA
| | - Traci M Bartz
- Cardiovascular Health Research Unit, Departments of Biostatistics and Medicine, University of Washington, Seattle, WA, USA
| | - Oscar R Benavente
- Division of Neurology, Faculty of Medicine, Brain Research Center, University of British Columbia, Vancouver, British Columbia, Canada
| | - Steve Bevan
- School of Life Science, University of Lincoln, Lincoln, UK
| | - Giorgio B Boncoraglio
- Department of Cerebrovascular Diseases, Fondazione IRCCS Istituto Neurologico 'Carlo Besta', Milan, Italy
| | - Robert D Brown
- Department of Neurology, Mayo Clinic Rochester, Rochester, MN, USA
| | - Adam S Butterworth
- MRC/BHF Cardiovascular Epidemiology Unit, Department of Public Health and Primary Care, University of Cambridge, Cambridge, UK
- National Institute for Health Research Blood and Transplant Research Unit in Donor Health and Genomics, University of Cambridge, Cambridge, UK
| | - Caty Carrera
- Neurovascular Research Laboratory, Vall d'Hebron Institut of Research, Neurology and Medicine Departments-Universitat Autònoma de Barcelona, Vall d'Hebrón Hospital, Barcelona, Spain
- Stroke Pharmacogenomics and Genetics, Fundacio Docència i Recerca MutuaTerrassa, Terrassa, Spain
| | - Cara L Carty
- Children's Research Institute, Children's National Medical Center, Washington, DC, USA
- Center for Translational Science, George Washington University, Washington, DC, USA
| | - Daniel I Chasman
- Division of Preventive Medicine, Brigham and Women's Hospital, Boston, MA, USA
- Harvard Medical School, Boston, MA, USA
| | - Wei-Min Chen
- Center for Public Health Genomics, Department of Public Health Sciences, University of Virginia, Charlottesville, VA, USA
| | - John W Cole
- Department of Neurology, University of Maryland School of Medicine and Baltimore VAMC, Baltimore, MD, USA
| | - Adolfo Correa
- Departments of Medicine, Pediatrics and Population Health Science, University of Mississippi Medical Center, Jackson, MS, USA
| | - Ioana Cotlarciuc
- Institute of Cardiovascular Research, Royal Holloway University of London, London, UK, and Ashford and St Peters Hospital, Surrey, UK
| | - Carlos Cruchaga
- Department of Psychiatry, Hope Center Program on Protein Aggregation and Neurodegeneration (HPAN), Washington University School of Medicine, St. Louis, MO, USA
- Department of Developmental Biology, Washington University School of Medicine, St. Louis, MO, USA
| | - John Danesh
- MRC/BHF Cardiovascular Epidemiology Unit, Department of Public Health and Primary Care, University of Cambridge, Cambridge, UK
- NIHR Blood and Transplant Research Unit in Donor Health and Genomics, Department of Public Health and Primary Care, University of Cambridge, Cambridge, UK
- Wellcome Trust Sanger Institute, Hinxton, Cambridge, UK
- British Heart Foundation, Cambridge Centre of Excellence, Department of Medicine, University of Cambridge, Cambridge, UK
| | - Paul I W de Bakker
- Department of Medical Genetics, University Medical Center Utrecht, Utrecht, the Netherlands
- Department of Epidemiology, Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht, the Netherlands
| | - Anita L DeStefano
- Boston University School of Public Health, Boston, MA, USA
- Framingham Heart Study, Framingham, MA, USA
| | - Marcel den Hoed
- Department of Immunology, Genetics and Pathology and Science for Life Laboratory, Uppsala University, Uppsala, Sweden
| | - Qing Duan
- Department of Genetics, University of North Carolina, Chapel Hill, NC, USA
| | - Stefan T Engelter
- Department of Neurology and Stroke Center, Basel University Hospital, Basel, Switzerland
- Neurorehabilitation Unit, University of Basel and University Center for Medicine of Aging and Rehabilitation Basel, Felix Platter Hospital, Basel, Switzerland
| | - Guido J Falcone
- Department of Neurology, Yale University School of Medicine, New Haven, CT, USA
- Program in Medical and Population Genetics, Broad Institute of Harvard and MIT, Cambridge, MA, USA
| | - Rebecca F Gottesman
- Department of Neurology, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Raji P Grewal
- Neuroscience Institute, SF Medical Center, Trenton, NJ, USA
| | - Vilmundur Gudnason
- Icelandic Heart Association Research Institute, Kopavogur, Iceland
- Faculty of Medicine, University of Iceland, Reykjavik, Iceland
| | - Stefan Gustafsson
- Department of Medical Sciences, Molecular Epidemiology and Science for Life Laboratory, Uppsala University, Uppsala, Sweden
| | - Jeffrey Haessler
- Division of Public Health Sciences, Fred Hutchinson Cancer Research Center, Seattle, WA, USA
| | - Tamara B Harris
- Laboratory of Epidemiology and Population Science, National Institute on Aging, National Institutes of Health, Bethesda, MD, USA
| | - Ahamad Hassan
- Department of Neurology, Leeds General Infirmary, Leeds Teaching Hospitals NHS Trust, Leeds, UK
| | - Aki S Havulinna
- National Institute for Health and Welfare, Helsinki, Finland
- FIMM-Institute for Molecular Medicine Finland, Helsinki, Finland
| | - Susan R Heckbert
- Department of Epidemiology, University of Washington, Seattle, WA, USA
| | - Elizabeth G Holliday
- Public Health Stream, Hunter Medical Research Institute, New Lambton, New South Wales, Australia
- Faculty of Health and Medicine, University of Newcastle, Newcastle, New South Wales, Australia
| | - George Howard
- School of Public Health, University of Alabama at Birmingham, Birmingham, AL, USA
| | - Fang-Chi Hsu
- Department of Biostatistical Sciences, Wake Forest School of Medicine, Winston-Salem, NC, USA
| | - Hyacinth I Hyacinth
- Aflac Cancer and Blood Disorder Center, Department of Pediatrics, Emory University School of Medicine, Atlanta, GA, USA
| | - M Arfan Ikram
- Department of Epidemiology, Erasmus University Medical Center, Rotterdam, the Netherlands
| | - Erik Ingelsson
- Department of Medicine, Division of Cardiovascular Medicine, Stanford University School of Medicine, Stanford, CA, USA
- Department of Medical Sciences, Molecular Epidemiology and Science for Life Laboratory, Uppsala University, Uppsala, Sweden
| | - Marguerite R Irvin
- Epidemiology, School of Public Health, University of Alabama at Birmingham, Birmingham, AL, USA
| | - Xueqiu Jian
- Brown Foundation Institute of Molecular Medicine, University of Texas Health Science Center at Houston, Houston, TX, USA
| | - Jordi Jiménez-Conde
- Neurovascular Research Group (NEUVAS), Neurology Department, Institut Hospital del Mar d'Investigació Mèdica, Universitat Autònoma de Barcelona, Barcelona, Spain
| | - Julie A Johnson
- Department of Pharmacotherapy and Translational Research and Center for Pharmacogenomics, University of Florida, College of Pharmacy, Gainesville, FL, USA
- Division of Cardiovascular Medicine, College of Medicine, University of Florida, Gainesville, FL, USA
| | - J Wouter Jukema
- Department of Cardiology, Leiden University Medical Center, Leiden, the Netherlands
| | - Masahiro Kanai
- Laboratory for Statistical Analysis, RIKEN Center for Integrative Medical Sciences, Yokohama, Japan
- Department of Statistical Genetics, Osaka University Graduate School of Medicine, Osaka, Japan
- Program in Bioinformatics and Integrative Genomics, Harvard Medical School, Boston, MA, USA
| | - Keith L Keene
- Department of Biology, East Carolina University, Greenville, NC, USA
- Center for Health Disparities, East Carolina University, Greenville, NC, USA
| | - Brett M Kissela
- University of Cincinnati College of Medicine, Cincinnati, OH, USA
| | | | - Charles Kooperberg
- Division of Public Health Sciences, Fred Hutchinson Cancer Research Center, Seattle, WA, USA
| | - Michiaki Kubo
- RIKEN Center for Integrative Medical Sciences, Yokohama, Japan
| | - Leslie A Lange
- Department of Medicine, University of Colorado Denver, Anschutz Medical Campus, Aurora, CO, USA
| | - Carl D Langefeld
- Center for Public Health Genomics and Department of Biostatistical Sciences, Wake Forest School of Medicine, Winston-Salem, NC, USA
| | - Claudia Langenberg
- MRC Epidemiology Unit, University of Cambridge School of Clinical Medicine, Institute of Metabolic Science, Cambridge, UK
| | - Lenore J Launer
- Intramural Research Program, National Institute on Aging, National Institutes of Health, Bethesda, MD, USA
| | - Jin-Moo Lee
- Department of Neurology, Radiology, and Biomedical Engineering, Washington University School of Medicine, St. Louis, MO, USA
| | - Robin Lemmens
- Department of Neurosciences, Experimental Neurology, KU Leuven-University of Leuven, Leuven, Belgium
- VIB Center for Brain & Disease Research, University Hospitals Leuven, Department of Neurology, Leuven, Belgium
| | - Didier Leys
- INSERM U 1171, CHU Lille, Université Lille, Lille, France
| | - Cathryn M Lewis
- Department of Medical and Molecular Genetics, King's College London, London, UK
- SGDP Centre, Institute of Psychiatry, Psychology & Neuroscience, King's College London, London, UK
| | - Wei-Yu Lin
- MRC/BHF Cardiovascular Epidemiology Unit, Department of Public Health and Primary Care, University of Cambridge, Cambridge, UK
- Northern Institute for Cancer Research, Newcastle University, Newcastle, UK
| | - Arne G Lindgren
- Department of Clinical Sciences Lund, Neurology, Lund University, Lund, Sweden
- Department of Neurology and Rehabilitation Medicine, Skåne University Hospital, Lund, Sweden
| | - Erik Lorentzen
- Bioinformatics Core Facility, University of Gothenburg, Gothenburg, Sweden
| | - Patrik K Magnusson
- Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden
| | - Jane Maguire
- University of Technology Sydney, Faculty of Health, Ultimo, New South Wales, Australia
| | - Ani Manichaikul
- Center for Public Health Genomics, Department of Public Health Sciences, University of Virginia, Charlottesville, VA, USA
| | - Patrick F McArdle
- Department of Medicine, University of Maryland School of Medicine, Baltimore, MD, USA
| | | | - Braxton D Mitchell
- Department of Medicine, University of Maryland School of Medicine, Baltimore, MD, USA
- Geriatrics Research and Education Clinical Center, Baltimore Veterans Administration Medical Center, Baltimore, MD, USA
| | - Thomas H Mosley
- Division of Geriatrics, School of Medicine, University of Mississippi Medical Center, Jackson, MS, USA
- Memory Impairment and Neurodegenerative Dementia Center, University of Mississippi Medical Center, Jackson, MS, USA
| | - Michael A Nalls
- Laboratory of Neurogenetics, National Institute on Aging, National Institutes of Health, Bethesda, MD, USA
- Data Tecnica International, Glen Echo, MD, USA
| | - Toshiharu Ninomiya
- Department of Epidemiology and Public Health, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan
| | - Martin J O'Donnell
- Population Health Research Institute, McMaster University, Hamilton, Ontario, Canada
- Clinical Research Facility, Department of Medicine, NUI Galway, Galway, Ireland
| | - Bruce M Psaty
- Cardiovascular Health Research Unit, Department of Medicine, University of Washington, Seattle, WA, USA
- Department of Epidemiology, University of Washington, Seattle, WA, USA
- Department of Health Services, University of Washington, Seattle, WA, USA
- Kaiser Permanente Washington Health Research Institute, Seattle, WA, USA
| | - Sara L Pulit
- Department of Medical Genetics, University Medical Center Utrecht, Utrecht, the Netherlands
- Brain Center Rudolf Magnus, Department of Neurology, University Medical Center Utrecht, Utrecht, the Netherlands
| | - Kristiina Rannikmäe
- Usher Institute of Population Health Sciences and Informatics, University of Edinburgh, Edinburgh, UK
- Centre for Clinical Brain Sciences, University of Edinburgh, Edinburgh, UK
| | - Alexander P Reiner
- Department of Epidemiology, University of Washington, Seattle, WA, USA
- Fred Hutchinson Cancer Research Center, University of Washington, Seattle, WA, USA
| | - Kathryn M Rexrode
- Department of Medicine, Brigham and Women's Hospital, Boston, MA, USA
| | - Kenneth Rice
- Department of Biostatistics, University of Washington, Seattle, WA, USA
| | - Stephen S Rich
- Center for Public Health Genomics, Department of Public Health Sciences, University of Virginia, Charlottesville, VA, USA
| | - Paul M Ridker
- Division of Preventive Medicine, Brigham and Women's Hospital, Boston, MA, USA
- Harvard Medical School, Boston, MA, USA
| | - Natalia S Rost
- Department of Neurology, Massachusetts General Hospital (MGH), Harvard Medical School, Boston, MA, USA
- J. Philip Kistler Stroke Research Center, Department of Neurology, MGH, Boston, MA, USA
| | - Peter M Rothwell
- Nuffield Department of Clinical Neurosciences, University of Oxford, Oxford, UK
| | - Jerome I Rotter
- Institute for Translational Genomics and Population Sciences, Los Angeles Biomedical Research Institute at Harbor-UCLA Medical Center, Torrance, CA, USA
- Division of Genomic Outcomes, Department of Pediatrics, Harbor-UCLA Medical Center, Torrance, CA, USA
| | - Tatjana Rundek
- Department of Neurology, Miller School of Medicine, University of Miami, Miami, FL, USA
| | - Ralph L Sacco
- Department of Neurology, Miller School of Medicine, University of Miami, Miami, FL, USA
| | - Saori Sakaue
- Department of Statistical Genetics, Osaka University Graduate School of Medicine, Osaka, Japan
- Department of Allergy and Rheumatology, Graduate School of Medicine, University of Tokyo, Tokyo, Japan
| | - Michele M Sale
- Center for Public Health Genomics, University of Virginia, Charlottesville, VA, USA
| | - Veikko Salomaa
- National Institute for Health and Welfare, Helsinki, Finland
| | - Bishwa R Sapkota
- Department of Pediatrics, College of Medicine, University of Oklahoma Health Sciences Center, Oklahoma City, OK, USA
| | - Reinhold Schmidt
- Department of Neurology, Medical University of Graz, Graz, Austria
| | - Carsten O Schmidt
- Institute for Community Medicine, SHIP-KEF, University Medicine Greifswald, Greifswald, Germany
| | - Ulf Schminke
- Department of Neurology, University Medicine Greifswald, Greifswald, Germany
| | - Pankaj Sharma
- Institute of Cardiovascular Research, Royal Holloway University of London, London, UK, and Ashford and St Peters Hospital, Surrey, UK
| | - Agnieszka Slowik
- Department of Neurology, Jagiellonian University, Krakow, Poland
| | - Cathie L M Sudlow
- Usher Institute of Population Health Sciences and Informatics, University of Edinburgh, Edinburgh, UK
- Centre for Clinical Brain Sciences, University of Edinburgh, Edinburgh, UK
| | | | - Turgut Tatlisumak
- Department of Clinical Neurosciences/Neurology, Institute of Neuroscience and Physiology, Sahlgrenska Academy at University of Gothenburg, Gothenburg, Sweden
- Sahlgrenska University Hospital, Gothenburg, Sweden
| | - Kent D Taylor
- Institute for Translational Genomics and Population Sciences, Los Angeles Biomedical Research Institute at Harbor-UCLA Medical Center, Torrance, CA, USA
- Division of Genomic Outcomes, Department of Pediatrics, Harbor-UCLA Medical Center, Torrance, CA, USA
| | - Vincent N S Thijs
- Stroke Division, Florey Institute of Neuroscience and Mental Health, University of Melbourne, Heidelberg, Victoria, Australia
- Austin Health, Department of Neurology, Heidelberg, Victoria, Australia
| | | | | | - Steffen Tiedt
- Institute for Stroke and Dementia Research (ISD), University Hospital, LMU Munich, Munich, Germany
| | - Stella Trompet
- Department of Internal Medicine, Section Gerontology and Geriatrics, Leiden University Medical Center, Leiden, the Netherlands
| | - Christophe Tzourio
- INSERM U1219 Bordeaux Population Health Research Center, University of Bordeaux, Bordeaux, France
- INSERM, U1219, Bordeaux, France
- Department of Public Health, Bordeaux University Hospital, Bordeaux, France
| | - Cornelia M van Duijn
- Genetic Epidemiology Unit, Department of Epidemiology, Erasmus University Medical Center, Rotterdam, the Netherlands
- Center for Medical Systems Biology, Leiden, the Netherlands
| | - Matthew Walters
- School of Medicine, Dentistry and Nursing at the University of Glasgow, Glasgow, UK
| | - Nicholas J Wareham
- MRC Epidemiology Unit, University of Cambridge School of Clinical Medicine, Institute of Metabolic Science, Cambridge, UK
| | - Sylvia Wassertheil-Smoller
- Department of Epidemiology and Population Health, Albert Einstein College of Medicine, New York, NY, USA
| | - James G Wilson
- Department of Physiology and Biophysics, University of Mississippi Medical Center, Jackson, MS, USA
| | - Kerri L Wiggins
- Cardiovascular Health Research Unit, Department of Medicine, University of Washington, Seattle, WA, USA
| | - Qiong Yang
- Boston University School of Public Health, Boston, MA, USA
| | - Salim Yusuf
- Population Health Research Institute, McMaster University, Hamilton, Ontario, Canada
| | - Joshua C Bis
- Cardiovascular Health Research Unit, Department of Medicine, University of Washington, Seattle, WA, USA
| | - Tomi Pastinen
- Department of Human Genetics, McGill University, Montreal, Quebec, Canada
| | - Arno Ruusalepp
- Department of Pathophysiology, Institute of Biomedicine and Translation Medicine, University of Tartu, Tartu, Estonia
- Department of Cardiac Surgery, Tartu University Hospital, Tartu, Estonia
- Clinical Gene Networks AB, Stockholm, Sweden
| | - Eric E Schadt
- Department of Genetics and Genomic Sciences, Icahn Institute for Genomics and Multiscale Biology Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Simon Koplev
- Department of Genetics and Genomic Sciences, Icahn Institute for Genomics and Multiscale Biology Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Johan L M Björkegren
- Department of Genetics and Genomic Sciences, Icahn Institute for Genomics and Multiscale Biology Icahn School of Medicine at Mount Sinai, New York, NY, USA
- Department of Pathophysiology, Institute of Biomedicine and Translation Medicine, Biomeedikum, University of Tartu, Tartu, Estonia
- Integrated Cardio Metabolic Centre, Department of Medicine, Karolinska Institutet, Karolinska Universitetssjukhuset, Huddinge, Sweden
- Clinical Gene Networks AB, Stockholm, Sweden
| | - Veronica Codoni
- UPMC Univ. Paris 06, INSERM, UMR_S 1166, Team Genomics & Pathophysiology of Cardiovascular Diseases, Sorbonne Universités, Paris, France
- ICAN Institute for Cardiometabolism and Nutrition, Paris, France
| | - Mete Civelek
- Center for Public Health Genomics, University of Virginia, Charlottesville, VA, USA
- Department of Biomedical Engineering, University of Virginia, Charlottesville, VA, USA
| | - Nicholas L Smith
- Department of Epidemiology, University of Washington, Seattle, WA, USA
- Group Health Research Institute, Group Health Cooperative, Seattle, WA, USA
- Seattle Epidemiologic Research and Information Center, VA Office of Research and Development, Seattle, WA, USA
| | - David A Trégouët
- UPMC Univ. Paris 06, INSERM, UMR_S 1166, Team Genomics & Pathophysiology of Cardiovascular Diseases, Sorbonne Universités, Paris, France
- ICAN Institute for Cardiometabolism and Nutrition, Paris, France
| | - Ingrid E Christophersen
- Program in Medical and Population Genetics, Broad Institute of Harvard and MIT, Cambridge, MA, USA
- Cardiovascular Research Center, MGH, Boston, MA, USA
- Department of Medical Research, Bærum Hospital, Vestre Viken Hospital Trust, Gjettum, Norway
| | - Carolina Roselli
- Program in Medical and Population Genetics, Broad Institute of Harvard and MIT, Cambridge, MA, USA
| | - Steven A Lubitz
- Program in Medical and Population Genetics, Broad Institute of Harvard and MIT, Cambridge, MA, USA
- Cardiovascular Research Center, MGH, Boston, MA, USA
| | - Patrick T Ellinor
- Program in Medical and Population Genetics, Broad Institute of Harvard and MIT, Cambridge, MA, USA
- Cardiovascular Research Center, MGH, Boston, MA, USA
| | - E Shyong Tai
- Saw Swee Hock School of Public Health, National University of Singapore and National University Health System, Singapore, Singapore
| | - Jaspal S Kooner
- National Heart and Lung Institute, Imperial College London, London, UK
| | - Norihiro Kato
- Department of Gene Diagnostics and Therapeutics, Research Institute, National Center for Global Health and Medicine, Tokyo, Japan
| | - Jiang He
- Department of Epidemiology, Tulane University School of Public Health and Tropical Medicine, New Orleans, LA, USA
| | - Pim van der Harst
- Department of Cardiology, University Medical Center Groningen, University of Groningen, Groningen, the Netherlands
| | - Paul Elliott
- MRC-PHE Centre for Environment and Health, School of Public Health, Department of Epidemiology and Biostatistics and the NIHR Imperial Biomedical Research Centre, Imperial College London, London, UK
| | - John C Chambers
- Department of Epidemiology and Biostatistics, Imperial College London, London, UK
- Department of Cardiology, Ealing Hospital NHS Trust, Southall, UK
| | - Fumihiko Takeuchi
- Department of Gene Diagnostics and Therapeutics, Research Institute, National Center for Global Health and Medicine, Tokyo, Japan
| | - Andrew D Johnson
- Framingham Heart Study, Framingham, MA, USA
- National Heart, Lung and Blood Research Institute, Division of Intramural Research, Population Sciences Branch, Framingham, MA, USA
| | - Dharambir K Sanghera
- Department of Pediatrics, College of Medicine, University of Oklahoma Health Sciences Center, Oklahoma City, OK, USA
- Department of Pharmaceutical Sciences, College of Pharmacy, University of Oklahoma Health Sciences Center, Oklahoma City, OK, USA
- Oklahoma Center for Neuroscience, Oklahoma City, OK, USA
| | - Olle Melander
- Department of Clinical Sciences, Lund University, Malmö, Sweden
| | - Christina Jern
- Department of Pathology and Genetics, Institute of Biomedicine, Sahlgrenska Academy at University of Gothenburg, Gothenburg, Sweden
| | - Daniel Strbian
- Department of Neurology, Helsinki University Hospital, Helsinki, Finland
- Clinical Neurosciences, Neurology, University of Helsinki, Helsinki, Finland
| | - Israel Fernandez-Cadenas
- Neurovascular Research Laboratory, Vall d'Hebron Institut of Research, Neurology and Medicine Departments-Universitat Autònoma de Barcelona, Vall d'Hebrón Hospital, Barcelona, Spain
- Stroke Pharmacogenomics and Genetics, Fundacio Docència i Recerca MutuaTerrassa, Terrassa, Spain
| | - W T Longstreth
- Department of Epidemiology, University of Washington, Seattle, WA, USA
- Department of Neurology, University of Washington, Seattle, WA, USA
| | - Arndt Rolfs
- Albrecht Kossel Institute, University Clinic of Rostock, Rostock, Germany
| | - Jun Hata
- Department of Epidemiology and Public Health, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan
| | - Daniel Woo
- University of Cincinnati College of Medicine, Cincinnati, OH, USA
| | - Jonathan Rosand
- Center for Genomic Medicine, MGH, Boston, MA, USA
- J. Philip Kistler Stroke Research Center, Department of Neurology, MGH, Boston, MA, USA
- Program in Medical and Population Genetics, Broad Institute, Cambridge, MA, USA
| | - Guillaume Pare
- Population Health Research Institute, McMaster University, Hamilton, Ontario, Canada
| | - Jemma C Hopewell
- Clinical Trial Service Unit and Epidemiological Studies Unit, Nuffield Department of Population Health, University of Oxford, Oxford, UK
| | - Danish Saleheen
- Department of Genetics, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA
| | - Kari Stefansson
- deCODE genetics/AMGEN Inc., Reykjavik, Iceland
- Faculty of Medicine, University of Iceland, Reykjavik, Iceland
| | - Bradford B Worrall
- Departments of Neurology and Public Health Sciences, University of Virginia School of Medicine, Charlottesville, VA, USA
| | - Steven J Kittner
- Department of Neurology, University of Maryland School of Medicine and Baltimore VAMC, Baltimore, MD, USA
| | - Sudha Seshadri
- Framingham Heart Study, Framingham, MA, USA
- Glenn Biggs Institute for Alzheimer's and Neurodegenerative Diseases, University of Texas Health Sciences Center, San Antonio, San Antonio, TX, USA
| | - Myriam Fornage
- Brown Foundation Institute of Molecular Medicine, University of Texas Health Science Center at Houston, Houston, TX, USA
- Human Genetics Center, University of Texas Health Science Center at Houston, Houston, TX, USA
| | - Hugh S Markus
- Stroke Research Group, Division of Clinical Neurosciences, University of Cambridge, Cambridge, UK
| | - Joanna M M Howson
- MRC/BHF Cardiovascular Epidemiology Unit, Department of Public Health and Primary Care, University of Cambridge, Cambridge, UK
| | - Yoichiro Kamatani
- Laboratory for Statistical Analysis, RIKEN Center for Integrative Medical Sciences, Yokohama, Japan
- Center for Genomic Medicine, Kyoto University Graduate School of Medicine, Kyoto, Japan
| | - Stephanie Debette
- INSERM U1219 Bordeaux Population Health Research Center, University of Bordeaux, Bordeaux, France.
- Department of Neurology, Institute for Neurodegenerative Disease, Bordeaux University Hospital, Bordeaux, France.
| | - Martin Dichgans
- Institute for Stroke and Dementia Research (ISD), University Hospital, LMU Munich, Munich, Germany.
- Munich Cluster for Systems Neurology (SyNergy), Munich, Germany.
- German Center for Neurodegenerative Diseases (DZNE), Munich, Germany.
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16
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Mbizvo GK, Lentell IC, Leen C, Roddie H, Derry CP, Duncan SE, Rannikmäe K. Epilepsia partialis continua complicated by disseminated tuberculosis and hemophagocytic lymphohistiocytosis: a case report. J Med Case Rep 2019; 13:191. [PMID: 31230590 PMCID: PMC6589876 DOI: 10.1186/s13256-019-2092-x] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/11/2019] [Accepted: 04/18/2019] [Indexed: 11/11/2022] Open
Abstract
Background We describe a patient copresenting with epilepsia partialis continua, tuberculosis, and hemophagocytic lymphohistiocytosis. To our knowledge, this is the first documented case of this triad. Case presentation A 54-year-old black South African woman presented to a hospital in Scotland with an acute history of right-sided facial twitching, breathlessness, and several months of episodic night sweats. Clinical examination revealed pyrexia and continuous, stereotyped, right-sided facial contractions. These worsened with speech and continued through sleep. A clinical diagnosis of epilepsia partialis continua was made, and we provide a video of her seizures. Computed tomographic imaging of the chest and serous fluid analyses were consistent with a diagnosis of disseminated Mycobacterium tuberculosis. An additional diagnosis of hemophagocytic lymphohistiocytosis was made following the identification of pancytopenia and hyperferritinemia in peripheral blood, with hemophagocytosis evident in bone marrow investigation. We provide images of her hematopathology. The patient was extremely unwell and was hospitalized for 6 months, including two admissions to the intensive care unit for ventilatory support. She was treated successfully with high doses of antiepileptic drugs (benzodiazepines, levetiracetam, and phenytoin) and 12 months of oral antituberculosis therapy, and she underwent chemotherapy with 8 weeks of etoposide and dexamethasone for hemophagocytic lymphohistiocytosis, followed by 12 months of cyclosporine and prednisolone. Conclusions This combination of pathologies is unusual, and this case report helps educate clinicians on how such a patient may present and be managed. A lack of evidence surrounding the coexpression of this triad may represent absolute rarity, underdiagnosis, or incomplete case ascertainment due to early death caused by untreated tuberculosis or hemophagocytic lymphohistiocytosis. Further research is needed. Electronic supplementary material The online version of this article (10.1186/s13256-019-2092-x) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Gashirai K Mbizvo
- Muir Maxwell Epilepsy Centre, Centre for Clinical Brain Sciences, The University of Edinburgh, 20 Sylvan Place, Edinburgh, EH9 1UW, UK. .,Department of Clinical Neurosciences, Western General Hospital, Edinburgh, UK.
| | - Isabel C Lentell
- Haematology, Cambridge University Hospitals NHS Foundation Trust, Cambridge, UK
| | - Clifford Leen
- Regional Infectious Diseases Unit, Western General Hospital, Edinburgh, UK
| | - Huw Roddie
- Department of Haematology, Western General Hospital, Edinburgh, UK
| | - Christopher P Derry
- Department of Clinical Neurosciences, Western General Hospital, Edinburgh, UK.,Department of Clinical Neurosciences and Sleep Medicine, Centre for Clinical Brain Sciences, The University of Edinburgh, Edinburgh, UK
| | - Susan E Duncan
- Muir Maxwell Epilepsy Centre, Centre for Clinical Brain Sciences, The University of Edinburgh, 20 Sylvan Place, Edinburgh, EH9 1UW, UK.,Department of Clinical Neurosciences, Western General Hospital, Edinburgh, UK
| | - Kristiina Rannikmäe
- Forth Valley Royal Hospital, Larbert, and Usher Institute of Population Health Sciences and Informatics, The University of Edinburgh, Edinburgh, UK
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17
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Wilkinson T, Schnier C, Bush K, Rannikmäe K, Henshall DE, Lerpiniere C, Allen NE, Flaig R, Russ TC, Bathgate D, Pal S, O'Brien JT, Sudlow CLM. Identifying dementia outcomes in UK Biobank: a validation study of primary care, hospital admissions and mortality data. Eur J Epidemiol 2019. [PMID: 30806901 DOI: 10.1007/s10654-01900499-1] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/01/2023]
Abstract
Prospective, population-based studies that recruit participants in mid-life are valuable resources for dementia research. Follow-up in these studies is often through linkage to routinely-collected healthcare datasets. We investigated the accuracy of these datasets for dementia case ascertainment in a validation study using data from UK Biobank-an open access, population-based study of > 500,000 adults aged 40-69 years at recruitment in 2006-2010. From 17,198 UK Biobank participants recruited in Edinburgh, we identified those with ≥ 1 dementia code in their linked primary care, hospital admissions or mortality data and compared their coded diagnoses to clinical expert adjudication of their full-text medical record. We calculated the positive predictive value (PPV, the proportion of cases identified that were true positives) for all-cause dementia, Alzheimer's disease and vascular dementia for each dataset alone and in combination, and explored algorithmic code combinations to improve PPV. Among 120 participants, PPVs for all-cause dementia were 86.8%, 87.3% and 80.0% for primary care, hospital admissions and mortality data respectively and 82.5% across all datasets. We identified three algorithms that balanced a high PPV with reasonable case ascertainment. For Alzheimer's disease, PPVs were 74.1% for primary care, 68.2% for hospital admissions, 50.0% for mortality data and 71.4% in combination. PPV for vascular dementia was 43.8% across all sources. UK routinely-collected healthcare data can be used to identify all-cause dementia in prospective studies. PPVs for Alzheimer's disease and vascular dementia are lower. Further research is required to explore the geographic generalisability of these findings.
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Affiliation(s)
- Tim Wilkinson
- Centre for Medical Informatics, Usher Institute of Population Health Sciences and Informatics, University of Edinburgh, Edinburgh, UK.
- Centre for Clinical Brain Sciences, University of Edinburgh, Edinburgh, UK.
- Anne Rowling Regenerative Neurology Clinic, University of Edinburgh, Edinburgh, UK.
| | - Christian Schnier
- Centre for Medical Informatics, Usher Institute of Population Health Sciences and Informatics, University of Edinburgh, Edinburgh, UK
| | - Kathryn Bush
- Centre for Medical Informatics, Usher Institute of Population Health Sciences and Informatics, University of Edinburgh, Edinburgh, UK
- Centre for Clinical Brain Sciences, University of Edinburgh, Edinburgh, UK
| | - Kristiina Rannikmäe
- Centre for Medical Informatics, Usher Institute of Population Health Sciences and Informatics, University of Edinburgh, Edinburgh, UK
- Centre for Clinical Brain Sciences, University of Edinburgh, Edinburgh, UK
| | - David E Henshall
- Centre for Clinical Brain Sciences, University of Edinburgh, Edinburgh, UK
| | - Chris Lerpiniere
- Centre for Clinical Brain Sciences, University of Edinburgh, Edinburgh, UK
- Anne Rowling Regenerative Neurology Clinic, University of Edinburgh, Edinburgh, UK
| | - Naomi E Allen
- Clinical Trial Service Unit and Epidemiological Studies Unit, Nuffield Department of Population Health, University of Oxford, Oxford, UK
| | - Robin Flaig
- Centre for Medical Informatics, Usher Institute of Population Health Sciences and Informatics, University of Edinburgh, Edinburgh, UK
| | - Tom C Russ
- Alzheimer Scotland Dementia Research Centre, University of Edinburgh, Edinburgh, UK
- Centre for Dementia Prevention, University of Edinburgh, Edinburgh, UK
| | | | - Suvankar Pal
- Centre for Clinical Brain Sciences, University of Edinburgh, Edinburgh, UK
- Anne Rowling Regenerative Neurology Clinic, University of Edinburgh, Edinburgh, UK
| | - John T O'Brien
- Department of Psychiatry, University of Cambridge, Cambridge, UK
| | - Cathie L M Sudlow
- Centre for Medical Informatics, Usher Institute of Population Health Sciences and Informatics, University of Edinburgh, Edinburgh, UK
- Centre for Clinical Brain Sciences, University of Edinburgh, Edinburgh, UK
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18
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Söderholm M, Pedersen A, Lorentzen E, Stanne TM, Bevan S, Olsson M, Cole JW, Fernandez-Cadenas I, Hankey GJ, Jimenez-Conde J, Jood K, Lee JM, Lemmens R, Levi C, Mitchell BD, Norrving B, Rannikmäe K, Rost NS, Rosand J, Rothwell PM, Scott R, Strbian D, Sturm JW, Sudlow C, Traylor M, Thijs V, Tatlisumak T, Woo D, Worrall BB, Maguire JM, Lindgren A, Jern C. Genome-wide association meta-analysis of functional outcome after ischemic stroke. Neurology 2019; 92:e1271-e1283. [PMID: 30796134 PMCID: PMC6511098 DOI: 10.1212/wnl.0000000000007138] [Citation(s) in RCA: 82] [Impact Index Per Article: 16.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/06/2018] [Accepted: 11/09/2018] [Indexed: 12/15/2022] Open
Abstract
OBJECTIVE To discover common genetic variants associated with poststroke outcomes using a genome-wide association (GWA) study. METHODS The study comprised 6,165 patients with ischemic stroke from 12 studies in Europe, the United States, and Australia included in the GISCOME (Genetics of Ischaemic Stroke Functional Outcome) network. The primary outcome was modified Rankin Scale score after 60 to 190 days, evaluated as 2 dichotomous variables (0-2 vs 3-6 and 0-1 vs 2-6) and subsequently as an ordinal variable. GWA analyses were performed in each study independently and results were meta-analyzed. Analyses were adjusted for age, sex, stroke severity (baseline NIH Stroke Scale score), and ancestry. The significance level was p < 5 × 10-8. RESULTS We identified one genetic variant associated with functional outcome with genome-wide significance (modified Rankin Scale scores 0-2 vs 3-6, p = 5.3 × 10-9). This intronic variant (rs1842681) in the LOC105372028 gene is a previously reported trans-expression quantitative trait locus for PPP1R21, which encodes a regulatory subunit of protein phosphatase 1. This ubiquitous phosphatase is implicated in brain functions such as brain plasticity. Several variants detected in this study demonstrated suggestive association with outcome (p < 10-5), some of which are within or near genes with experimental evidence of influence on ischemic stroke volume and/or brain recovery (e.g., NTN4, TEK, and PTCH1). CONCLUSIONS In this large GWA study on functional outcome after ischemic stroke, we report one significant variant and several variants with suggestive association to outcome 3 months after stroke onset with plausible mechanistic links to poststroke recovery. Future replication studies and exploration of potential functional mechanisms for identified genetic variants are warranted.
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19
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Wilkinson T, Schnier C, Bush K, Rannikmäe K, Henshall DE, Lerpiniere C, Allen NE, Flaig R, Russ TC, Bathgate D, Pal S, O'Brien JT, Sudlow CLM. Identifying dementia outcomes in UK Biobank: a validation study of primary care, hospital admissions and mortality data. Eur J Epidemiol 2019; 34:557-565. [PMID: 30806901 PMCID: PMC6497624 DOI: 10.1007/s10654-019-00499-1] [Citation(s) in RCA: 158] [Impact Index Per Article: 31.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/18/2018] [Accepted: 02/19/2019] [Indexed: 11/29/2022]
Abstract
Prospective, population-based studies that recruit participants in mid-life are valuable resources for dementia research. Follow-up in these studies is often through linkage to routinely-collected healthcare datasets. We investigated the accuracy of these datasets for dementia case ascertainment in a validation study using data from UK Biobank—an open access, population-based study of > 500,000 adults aged 40–69 years at recruitment in 2006–2010. From 17,198 UK Biobank participants recruited in Edinburgh, we identified those with ≥ 1 dementia code in their linked primary care, hospital admissions or mortality data and compared their coded diagnoses to clinical expert adjudication of their full-text medical record. We calculated the positive predictive value (PPV, the proportion of cases identified that were true positives) for all-cause dementia, Alzheimer’s disease and vascular dementia for each dataset alone and in combination, and explored algorithmic code combinations to improve PPV. Among 120 participants, PPVs for all-cause dementia were 86.8%, 87.3% and 80.0% for primary care, hospital admissions and mortality data respectively and 82.5% across all datasets. We identified three algorithms that balanced a high PPV with reasonable case ascertainment. For Alzheimer’s disease, PPVs were 74.1% for primary care, 68.2% for hospital admissions, 50.0% for mortality data and 71.4% in combination. PPV for vascular dementia was 43.8% across all sources. UK routinely-collected healthcare data can be used to identify all-cause dementia in prospective studies. PPVs for Alzheimer’s disease and vascular dementia are lower. Further research is required to explore the geographic generalisability of these findings.
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Affiliation(s)
- Tim Wilkinson
- Centre for Medical Informatics, Usher Institute of Population Health Sciences and Informatics, University of Edinburgh, Edinburgh, UK. .,Centre for Clinical Brain Sciences, University of Edinburgh, Edinburgh, UK. .,Anne Rowling Regenerative Neurology Clinic, University of Edinburgh, Edinburgh, UK.
| | - Christian Schnier
- Centre for Medical Informatics, Usher Institute of Population Health Sciences and Informatics, University of Edinburgh, Edinburgh, UK
| | - Kathryn Bush
- Centre for Medical Informatics, Usher Institute of Population Health Sciences and Informatics, University of Edinburgh, Edinburgh, UK.,Centre for Clinical Brain Sciences, University of Edinburgh, Edinburgh, UK
| | - Kristiina Rannikmäe
- Centre for Medical Informatics, Usher Institute of Population Health Sciences and Informatics, University of Edinburgh, Edinburgh, UK.,Centre for Clinical Brain Sciences, University of Edinburgh, Edinburgh, UK
| | - David E Henshall
- Centre for Clinical Brain Sciences, University of Edinburgh, Edinburgh, UK
| | - Chris Lerpiniere
- Centre for Clinical Brain Sciences, University of Edinburgh, Edinburgh, UK.,Anne Rowling Regenerative Neurology Clinic, University of Edinburgh, Edinburgh, UK
| | - Naomi E Allen
- Clinical Trial Service Unit and Epidemiological Studies Unit, Nuffield Department of Population Health, University of Oxford, Oxford, UK
| | - Robin Flaig
- Centre for Medical Informatics, Usher Institute of Population Health Sciences and Informatics, University of Edinburgh, Edinburgh, UK
| | - Tom C Russ
- Alzheimer Scotland Dementia Research Centre, University of Edinburgh, Edinburgh, UK.,Centre for Dementia Prevention, University of Edinburgh, Edinburgh, UK
| | | | - Suvankar Pal
- Centre for Clinical Brain Sciences, University of Edinburgh, Edinburgh, UK.,Anne Rowling Regenerative Neurology Clinic, University of Edinburgh, Edinburgh, UK
| | - John T O'Brien
- Department of Psychiatry, University of Cambridge, Cambridge, UK
| | - Cathie L M Sudlow
- Centre for Medical Informatics, Usher Institute of Population Health Sciences and Informatics, University of Edinburgh, Edinburgh, UK.,Centre for Clinical Brain Sciences, University of Edinburgh, Edinburgh, UK
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20
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Harding Z, Wilkinson T, Stevenson A, Horrocks S, Ly A, Schnier C, Breen DP, Rannikmäe K, Sudlow CLM. Identifying Parkinson's disease and parkinsonism cases using routinely collected healthcare data: A systematic review. PLoS One 2019; 14:e0198736. [PMID: 30703084 PMCID: PMC6354966 DOI: 10.1371/journal.pone.0198736] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/23/2018] [Accepted: 01/11/2019] [Indexed: 12/14/2022] Open
Abstract
Background Population-based, prospective studies can provide important insights into Parkinson’s disease (PD) and other parkinsonian disorders. Participant follow-up in such studies is often achieved through linkage to routinely collected healthcare datasets. We systematically reviewed the published literature on the accuracy of these datasets for this purpose. Methods We searched four electronic databases for published studies that compared PD and parkinsonism cases identified using routinely collected data to a reference standard. We extracted study characteristics and two accuracy measures: positive predictive value (PPV) and/or sensitivity. Results We identified 18 articles, resulting in 27 measures of PPV and 14 of sensitivity. For PD, PPV ranged from 56–90% in hospital datasets, 53–87% in prescription datasets, 81–90% in primary care datasets and was 67% in mortality datasets. Combining diagnostic and medication codes increased PPV. For parkinsonism, PPV ranged from 36–88% in hospital datasets, 40–74% in prescription datasets, and was 94% in mortality datasets. Sensitivity ranged from 15–73% in single datasets for PD and 43–63% in single datasets for parkinsonism. Conclusions In many settings, routinely collected datasets generate good PPVs and reasonable sensitivities for identifying PD and parkinsonism cases. However, given the wide range of identified accuracy estimates, we recommend cohorts conduct their own context-specific validation studies if existing evidence is lacking. Further research is warranted to investigate primary care and medication datasets, and to develop algorithms that balance a high PPV with acceptable sensitivity.
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Affiliation(s)
- Zoe Harding
- College of Medicine & Veterinary Medicine, University of Edinburgh, Edinburgh, United Kingdom
| | - Tim Wilkinson
- Centre for Clinical Brain Sciences, University of Edinburgh, Edinburgh, United Kingdom
- Centre for Medical Informatics, Usher Institute of Population Health Sciences and Informatics, University of Edinburgh, Edinburgh, United Kingdom
- * E-mail:
| | - Anna Stevenson
- Institute of Genetics and Molecular Medicine, University of Edinburgh, Edinburgh, United Kingdom
- Centre for Cognitive Ageing and Cognitive Epidemiology, Edinburgh, United Kingdom
| | - Sophie Horrocks
- College of Medicine & Veterinary Medicine, University of Edinburgh, Edinburgh, United Kingdom
| | - Amanda Ly
- Centre for Medical Informatics, Usher Institute of Population Health Sciences and Informatics, University of Edinburgh, Edinburgh, United Kingdom
| | - Christian Schnier
- Centre for Medical Informatics, Usher Institute of Population Health Sciences and Informatics, University of Edinburgh, Edinburgh, United Kingdom
| | - David P. Breen
- Centre for Clinical Brain Sciences, University of Edinburgh, Edinburgh, United Kingdom
- Centre for Medical Informatics, Usher Institute of Population Health Sciences and Informatics, University of Edinburgh, Edinburgh, United Kingdom
- Anne Rowling Regenerative Neurology Clinic, University of Edinburgh, Edinburgh, Scotland
| | - Kristiina Rannikmäe
- Centre for Clinical Brain Sciences, University of Edinburgh, Edinburgh, United Kingdom
- Centre for Medical Informatics, Usher Institute of Population Health Sciences and Informatics, University of Edinburgh, Edinburgh, United Kingdom
| | - Cathie L. M. Sudlow
- Centre for Clinical Brain Sciences, University of Edinburgh, Edinburgh, United Kingdom
- Centre for Medical Informatics, Usher Institute of Population Health Sciences and Informatics, University of Edinburgh, Edinburgh, United Kingdom
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21
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Malik R, Rannikmäe K, Traylor M, Georgakis MK, Sargurupremraj M, Markus HS, Hopewell JC, Debette S, Sudlow CLM, Dichgans M. Genome-wide meta-analysis identifies 3 novel loci associated with stroke. Ann Neurol 2018; 84:934-939. [PMID: 30383316 PMCID: PMC6644297 DOI: 10.1002/ana.25369] [Citation(s) in RCA: 60] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/09/2018] [Revised: 10/29/2018] [Accepted: 10/29/2018] [Indexed: 12/19/2022]
Abstract
We conducted a European-only and transancestral genome-wide association meta-analysis in 72,147 stroke patients and 823,869 controls using data from UK Biobank (UKB) and the MEGASTROKE consortium. We identified an exonic polymorphism in NOS3 (rs1799983, p.Glu298Asp; p = 2.2E-8, odds ratio [OR] = 1.05, 95% confidence interval [CI] = 1.04-1.07) and variants in an intron of COL4A1 (rs9521634; p = 3.8E-8, OR = 1.04, 95% CI = 1.03-1.06) and near DYRK1A (rs720470; p = 6.1E-9, OR = 1.05, 95% CI = 1.03-1.07) at genome-wide significance for stroke. Effect sizes of known stroke loci were highly correlated between UKB and MEGASTROKE. Using Mendelian randomization, we further show that genetic variation in the nitric oxide synthase-nitric oxide pathway in part affects stroke risk via variation in blood pressure. Ann Neurol 2018;84:934-939.
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Affiliation(s)
- Rainer Malik
- Institute for Stroke and Dementia Research, University Hospital, Ludwig Maximilian University of MunichMunichGermany
| | - Kristiina Rannikmäe
- Usher Institute of Population Health Sciences and Informatics, University of EdinburghEdinburghUK
- Centre for Clinical Brain SciencesUniversity of EdinburghEdinburghUK
| | - Matthew Traylor
- Stroke Research Group, Division of Clinical NeurosciencesUniversity of CambridgeCambridgeUK
| | - Marios K. Georgakis
- Institute for Stroke and Dementia Research, University Hospital, Ludwig Maximilian University of MunichMunichGermany
| | - Muralidharan Sargurupremraj
- INSERM U1219, Bordeaux Population Health Research Center, University of BordeauxBordeauxFrance
- Department of NeurologyInstitute for Neurodegenerative Disease, Bordeaux University HospitalBordeauxFrance
| | - Hugh S. Markus
- Stroke Research Group, Division of Clinical NeurosciencesUniversity of CambridgeCambridgeUK
| | - Jemma C. Hopewell
- Clinical Trial Service Unit and Epidemiological Studies Unit, Nuffield Department of Population HealthUniversity of OxfordOxfordUK
| | - Stephanie Debette
- INSERM U1219, Bordeaux Population Health Research Center, University of BordeauxBordeauxFrance
- Department of NeurologyInstitute for Neurodegenerative Disease, Bordeaux University HospitalBordeauxFrance
| | - Cathie L. M. Sudlow
- Usher Institute of Population Health Sciences and Informatics, University of EdinburghEdinburghUK
- Centre for Clinical Brain SciencesUniversity of EdinburghEdinburghUK
| | - Martin Dichgans
- Institute for Stroke and Dementia Research, University Hospital, Ludwig Maximilian University of MunichMunichGermany
- Munich Cluster for Systems NeurologyMunichGermany
- German Center for Neurodegenerative DiseasesMunichGermany
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22
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Rutten-Jacobs LC, Larsson SC, Malik R, Rannikmäe K, Sudlow CL, Dichgans M, Markus HS, Traylor M. Genetic risk, incident stroke, and the benefits of adhering to a healthy lifestyle: cohort study of 306 473 UK Biobank participants. BMJ 2018; 363:k4168. [PMID: 30355576 PMCID: PMC6199557 DOI: 10.1136/bmj.k4168] [Citation(s) in RCA: 130] [Impact Index Per Article: 21.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
OBJECTIVE To evaluate the associations of a polygenic risk score and healthy lifestyle with incident stroke. DESIGN Prospective population based cohort study. SETTING UK Biobank Study, UK. PARTICIPANTS 306 473 men and women, aged 40-73 years, recruited between 2006 and 2010. MAIN OUTCOME MEASURE Hazard ratios for a first stroke, estimated using Cox regression. A polygenic risk score of 90 single nucleotide polymorphisms previously associated with stroke was constructed at P<1×10-5 to test for an association with incident stroke. Adherence to a healthy lifestyle was determined on the basis of four factors: non-smoker, healthy diet, body mass index <30 kg/m2, and regular physical exercise. RESULTS During a median follow-up of 7.1 years (2 138 443 person years), 2077 incident strokes (1541 ischaemic stroke, 287 intracerebral haemorrhage, and 249 subarachnoid haemorrhage) were ascertained. The risk of incident stroke was 35% higher among those at high genetic risk (top third of polygenic score) compared with those at low genetic risk (bottom third): hazard ratio 1.35 (95% confidence interval 1.21 to 1.50), P=3.9×10-8. Unfavourable lifestyle (0 or 1 healthy lifestyle factors) was associated with a 66% increased risk of stroke compared with a favourable lifestyle (3 or 4 healthy lifestyle factors): 1.66 (1.45 to 1.89), P=1.19×10-13. The association with lifestyle was independent of genetic risk stratums. CONCLUSION In this cohort study, genetic and lifestyle factors were independently associated with incident stroke. These results emphasise the benefit of entire populations adhering to a healthy lifestyle, independent of genetic risk.
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Affiliation(s)
- Loes Ca Rutten-Jacobs
- German Center for Neurodegenerative diseases (DZNE), Population Health Sciences, Sigmund-Freud-Strasse 27, 53127 Bonn, Germany
- Department of Clinical Neurosciences, Stroke Research Group, University of Cambridge, UK
| | - Susanna C Larsson
- Unit of Nutritional Epidemiology, Institute of Environmental Medicine, Karolinska Institutet, Stockholm, Sweden
| | - Rainer Malik
- Institute for Stroke and Dementia Research (ISD), University Hospital, LMU Munich, Munich, Germany
| | - Kristiina Rannikmäe
- Centre for Medical Informatics, Usher Institute of Population Health Sciences and Informatics, University of Edinburgh, Edinburgh, UK
- Centre for Clinical Brain Sciences, University of Edinburgh, Edinburgh, UK
| | - Cathie L Sudlow
- Centre for Medical Informatics, Usher Institute of Population Health Sciences and Informatics, University of Edinburgh, Edinburgh, UK
- Centre for Clinical Brain Sciences, University of Edinburgh, Edinburgh, UK
- Institute of Genetics and Molecular Medicine, University of Edinburgh, Edinburgh, UK
| | - Martin Dichgans
- Institute for Stroke and Dementia Research (ISD), University Hospital, LMU Munich, Munich, Germany
- Munich Cluster for Systems Neurology (SyNergy), Munich, Germany
- German Center for Neurodegenerative Diseases (DZNE), Munich, Germany
| | - Hugh S Markus
- Department of Clinical Neurosciences, Stroke Research Group, University of Cambridge, UK
| | - Matthew Traylor
- Department of Clinical Neurosciences, Stroke Research Group, University of Cambridge, UK
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23
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Wilkinson T, Ly A, Schnier C, Rannikmäe K, Bush K, Brayne C, Quinn TJ, Sudlow CLM. Identifying dementia cases with routinely collected health data: A systematic review. Alzheimers Dement 2018; 14:1038-1051. [PMID: 29621480 PMCID: PMC6105076 DOI: 10.1016/j.jalz.2018.02.016] [Citation(s) in RCA: 144] [Impact Index Per Article: 24.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/22/2017] [Revised: 01/31/2018] [Accepted: 02/12/2018] [Indexed: 12/14/2022]
Abstract
Introduction Prospective, population-based studies can be rich resources for dementia research. Follow-up in many such studies is through linkage to routinely collected, coded health-care data sets. We evaluated the accuracy of these data sets for dementia case identification. Methods We systematically reviewed the literature for studies comparing dementia coding in routinely collected data sets to any expert-led reference standard. We recorded study characteristics and two accuracy measures—positive predictive value (PPV) and sensitivity. Results We identified 27 eligible studies with 25 estimating PPV and eight estimating sensitivity. Study settings and methods varied widely. For all-cause dementia, PPVs ranged from 33%–100%, but 16/27 were >75%. Sensitivities ranged from 21% to 86%. PPVs for Alzheimer's disease (range 57%–100%) were generally higher than those for vascular dementia (range 19%–91%). Discussion Linkage to routine health-care data can achieve a high PPV and reasonable sensitivity in certain settings. Given the heterogeneity in accuracy estimates, cohorts should ideally conduct their own setting-specific validation.
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Affiliation(s)
- Tim Wilkinson
- Centre for Clinical Brain Sciences, University of Edinburgh, Edinburgh, Scotland; Usher Institute of Population Health Sciences and Informatics, Nine Bioquarter, Edinburgh, Scotland.
| | - Amanda Ly
- Usher Institute of Population Health Sciences and Informatics, Nine Bioquarter, Edinburgh, Scotland
| | - Christian Schnier
- Usher Institute of Population Health Sciences and Informatics, Nine Bioquarter, Edinburgh, Scotland
| | - Kristiina Rannikmäe
- Centre for Clinical Brain Sciences, University of Edinburgh, Edinburgh, Scotland; Usher Institute of Population Health Sciences and Informatics, Nine Bioquarter, Edinburgh, Scotland
| | - Kathryn Bush
- Centre for Clinical Brain Sciences, University of Edinburgh, Edinburgh, Scotland; Usher Institute of Population Health Sciences and Informatics, Nine Bioquarter, Edinburgh, Scotland
| | - Carol Brayne
- Institute of Public Health, Cambridge University, Cambridge, UK
| | - Terence J Quinn
- Institute of Cardiovascular and Medical Sciences, University of Glasgow, Glasgow, Scotland
| | - Cathie L M Sudlow
- Centre for Clinical Brain Sciences, University of Edinburgh, Edinburgh, Scotland; Usher Institute of Population Health Sciences and Informatics, Nine Bioquarter, Edinburgh, Scotland; UK Biobank, Coordinating Centre, Stockport, UK
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Malik R, Chauhan G, Traylor M, Sargurupremraj M, Okada Y, Mishra A, Rutten-Jacobs L, Giese AK, van der Laan SW, Gretarsdottir S, Anderson CD, Chong M, Adams HHH, Ago T, Almgren P, Amouyel P, Ay H, Bartz TM, Benavente OR, Bevan S, Boncoraglio GB, Brown RD, Butterworth AS, Carrera C, Carty CL, Chasman DI, Chen WM, Cole JW, Correa A, Cotlarciuc I, Cruchaga C, Danesh J, de Bakker PIW, DeStefano AL, den Hoed M, Duan Q, Engelter ST, Falcone GJ, Gottesman RF, Grewal RP, Gudnason V, Gustafsson S, Haessler J, Harris TB, Hassan A, Havulinna AS, Heckbert SR, Holliday EG, Howard G, Hsu FC, Hyacinth HI, Ikram MA, ingelsson E, Irvin MR, Jian X, Jimenez-Conde J, Johnson JA, Jukema JW, Kanai M, Keene KL, Kissela BM, Kleindorfer DO, Kooperberg C, Kubo M, Lange LA, Langefeld CD, Langenberg C, Launer LJ, Lee JM, Lemmens R, Leys D, Lewis CM, Lin WY, Lindgren AG, Lorentzen E, Magnusson PK, Maguire J, Manichaikul A, McArdle PF, Meschia JF, Mitchell BD, Mosley TH, Nalls MA, Ninomiya T, O’Donnell MJ, Psaty BM, Pulit SL, Rannikmäe K, Reiner AP, Rexrode KM, Rice K, Rich SS, Ridker PM, Rost NS, Rothwell PM, Rotter JI, Rundek T, Sacco RL, Sakaue S, Sale MM, Salomaa V, Sapkota BR, Schmidt R, Schmidt CO, Schminke U, Sharma P, Slowik A, Sudlow CLM, Tanislav C, Tatlisumak T, Taylor KD, Thijs VNS, Thorleifsson G, Thorsteinsdottir U, Tiedt S, Trompet S, Tzourio C, van Duijn CM, Walters M, Wareham NJ, Wassertheil-Smoller S, Wilson JG, Wiggins KL, Yang Q, Yusuf S, Bis JC, Pastinen T, Ruusalepp A, Schadt EE, Koplev S, Björkegren JLM, Codoni V, Civelek M, Smith NL, Tregouet DA, Christophersen IE, Roselli C, Lubitz SA, Ellinor PT, Tai ES, Kooner JS, Kato N, He J, van der Harst P, Elliott P, Chambers JC, Takeuchi F, Johnson AD, Sanghera DK, Melander O, Jern C, Strbian D, Fernandez-Cadenas I, Longstreth WT, Rolfs A, Hata J, Woo D, Rosand J, Pare G, Hopewell JC, Saleheen D, Stefansson K, Worrall BB, Kittner SJ, Seshadri S, Fornage M, Markus HS, Howson JMM, Kamatani Y, Debette S, Dichgans M. Multiancestry genome-wide association study of 520,000 subjects identifies 32 loci associated with stroke and stroke subtypes. Nat Genet 2018; 50:524-537. [PMID: 29531354 PMCID: PMC5968830 DOI: 10.1038/s41588-018-0058-3] [Citation(s) in RCA: 879] [Impact Index Per Article: 146.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/19/2017] [Accepted: 01/08/2018] [Indexed: 02/02/2023]
Abstract
Stroke has multiple etiologies, but the underlying genes and pathways are largely unknown. We conducted a multiancestry genome-wide-association meta-analysis in 521,612 individuals (67,162 cases and 454,450 controls) and discovered 22 new stroke risk loci, bringing the total to 32. We further found shared genetic variation with related vascular traits, including blood pressure, cardiac traits, and venous thromboembolism, at individual loci (n = 18), and using genetic risk scores and linkage-disequilibrium-score regression. Several loci exhibited distinct association and pleiotropy patterns for etiological stroke subtypes. Eleven new susceptibility loci indicate mechanisms not previously implicated in stroke pathophysiology, with prioritization of risk variants and genes accomplished through bioinformatics analyses using extensive functional datasets. Stroke risk loci were significantly enriched in drug targets for antithrombotic therapy.
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Affiliation(s)
- Rainer Malik
- Institute for Stroke and Dementia Research (ISD), University Hospital, LMU Munich, Munich, Germany
| | - Ganesh Chauhan
- Centre for Brain Research, Indian Institute of Science, Bangalore, India,INSERM U1219 Bordeaux Population Health Research Center, University of Bordeaux, France
| | - Matthew Traylor
- Stroke Research Group, Division of Clinical Neurosciences, University of Cambridge, Cambridge, UK
| | - Muralidharan Sargurupremraj
- INSERM U1219 Bordeaux Population Health Research Center, University of Bordeaux, France,Department of Neurology, Institute for Neurodegenerative Disease, Bordeaux University Hospital, Bordeaux, France
| | - Yukinori Okada
- Laboratory of Statistical Immunology, Immunology Frontier Research Center (WPI-IFReC), Osaka University, Suita, Japan,Faculty of Health and Medicine, University of Newcastle, Newcastle, New South Wales, Australia
| | - Aniket Mishra
- INSERM U1219 Bordeaux Population Health Research Center, University of Bordeaux, France,Department of Neurology, Institute for Neurodegenerative Disease, Bordeaux University Hospital, Bordeaux, France
| | - Loes Rutten-Jacobs
- Stroke Research Group, Division of Clinical Neurosciences, University of Cambridge, Cambridge, UK
| | - Anne-Katrin Giese
- Department of Neurology, Massachusetts General Hospital (MGH), Harvard Medical School, Boston, MA, USA
| | - Sander W. van der Laan
- Laboratory of Experimental Cardiology, Department of Cardiology, Division of Heart and Lungs, University Medical Center Utrecht, University of Utrecht, Utrecht, the Netherlands
| | | | - Christopher D. Anderson
- Center for Genomic Medicine, MGH, Boston, MA, USA,J. Philip Kistler Stroke Research Center, Department of Neurology, MGH, Boston, MA, USA,Program in Medical and Population Genetics, Broad Institute, Cambridge, MA, USA
| | - Michael Chong
- Population Health Research Institute, McMaster University, Hamilton, Ontario, Canada
| | - Hieab H. H. Adams
- Department of Epidemiology, Erasmus University Medical Center, Rotterdam, the Netherlands,Department of Radiology and Nuclear Medicine, Erasmus University Medical Center, Rotterdam, the Netherlands
| | - Tetsuro Ago
- Department of Medicine and Clinical Science, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan
| | - Peter Almgren
- Department of Clinical Sciences, Lund University, Malmö, Sweden
| | - Philippe Amouyel
- INSERM, Institut Pasteur de Lille, LabEx DISTALZ-UMR1167, Risk Factors and Molecular Determinants of Aging-Related Diseases, Université Lille, Lille, France,Centre Hospitalier Universite Lille, Epidemiology and Public Health Department, Lille, France
| | - Hakan Ay
- J. Philip Kistler Stroke Research Center, Department of Neurology, MGH, Boston, MA, USA,AA Martinos Center for Biomedical Imaging, Department of Radiology, MGH, Harvard Medical School, Boston, MA, USA
| | - Traci M. Bartz
- Cardiovascular Health Research Unit, Departments of Biostatistics and Medicine, University of Washington, Seattle, WA, USA
| | - Oscar R. Benavente
- Division of Neurology, Faculty of Medicine, Brain Research Center, University of British Columbia, Vancouver, British Columbia, Canada
| | - Steve Bevan
- School of Life Science, University of Lincoln, Lincoln, UK
| | - Giorgio B. Boncoraglio
- Department of Cerebrovascular Diseases, Fondazione IRCCS Istituto Neurologico ‘Carlo Besta’, Milan, Italy
| | - Robert D. Brown
- Department of Neurology, Mayo Clinic Rochester, Rochester, MN, USA
| | - Adam S. Butterworth
- MRC/BHF Cardiovascular Epidemiology Unit, Department of Public Health and Primary Care, University of Cambridge, Cambridge, UK,National Institute for Health Research Blood and Transplant Research Unit in Donor Health and Genomics, University of Cambridge, Cambridge, UK
| | - Caty Carrera
- Neurovascular Research Laboratory, Vall d’Hebron Institut of Research, Neurology and Medicine Departments-Universitat Autònoma de Barcelona, Vall d’Hebrón Hospital, Barcelona, Spain,Stroke Pharmacogenomics and Genetics, Fundacio Docència i Recerca MutuaTerrassa, Terrassa, Spain
| | - Cara L. Carty
- Children’s Research Institute, Children’s National Medical Center, Washington, DC, USA,Center for Translational Science, George Washington University, Washington, DC, USA
| | - Daniel I. Chasman
- Division of Preventive Medicine, Brigham and Women’s Hospital, Boston, MA, USA,Harvard Medical School, Boston, MA, USA
| | - Wei-Min Chen
- Center for Public Health Genomics, Department of Public Health Sciences, University of Virginia, Charlottesville, VA, USA
| | - John W. Cole
- Department of Neurology, University of Maryland School of Medicine and Baltimore VAMC, Baltimore, MD, USA
| | - Adolfo Correa
- Departments of Medicine, Pediatrics and Population Health Science, University of Mississippi Medical Center, Jackson, MS, USA
| | - Ioana Cotlarciuc
- Institute of Cardiovascular Research, Royal Holloway University of London, London, UK, and Ashford and St Peters Hospital, Surrey, UK
| | - Carlos Cruchaga
- Department of Psychiatry, Hope Center Program on Protein Aggregation and Neurodegeneration (HPAN), Washington University School of Medicine, St. Louis, MO, USA,Department of Developmental Biology, Washington University School of Medicine, St. Louis, MO, USA
| | - John Danesh
- MRC/BHF Cardiovascular Epidemiology Unit, Department of Public Health and Primary Care, University of Cambridge, Cambridge, UK,NIHR Blood and Transplant Research Unit in Donor Health and Genomics, Department of Public Health and Primary Care, University of Cambridge, Cambridge, UK,Wellcome Trust Sanger Institute, Hinxton, Cambridge, UK,British Heart Foundation, Cambridge Centre of Excellence, Department of Medicine, University of Cambridge, Cambridge, UK
| | - Paul I. W. de Bakker
- Department of Medical Genetics, University Medical Center Utrecht, Utrecht, the Netherlands,Department of Epidemiology, Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht, the Netherlands
| | - Anita L. DeStefano
- Boston University School of Public Health, Boston, MA, USA,Framingham Heart Study, Framingham, MA, USA
| | - Marcel den Hoed
- Department of Immunology, Genetics and Pathology and Science for Life Laboratory, Uppsala University, Uppsala, Sweden
| | - Qing Duan
- Department of Genetics, University of North Carolina, Chapel Hill, NC, USA
| | - Stefan T. Engelter
- Department of Neurology and Stroke Center, Basel University Hospital, Basel, Switzerland,Neurorehabilitation Unit, University of Basel and University Center for Medicine of Aging and Rehabilitation Basel, Felix Platter Hospital, Basel, Switzerland
| | - Guido J. Falcone
- Department of Neurology, Yale University School of Medicine, New Haven, CT, USA,Program in Medical and Population Genetics, Broad Institute of Harvard and MIT, Cambridge, MA, USA
| | - Rebecca F. Gottesman
- Department of Neurology, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Raji P. Grewal
- Neuroscience Institute, SF Medical Center, Trenton, NJ, USA
| | - Vilmundur Gudnason
- Icelandic Heart Association Research Institute, Kopavogur, Iceland,Faculty of Medicine, University of Iceland, Reykjavik, Iceland
| | - Stefan Gustafsson
- Department of Medical Sciences, Molecular Epidemiology and Science for Life Laboratory, Uppsala University, Uppsala, Sweden
| | - Jeffrey Haessler
- Division of Public Health Sciences, Fred Hutchinson Cancer Research Center, Seattle, WA, USA
| | - Tamara B. Harris
- Laboratory of Epidemiology and Population Science, National Institute on Aging, National Institutes of Health, Bethesda, MD, USA
| | - Ahamad Hassan
- Department of Neurology, Leeds General Infirmary, Leeds Teaching Hospitals NHS Trust, Leeds, UK
| | - Aki S. Havulinna
- National Institute for Health and Welfare, Helsinki, Finland,FIMM-Institute for Molecular Medicine Finland, Helsinki, Finland
| | - Susan R. Heckbert
- Department of Epidemiology, University of Washington, Seattle, WA, USA
| | - Elizabeth G. Holliday
- Public Health Stream, Hunter Medical Research Institute, New Lambton, New South Wales, Australia,Faculty of Health and Medicine, University of Newcastle, Newcastle, New South Wales, Australia
| | - George Howard
- School of Public Health, University of Alabama at Birmingham, Birmingham, AL, USA
| | - Fang-Chi Hsu
- Department of Biostatistical Sciences, Wake Forest School of Medicine, Winston-Salem, NC, USA
| | - Hyacinth I. Hyacinth
- Aflac Cancer and Blood Disorder Center, Department of Pediatrics, Emory University School of Medicine, Atlanta, GA, USA
| | - M. Arfan Ikram
- Department of Epidemiology, Erasmus University Medical Center, Rotterdam, the Netherlands
| | - Erik ingelsson
- Department of Medicine, Division of Cardiovascular Medicine, Stanford University School of Medicine, Stanford, CA, USA,Department of Medical Sciences, Molecular Epidemiology and Science for Life Laboratory, Uppsala University, Uppsala, Sweden
| | - Marguerite R. Irvin
- Epidemiology, School of Public Health, University of Alabama at Birmingham, Birmingham, AL, USA
| | - Xueqiu Jian
- Brown Foundation Institute of Molecular Medicine, University of Texas Health Science Center at Houston, Houston, TX, USA
| | - Jordi Jimenez-Conde
- Neurovascular Research Group (NEUVAS), Neurology Department, Institut Hospital del Mar d’Investigació Mèdica, Universitat Autònoma de Barcelona, Barcelona, Spain
| | - Julie A. Johnson
- Department of Pharmacotherapy and Translational Research and Center for Pharmacogenomics, University of Florida, College of Pharmacy, Gainesville, FL, USA,Division of Cardiovascular Medicine, College of Medicine, University of Florida, Gainesville, FL, USA
| | - J. Wouter Jukema
- Department of Cardiology, Leiden University Medical Center, Leiden, the Netherlands
| | - Masahiro Kanai
- Faculty of Health and Medicine, University of Newcastle, Newcastle, New South Wales, Australia,Program in Bioinformatics and Integrative Genomics, Harvard Medical School, Boston, MA, USA
| | - Keith L. Keene
- Department of Biology, East Carolina University, Greenville, NC, USA,Center for Health Disparities, East Carolina University, Greenville, NC, USA
| | - Brett M. Kissela
- University of Cincinnati College of Medicine, Cincinnati, OH, USA
| | | | - Charles Kooperberg
- Division of Public Health Sciences, Fred Hutchinson Cancer Research Center, Seattle, WA, USA
| | - Michiaki Kubo
- RIKEN Center for Integrative Medical Sciences, Yokohama, Japan
| | - Leslie A. Lange
- Department of Medicine, University of Colorado Denver, Anschutz Medical Campus, Aurora, CO, USA
| | - Carl D. Langefeld
- Center for Public Health Genomics and Department of Biostatistical Sciences, Wake Forest School of Medicine, Winston-Salem, NC, USA
| | - Claudia Langenberg
- MRC Epidemiology Unit, University of Cambridge School of Clinical Medicine, Institute of Metabolic Science, Cambridge, UK
| | - Lenore J. Launer
- Intramural Research Program, National Institute on Aging, National Institutes of Health, Bethesda, MD, USA
| | - Jin-Moo Lee
- Department of Neurology, Radiology, and Biomedical Engineering, Washington University School of Medicine, St. Louis, MO, USA
| | - Robin Lemmens
- Department of Neurosciences, Experimental Neurology, KU Leuven-University of Leuven, Leuven, Belgium,VIB Center for Brain & Disease Research, University Hospitals Leuven, Department of Neurology, Leuven, Belgium
| | - Didier Leys
- INSERM U 1171, CHU Lille, Universite Lille, Lille, France
| | - Cathryn M. Lewis
- Department of Medical and Molecular Genetics, King’s College London, London, UK,SGDP Centre, Institute of Psychiatry, Psychology & Neuroscience, King’s College London, London, UK
| | - Wei-Yu Lin
- MRC/BHF Cardiovascular Epidemiology Unit, Department of Public Health and Primary Care, University of Cambridge, Cambridge, UK,Northern Institute for Cancer Research, Newcastle University, Newcastle, UK
| | - Arne G. Lindgren
- Department of Clinical Sciences Lund, Neurology, Lund University, Lund, Sweden,Department of Neurology and Rehabilitation Medicine, Skåne University Hospital, Lund, Sweden
| | - Erik Lorentzen
- Bioinformatics Core Facility, University of Gothenburg, Gothenburg, Sweden
| | - Patrik K. Magnusson
- Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden
| | - Jane Maguire
- University of Technology Sydney, Faculty of Health, Ultimo, New South Wales, Australia
| | - Ani Manichaikul
- Center for Public Health Genomics, Department of Public Health Sciences, University of Virginia, Charlottesville, VA, USA
| | - Patrick F. McArdle
- Department of Medicine, University of Maryland School of Medicine, Baltimore, MD, USA
| | | | - Braxton D. Mitchell
- Department of Medicine, University of Maryland School of Medicine, Baltimore, MD, USA,Geriatrics Research and Education Clinical Center, Baltimore Veterans Administration Medical Center, Baltimore, MD, USA
| | - Thomas H. Mosley
- Division of Geriatrics, School of Medicine, University of Mississippi Medical Center, Jackson, MS, USA,Memory Impairment and Neurodegenerative Dementia Center, University of Mississippi Medical Center, Jackson, MS, USA
| | - Michael A. Nalls
- Laboratory of Neurogenetics, National Institute on Aging, National Institutes of Health, Bethesda, MD, USA,Data Tecnica International, Glen Echo, MD, USA
| | - Toshiharu Ninomiya
- Department of Epidemiology and Public Health, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan
| | - Martin J. O’Donnell
- Population Health Research Institute, McMaster University, Hamilton, Ontario, Canada,Clinical Research Facility, Department of Medicine, NUI Galway, Galway, Ireland
| | - Bruce M. Psaty
- Cardiovascular Health Research Unit, Department of Medicine, University of Washington, Seattle, WA, USA,Department of Epidemiology, University of Washington, Seattle, WA, USA,Department of Health Services, University of Washington, Seattle, WA, USA,Kaiser Permanente Washington Health Research Institute, Seattle, WA, USA
| | - Sara L. Pulit
- Department of Medical Genetics, University Medical Center Utrecht, Utrecht, the Netherlands,Brain Center Rudolf Magnus, Department of Neurology, University Medical Center Utrecht, Utrecht, the Netherlands
| | - Kristiina Rannikmäe
- Usher Institute of Population Health Sciences and Informatics, University of Edinburgh, Edinburgh, UK,Centre for Clinical Brain Sciences, University of Edinburgh, Edinburgh, UK
| | - Alexander P. Reiner
- Department of Epidemiology, University of Washington, Seattle, WA, USA,Fred Hutchinson Cancer Research Center, University of Washington, Seattle, WA, USA
| | | | - Kenneth Rice
- Department of Biostatistics, University of Washington, Seattle, WA, USA
| | - Stephen S. Rich
- Center for Public Health Genomics, Department of Public Health Sciences, University of Virginia, Charlottesville, VA, USA
| | - Paul M. Ridker
- Division of Preventive Medicine, Brigham and Women’s Hospital, Boston, MA, USA,Harvard Medical School, Boston, MA, USA
| | - Natalia S. Rost
- Department of Neurology, Massachusetts General Hospital (MGH), Harvard Medical School, Boston, MA, USA,J. Philip Kistler Stroke Research Center, Department of Neurology, MGH, Boston, MA, USA
| | - Peter M. Rothwell
- Nuffield Department of Clinical Neurosciences, University of Oxford, Oxford, UK
| | - Jerome I. Rotter
- Institute for Translational Genomics and Population Sciences, Los Angeles Biomedical Research Institute at Harbor-UCLA Medical Center, Torrance, CA, USA,Division of Genomic Outcomes, Department of Pediatrics, Harbor-UCLA Medical Center, Torrance, CA, USA
| | - Tatjana Rundek
- Department of Neurology, Miller School of Medicine, University of Miami, Miami, FL, USA
| | - Ralph L. Sacco
- Department of Neurology, Miller School of Medicine, University of Miami, Miami, FL, USA
| | - Saori Sakaue
- Department of Statistical Genetics, Osaka University Graduate School of Medicine, Osaka, Japan,Department of Allergy and Rheumatology, Graduate School of Medicine, University of Tokyo, Tokyo, Japan
| | - Michele M. Sale
- Center for Public Health Genomics, University of Virginia, Charlottesville, VA, USA
| | - Veikko Salomaa
- National Institute for Health and Welfare, Helsinki, Finland
| | - Bishwa R. Sapkota
- Department of Pediatrics, College of Medicine, University of Oklahoma Health Sciences Center, Oklahoma City, OK, USA
| | - Reinhold Schmidt
- Department of Neurology, Medical University of Graz, Graz, Austria
| | - Carsten O. Schmidt
- Institute for Community Medicine, SHIP-KEF, University Medicine Greifswald, Greifswald, Germany
| | - Ulf Schminke
- Department of Neurology, University Medicine Greifswald, Greifswald, Germany
| | - Pankaj Sharma
- Institute of Cardiovascular Research, Royal Holloway University of London, London, UK, and Ashford and St Peters Hospital, Surrey, UK
| | - Agnieszka Slowik
- Department of Neurology, Jagiellonian University, Krakow, Poland
| | - Cathie L. M. Sudlow
- Usher Institute of Population Health Sciences and Informatics, University of Edinburgh, Edinburgh, UK,Centre for Clinical Brain Sciences, University of Edinburgh, Edinburgh, UK
| | | | - Turgut Tatlisumak
- Department of Clinical Neurosciences/Neurology, Institute of Neuroscience and Physiology, Sahlgrenska Academy at University of Gothenburg, Gothenburg, Sweden,Sahlgrenska University Hospital, Gothenburg, Sweden
| | - Kent D. Taylor
- Institute for Translational Genomics and Population Sciences, Los Angeles Biomedical Research Institute at Harbor-UCLA Medical Center, Torrance, CA, USA,Division of Genomic Outcomes, Department of Pediatrics, Harbor-UCLA Medical Center, Torrance, CA, USA
| | - Vincent N. S. Thijs
- Stroke Division, Florey Institute of Neuroscience and Mental Health, University of Melbourne, Heidelberg, Victoria, Australia,Austin Health, Department of Neurology, Heidelberg, Victoria, Australia
| | | | | | - Steffen Tiedt
- Institute for Stroke and Dementia Research (ISD), University Hospital, LMU Munich, Munich, Germany
| | - Stella Trompet
- Department of Internal Medicine, Section Gerontology and Geriatrics, Leiden University Medical Center, Leiden, the Netherlands
| | - Christophe Tzourio
- INSERM U1219 Bordeaux Population Health Research Center, University of Bordeaux, France,INSERM, U1219 Bordeaux, France,Department of Public Health, Bordeaux University Hospital, Bordeaux, France
| | - Cornelia M. van Duijn
- Genetic Epidemiology Unit, Department of Epidemiology, Erasmus University Medical Center, Rotterdam, the Netherlands,Center for Medical Systems Biology, Leiden, the Netherlands
| | - Matthew Walters
- School of Medicine, Dentistry and Nursing at the University of Glasgow, Glasgow, UK
| | - Nicholas J. Wareham
- MRC Epidemiology Unit, University of Cambridge School of Clinical Medicine, Institute of Metabolic Science, Cambridge, UK
| | - Sylvia Wassertheil-Smoller
- Department of Epidemiology and Population Health, Albert Einstein College of Medicine, New York, NY, USA
| | - James G. Wilson
- Department of Physiology and Biophysics, University of Mississippi Medical Center, Jackson, MS, USA
| | - Kerri L. Wiggins
- Cardiovascular Health Research Unit, Department of Medicine, University of Washington, Seattle, WA, USA
| | - Qiong Yang
- Boston University School of Public Health, Boston, MA, USA
| | - Salim Yusuf
- Population Health Research Institute, McMaster University, Hamilton, Ontario, Canada
| | - AFGen Consortium
- A list of members and affiliations appears in the Supplementary Note
| | | | | | - INVENT Consortium
- A list of members and affiliations appears in the Supplementary Note
| | - STARNET
- A list of members and affiliations appears in the Supplementary Note
| | - Joshua C. Bis
- Cardiovascular Health Research Unit, Department of Medicine, University of Washington, Seattle, WA, USA
| | - Tomi Pastinen
- Department of Human Genetics, McGill University, Montreal, Quebec, Canada
| | - Arno Ruusalepp
- Department of Pathophysiology, Institute of Biomedicine and Translation Medicine, University of Tartu, Tartu, Estonia,Department of Cardiac Surgery, Tartu University Hospital, Tartu, Estonia,Clinical Gene Networks AB, Stockholm, Sweden
| | - Eric E. Schadt
- Department of Genetics and Genomic Sciences, Icahn Institute for Genomics and Multiscale Biology Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Simon Koplev
- Department of Genetics and Genomic Sciences, Icahn Institute for Genomics and Multiscale Biology Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Johan L. M. Björkegren
- Department of Genetics and Genomic Sciences, Icahn Institute for Genomics and Multiscale Biology Icahn School of Medicine at Mount Sinai, New York, NY, USA,Department of Pathophysiology, Institute of Biomedicine and Translation Medicine, Biomeedikum, University of Tartu, Tartu, Estonia,Integrated Cardio Metabolic Centre, Department of Medicine, Karolinska Institutet, Karolinska Universitetssjukhuset, Huddinge, Sweden,Clinical Gene Networks AB, Stockholm, Sweden
| | - Veronica Codoni
- UPMC Univ. Paris 06, INSERM, UMR_S 1166, Team Genomics & Pathophysiology of Cardiovascular Diseases, Sorbonne Universités, Paris, France,I CAN Institute for Cardiometabolism and Nutrition, Paris, France
| | - Mete Civelek
- Center for Public Health Genomics, University of Virginia, Charlottesville, VA, USA,Department of Biomedical Engineering, University of Virginia, Charlottesville, VA, USA
| | - Nicholas L. Smith
- Department of Epidemiology, University of Washington, Seattle, WA, USA,Group Health Research Institute, Group Health Cooperative, Seattle, WA, USA,Seattle Epidemiologic Research and Information Center, VA Office of Research and Development, Seattle, WA, USA
| | - David A. Tregouet
- UPMC Univ. Paris 06, INSERM, UMR_S 1166, Team Genomics & Pathophysiology of Cardiovascular Diseases, Sorbonne Universités, Paris, France,I CAN Institute for Cardiometabolism and Nutrition, Paris, France
| | - Ingrid E. Christophersen
- Program in Medical and Population Genetics, Broad Institute of Harvard and MIT, Cambridge, MA, USA,Cardiovascular Research Center, MGH, Boston, MA, USA,Department of Medical Research, Bærum Hospital, Vestre Viken Hospital Trust, Gjettum, Norway
| | - Carolina Roselli
- Program in Medical and Population Genetics, Broad Institute of Harvard and MIT, Cambridge, MA, USA
| | - Steven A. Lubitz
- Program in Medical and Population Genetics, Broad Institute of Harvard and MIT, Cambridge, MA, USA,Cardiovascular Research Center, MGH, Boston, MA, USA
| | - Patrick T. Ellinor
- Program in Medical and Population Genetics, Broad Institute of Harvard and MIT, Cambridge, MA, USA,Cardiovascular Research Center, MGH, Boston, MA, USA
| | - E. Shyong Tai
- Saw Swee Hock School of Public Health, National University of Singapore and National University Health System, Singapore, Singapore
| | - Jaspal S. Kooner
- National Heart and Lung Institute, Imperial College London, London, UK
| | - Norihiro Kato
- Department of Gene Diagnostics and Therapeutics, Research Institute, National Center for Global Health and Medicine, Tokyo, Japan
| | - Jiang He
- Department of Epidemiology, Tulane University School of Public Health and Tropical Medicine, New Orleans, LA, USA
| | - Pim van der Harst
- Department of Cardiology, University Medical Center Groningen, University of Groningen, Groningen, the Netherlands
| | - Paul Elliott
- MRC-PHE Centre for Environment and Health, School of Public Health, Department of Epidemiology and Biostatistics and the NIHR Imperial Biomedical Research Centre, Imperial College London, London, UK
| | - John C. Chambers
- Department of Epidemiology and Biostatistics, Imperial College London, London, UK,Department of Cardiology, Ealing Hospital NHS Trust, Southall, UK
| | - Fumihiko Takeuchi
- Department of Gene Diagnostics and Therapeutics, Research Institute, National Center for Global Health and Medicine, Tokyo, Japan
| | - Andrew D. Johnson
- Framingham Heart Study, Framingham, MA, USA,National Heart, Lung and Blood Research Institute, Division of Intramural Research, Population Sciences Branch, Framingham, MA, USA
| | | | | | | | | | | | | | | | | | | | | | - Dharambir K. Sanghera
- Department of Pediatrics, College of Medicine, University of Oklahoma Health Sciences Center, Oklahoma City, OK, USA,Department of Pharmaceutical Sciences, College of Pharmacy, University of Oklahoma Health Sciences Center, Oklahoma City, OK, USA,Oklahoma Center for Neuroscience, Oklahoma City, OK, USA
| | - Olle Melander
- Department of Clinical Sciences, Lund University, Malmö, Sweden
| | - Christina Jern
- Department of Pathology and Genetics, Institute of Biomedicine, Sahlgrenska Academy at University of Gothenburg, Gothenburg, Sweden
| | - Daniel Strbian
- Department of Neurology, Helsinki University Hospital, Helsinki, Finland,Clinical Neurosciences, Neurology, University of Helsinki, Helsinki, Finland
| | - Israel Fernandez-Cadenas
- Neurovascular Research Laboratory, Vall d’Hebron Institut of Research, Neurology and Medicine Departments-Universitat Autònoma de Barcelona, Vall d’Hebrón Hospital, Barcelona, Spain,Stroke Pharmacogenomics and Genetics, Fundacio Docència i Recerca MutuaTerrassa, Terrassa, Spain
| | - W. T. Longstreth
- Department of Epidemiology, University of Washington, Seattle, WA, USA,Department of Neurology, University of Washington, Seattle, WA, USA
| | - Arndt Rolfs
- Albrecht Kossel Institute, University Clinic of Rostock, Rostock, Germany
| | - Jun Hata
- Department of Epidemiology and Public Health, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan
| | - Daniel Woo
- University of Cincinnati College of Medicine, Cincinnati, OH, USA
| | - Jonathan Rosand
- Center for Genomic Medicine, MGH, Boston, MA, USA,J. Philip Kistler Stroke Research Center, Department of Neurology, MGH, Boston, MA, USA,Program in Medical and Population Genetics, Broad Institute, Cambridge, MA, USA
| | - Guillaume Pare
- Population Health Research Institute, McMaster University, Hamilton, Ontario, Canada
| | - Jemma C. Hopewell
- Clinical Trial Service Unit and Epidemiological Studies Unit, Nuffield Department of Population Health, University of Oxford, Oxford, UK
| | - Danish Saleheen
- Department of Genetics, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA
| | - Kari Stefansson
- deCODE genetics/AMGEN Inc., Reykjavik, Iceland,Faculty of Medicine, University of Iceland, Reykjavik, Iceland
| | - Bradford B. Worrall
- Departments of Neurology and Public Health Sciences, University of Virginia School of Medicine, Charlottesville, VA, USA
| | - Steven J. Kittner
- Department of Neurology, University of Maryland School of Medicine and Baltimore VAMC, Baltimore, MD, USA
| | - Sudha Seshadri
- Framingham Heart Study, Framingham, MA, USA,Glenn Biggs Institute for Alzheimer’s and Neurodegenerative Diseases, University of Texas Health Sciences Center, San Antonio, San Antonio, TX, USA
| | - Myriam Fornage
- Brown Foundation Institute of Molecular Medicine, University of Texas Health Science Center at Houston, Houston, TX, USA,Human Genetics Center, University of Texas Health Science Center at Houston, Houston, TX, USA
| | - Hugh S. Markus
- Stroke Research Group, Division of Clinical Neurosciences, University of Cambridge, Cambridge, UK
| | - Joanna M. M. Howson
- MRC/BHF Cardiovascular Epidemiology Unit, Department of Public Health and Primary Care, University of Cambridge, Cambridge, UK
| | - Yoichiro Kamatani
- Laboratory for Statistical Analysis, RIKEN Center for Integrative Medical Sciences, Yokohama, Japan,Center for Genomic Medicine, Kyoto University Graduate School of Medicine, Kyoto, Japan
| | - Stephanie Debette
- Stroke Research Group, Division of Clinical Neurosciences, University of Cambridge, Cambridge, UK. .,Department of Neurology, Institute for Neurodegenerative Disease, Bordeaux University Hospital, Bordeaux, France.
| | - Martin Dichgans
- Institute for Stroke and Dementia Research (ISD), University Hospital, LMU Munich, Munich, Germany. .,Munich Cluster for Systems Neurology (SyNergy), Munich, Germany. .,German Center for Neurodegenerative Diseases (DZNE), Munich, Germany.
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McGlasson S, Rannikmäe K, Bevan S, Logan C, Bicknell LS, Jury A, Jackson AP, Markus HS, Sudlow C, Hunt DPJ. Rare variants of the 3'-5' DNA exonuclease TREX1 in early onset small vessel stroke. Wellcome Open Res 2017; 2:106. [PMID: 29387804 PMCID: PMC5717473 DOI: 10.12688/wellcomeopenres.12631.1] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/10/2017] [Indexed: 11/20/2022] Open
Abstract
Background: Monoallelic and biallelic mutations in the exonuclease TREX1 cause monogenic small vessel diseases (SVD). Given recent evidence for genetic and pathophysiological overlap between monogenic and polygenic forms of SVD, evaluation of TREX1 in small vessel stroke is warranted. Methods: We sequenced the TREX1 gene in an exploratory cohort of patients with lacunar stroke (Edinburgh Stroke Study, n=290 lacunar stroke cases). We subsequently performed a fully blinded case-control study of early onset MRI-confirmed small vessel stroke within the UK Young Lacunar Stroke Resource (990 cases, 939 controls). Results: No patients with canonical disease-causing mutations of TREX1 were identified in cases or controls. Analysis of an exploratory cohort identified a potential association between rare variants of TREX1 and patients with lacunar stroke. However, subsequent controlled and blinded evaluation of TREX1 in a larger and MRI-confirmed patient cohort, the UK Young Lacunar Stroke Resource, identified heterozygous rare variants in 2.1% of cases and 2.3% of controls. No association was observed with stroke risk (odds ratio = 0.90; 95% confidence interval, 0.49-1.65 p=0.74). Similarly no association was seen with rare TREX1 variants with predicted deleterious effects on enzyme function (odds ratio = 1.05; 95% confidence interval, 0.43-2.61 p=0.91). Conclusions: No patients with early-onset lacunar stroke had genetic evidence of a TREX1-associated monogenic microangiopathy. These results show no evidence of association between rare variants of TREX1 and early onset lacunar stroke. This includes rare variants that significantly affect protein and enzyme function. Routine sequencing of the TREX1 gene in patients with early onset lacunar stroke is therefore unlikely to be of diagnostic utility, in the absence of syndromic features or family history.
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Affiliation(s)
- Sarah McGlasson
- Centre for Clinical Brain Sciences, University of Edinburgh, Edinburgh, EH16 4SB, UK.,MRC Human Genetics Unit, Institute of Genetics and Molecular Medicine, University of Edinburgh, Edinburgh, EH4 2XU, UK
| | - Kristiina Rannikmäe
- Centre for Clinical Brain Sciences, University of Edinburgh, Edinburgh, EH16 4SB, UK
| | - Steven Bevan
- Stroke Research Group, Department of Clinical Neurosciences, Cambridge University, Cambridge, CB2 2PY , UK.,Joseph Banks Laboratories, University of Lincoln, Lincoln, LN6 7DL, UK
| | - Clare Logan
- MRC Human Genetics Unit, Institute of Genetics and Molecular Medicine, University of Edinburgh, Edinburgh, EH4 2XU, UK
| | - Louise S Bicknell
- MRC Human Genetics Unit, Institute of Genetics and Molecular Medicine, University of Edinburgh, Edinburgh, EH4 2XU, UK
| | - Alexa Jury
- Centre for Clinical Brain Sciences, University of Edinburgh, Edinburgh, EH16 4SB, UK.,MRC Human Genetics Unit, Institute of Genetics and Molecular Medicine, University of Edinburgh, Edinburgh, EH4 2XU, UK
| | | | - Andrew P Jackson
- MRC Human Genetics Unit, Institute of Genetics and Molecular Medicine, University of Edinburgh, Edinburgh, EH4 2XU, UK
| | - Hugh S Markus
- Stroke Research Group, Department of Clinical Neurosciences, Cambridge University, Cambridge, CB2 2PY , UK
| | - Cathie Sudlow
- Centre for Clinical Brain Sciences, University of Edinburgh, Edinburgh, EH16 4SB, UK.,MRC Human Genetics Unit, Institute of Genetics and Molecular Medicine, University of Edinburgh, Edinburgh, EH4 2XU, UK
| | - David P J Hunt
- Centre for Clinical Brain Sciences, University of Edinburgh, Edinburgh, EH16 4SB, UK.,MRC Human Genetics Unit, Institute of Genetics and Molecular Medicine, University of Edinburgh, Edinburgh, EH4 2XU, UK
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26
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Rannikmäe K, Sivakumaran V, Millar H, Malik R, Anderson CD, Chong M, Dave T, Falcone GJ, Fernandez-Cadenas I, Jimenez-Conde J, Lindgren A, Montaner J, O'Donnell M, Paré G, Radmanesh F, Rost NS, Slowik A, Söderholm M, Traylor M, Pulit SL, Seshadri S, Worrall BB, Woo D, Markus HS, Mitchell BD, Dichgans M, Rosand J, Sudlow CLM. COL4A2 is associated with lacunar ischemic stroke and deep ICH: Meta-analyses among 21,500 cases and 40,600 controls. Neurology 2017; 89:1829-1839. [PMID: 28954878 DOI: 10.1212/wnl.0000000000004560] [Citation(s) in RCA: 53] [Impact Index Per Article: 7.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/15/2016] [Accepted: 07/31/2017] [Indexed: 01/15/2023] Open
Abstract
OBJECTIVE To determine whether common variants in familial cerebral small vessel disease (SVD) genes confer risk of sporadic cerebral SVD. METHODS We meta-analyzed genotype data from individuals of European ancestry to determine associations of common single nucleotide polymorphisms (SNPs) in 6 familial cerebral SVD genes (COL4A1, COL4A2, NOTCH3, HTRA1, TREX1, and CECR1) with intracerebral hemorrhage (ICH) (deep, lobar, all; 1,878 cases, 2,830 controls) and ischemic stroke (IS) (lacunar, cardioembolic, large vessel disease, all; 19,569 cases, 37,853 controls). We applied data quality filters and set statistical significance thresholds accounting for linkage disequilibrium and multiple testing. RESULTS A locus in COL4A2 was associated (significance threshold p < 3.5 × 10-4) with both lacunar IS (lead SNP rs9515201: odds ratio [OR] 1.17, 95% confidence interval [CI] 1.11-1.24, p = 6.62 × 10-8) and deep ICH (lead SNP rs4771674: OR 1.28, 95% CI 1.13-1.44, p = 5.76 × 10-5). A SNP in HTRA1 was associated (significance threshold p < 5.5 × 10-4) with lacunar IS (rs79043147: OR 1.23, 95% CI 1.10-1.37, p = 1.90 × 10-4) and less robustly with deep ICH. There was no clear evidence for association of common variants in either COL4A2 or HTRA1 with non-SVD strokes or in any of the other genes with any stroke phenotype. CONCLUSIONS These results provide evidence of shared genetic determinants and suggest common pathophysiologic mechanisms of distinct ischemic and hemorrhagic cerebral SVD stroke phenotypes, offering new insights into the causal mechanisms of cerebral SVD.
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Affiliation(s)
- Kristiina Rannikmäe
- From the Centre for Clinical Brain Sciences (K.R., C.L.M.S.), College of Medicine and Veterinary Medicine (V.S., H.M.), and Institute for Genetics and Molecular Medicine (C.L.M.S.), University of Edinburgh, UK; Institute for Stroke and Dementia Research (R.M., M.D.), Klinikum der Universität München, Munich, Germany; Center for Human Genetic Research (C.D.A., F.R., J.R.) and J. Philip Kistler Stroke Research Center (C.D.A., F.R., N.S.R., J.R.) and Division of Neurocritical Care and Emergency Neurology (C.D.A., F.R., J.R.), Department of Neurology, Massachusetts General Hospital, Boston; Program in Medical and Population Genetics (C.D.A., F.R., J.R.), Broad Institute, Cambridge, MA; Population Health Research Institute (M.C., M.O., G.P.), McMaster University, Hamilton Health Sciences Centre, Ontario, Canada; Department of Medicine (T.D., B.D.M.), University of Maryland School of Medicine, Baltimore; Division of Neurocritical Care and Emergency Neurology (G.J.F.), Department of Neurology, Yale University School of Medicine, New Haven, CT; Stroke Pharmacogenomics and Genetics (I.F.-C.), Fundació Docència i Recerca Mutua Terrassa, Mutua de Terrassa Hospital; Neurovascular Research Unit (J.J.-C.), Department of Neurology, and Program in Inflammation and Cardiovascular Disorders (J.J.-C.), Institut Municipal d'Investigacio´Medica-Hospital del Mar, Universitat Autonoma de Barcelona, Spain; Department of Clinical Sciences Lund (A.L.), Neurology, Lund University; Department of Neurology and Rehabilitation Medicine (A.L., M.S.), Neurology, Skåne University Hospital, Lund, Sweden; Neurovascular Research Laboratory and Neurovascular Unit (J.M.), Institut de Recerca, Hospital Vall d'Hebron, Universitat Autonoma de Barcelona, Spain; HRB Clinical Research Facility (M.O.), NUI Galway, and University Hospital Galway, Ireland; Department of Neurology (A.S.), Jagiellonian University Medical College, Krakow, Poland; Cardiovascular Epidemiology Research Group (M.S.), Department of Clinical Sciences, Lund University, Malmö, Sweden; Department of Clinical Neurosciences (M.T., H.S.M.), University of Cambridge, UK; Department of Neurology (S.L.P.), Brain Centre Rudolf Magnus, University Medical Center Utrecht, the Netherlands; Boston University Schools of Medicine and Public Health (S.S.); Framingham Heart Study (S.S.), Framingham, MA; Departments of Neurology and Public Health Sciences (B.B.W.), University of Virginia, Charlottesville; Department of Neurology (D.W.), University of Cincinnati College of Medicine, OH; Geriatrics Research and Education Clinical Center (B.D.M.), Baltimore Veterans Administration Medical Center, MD; and Munich Cluster for Systems Neurology (SyNergy) (M.D.), Germany
| | - Vhinoth Sivakumaran
- From the Centre for Clinical Brain Sciences (K.R., C.L.M.S.), College of Medicine and Veterinary Medicine (V.S., H.M.), and Institute for Genetics and Molecular Medicine (C.L.M.S.), University of Edinburgh, UK; Institute for Stroke and Dementia Research (R.M., M.D.), Klinikum der Universität München, Munich, Germany; Center for Human Genetic Research (C.D.A., F.R., J.R.) and J. Philip Kistler Stroke Research Center (C.D.A., F.R., N.S.R., J.R.) and Division of Neurocritical Care and Emergency Neurology (C.D.A., F.R., J.R.), Department of Neurology, Massachusetts General Hospital, Boston; Program in Medical and Population Genetics (C.D.A., F.R., J.R.), Broad Institute, Cambridge, MA; Population Health Research Institute (M.C., M.O., G.P.), McMaster University, Hamilton Health Sciences Centre, Ontario, Canada; Department of Medicine (T.D., B.D.M.), University of Maryland School of Medicine, Baltimore; Division of Neurocritical Care and Emergency Neurology (G.J.F.), Department of Neurology, Yale University School of Medicine, New Haven, CT; Stroke Pharmacogenomics and Genetics (I.F.-C.), Fundació Docència i Recerca Mutua Terrassa, Mutua de Terrassa Hospital; Neurovascular Research Unit (J.J.-C.), Department of Neurology, and Program in Inflammation and Cardiovascular Disorders (J.J.-C.), Institut Municipal d'Investigacio´Medica-Hospital del Mar, Universitat Autonoma de Barcelona, Spain; Department of Clinical Sciences Lund (A.L.), Neurology, Lund University; Department of Neurology and Rehabilitation Medicine (A.L., M.S.), Neurology, Skåne University Hospital, Lund, Sweden; Neurovascular Research Laboratory and Neurovascular Unit (J.M.), Institut de Recerca, Hospital Vall d'Hebron, Universitat Autonoma de Barcelona, Spain; HRB Clinical Research Facility (M.O.), NUI Galway, and University Hospital Galway, Ireland; Department of Neurology (A.S.), Jagiellonian University Medical College, Krakow, Poland; Cardiovascular Epidemiology Research Group (M.S.), Department of Clinical Sciences, Lund University, Malmö, Sweden; Department of Clinical Neurosciences (M.T., H.S.M.), University of Cambridge, UK; Department of Neurology (S.L.P.), Brain Centre Rudolf Magnus, University Medical Center Utrecht, the Netherlands; Boston University Schools of Medicine and Public Health (S.S.); Framingham Heart Study (S.S.), Framingham, MA; Departments of Neurology and Public Health Sciences (B.B.W.), University of Virginia, Charlottesville; Department of Neurology (D.W.), University of Cincinnati College of Medicine, OH; Geriatrics Research and Education Clinical Center (B.D.M.), Baltimore Veterans Administration Medical Center, MD; and Munich Cluster for Systems Neurology (SyNergy) (M.D.), Germany
| | - Henry Millar
- From the Centre for Clinical Brain Sciences (K.R., C.L.M.S.), College of Medicine and Veterinary Medicine (V.S., H.M.), and Institute for Genetics and Molecular Medicine (C.L.M.S.), University of Edinburgh, UK; Institute for Stroke and Dementia Research (R.M., M.D.), Klinikum der Universität München, Munich, Germany; Center for Human Genetic Research (C.D.A., F.R., J.R.) and J. Philip Kistler Stroke Research Center (C.D.A., F.R., N.S.R., J.R.) and Division of Neurocritical Care and Emergency Neurology (C.D.A., F.R., J.R.), Department of Neurology, Massachusetts General Hospital, Boston; Program in Medical and Population Genetics (C.D.A., F.R., J.R.), Broad Institute, Cambridge, MA; Population Health Research Institute (M.C., M.O., G.P.), McMaster University, Hamilton Health Sciences Centre, Ontario, Canada; Department of Medicine (T.D., B.D.M.), University of Maryland School of Medicine, Baltimore; Division of Neurocritical Care and Emergency Neurology (G.J.F.), Department of Neurology, Yale University School of Medicine, New Haven, CT; Stroke Pharmacogenomics and Genetics (I.F.-C.), Fundació Docència i Recerca Mutua Terrassa, Mutua de Terrassa Hospital; Neurovascular Research Unit (J.J.-C.), Department of Neurology, and Program in Inflammation and Cardiovascular Disorders (J.J.-C.), Institut Municipal d'Investigacio´Medica-Hospital del Mar, Universitat Autonoma de Barcelona, Spain; Department of Clinical Sciences Lund (A.L.), Neurology, Lund University; Department of Neurology and Rehabilitation Medicine (A.L., M.S.), Neurology, Skåne University Hospital, Lund, Sweden; Neurovascular Research Laboratory and Neurovascular Unit (J.M.), Institut de Recerca, Hospital Vall d'Hebron, Universitat Autonoma de Barcelona, Spain; HRB Clinical Research Facility (M.O.), NUI Galway, and University Hospital Galway, Ireland; Department of Neurology (A.S.), Jagiellonian University Medical College, Krakow, Poland; Cardiovascular Epidemiology Research Group (M.S.), Department of Clinical Sciences, Lund University, Malmö, Sweden; Department of Clinical Neurosciences (M.T., H.S.M.), University of Cambridge, UK; Department of Neurology (S.L.P.), Brain Centre Rudolf Magnus, University Medical Center Utrecht, the Netherlands; Boston University Schools of Medicine and Public Health (S.S.); Framingham Heart Study (S.S.), Framingham, MA; Departments of Neurology and Public Health Sciences (B.B.W.), University of Virginia, Charlottesville; Department of Neurology (D.W.), University of Cincinnati College of Medicine, OH; Geriatrics Research and Education Clinical Center (B.D.M.), Baltimore Veterans Administration Medical Center, MD; and Munich Cluster for Systems Neurology (SyNergy) (M.D.), Germany
| | - Rainer Malik
- From the Centre for Clinical Brain Sciences (K.R., C.L.M.S.), College of Medicine and Veterinary Medicine (V.S., H.M.), and Institute for Genetics and Molecular Medicine (C.L.M.S.), University of Edinburgh, UK; Institute for Stroke and Dementia Research (R.M., M.D.), Klinikum der Universität München, Munich, Germany; Center for Human Genetic Research (C.D.A., F.R., J.R.) and J. Philip Kistler Stroke Research Center (C.D.A., F.R., N.S.R., J.R.) and Division of Neurocritical Care and Emergency Neurology (C.D.A., F.R., J.R.), Department of Neurology, Massachusetts General Hospital, Boston; Program in Medical and Population Genetics (C.D.A., F.R., J.R.), Broad Institute, Cambridge, MA; Population Health Research Institute (M.C., M.O., G.P.), McMaster University, Hamilton Health Sciences Centre, Ontario, Canada; Department of Medicine (T.D., B.D.M.), University of Maryland School of Medicine, Baltimore; Division of Neurocritical Care and Emergency Neurology (G.J.F.), Department of Neurology, Yale University School of Medicine, New Haven, CT; Stroke Pharmacogenomics and Genetics (I.F.-C.), Fundació Docència i Recerca Mutua Terrassa, Mutua de Terrassa Hospital; Neurovascular Research Unit (J.J.-C.), Department of Neurology, and Program in Inflammation and Cardiovascular Disorders (J.J.-C.), Institut Municipal d'Investigacio´Medica-Hospital del Mar, Universitat Autonoma de Barcelona, Spain; Department of Clinical Sciences Lund (A.L.), Neurology, Lund University; Department of Neurology and Rehabilitation Medicine (A.L., M.S.), Neurology, Skåne University Hospital, Lund, Sweden; Neurovascular Research Laboratory and Neurovascular Unit (J.M.), Institut de Recerca, Hospital Vall d'Hebron, Universitat Autonoma de Barcelona, Spain; HRB Clinical Research Facility (M.O.), NUI Galway, and University Hospital Galway, Ireland; Department of Neurology (A.S.), Jagiellonian University Medical College, Krakow, Poland; Cardiovascular Epidemiology Research Group (M.S.), Department of Clinical Sciences, Lund University, Malmö, Sweden; Department of Clinical Neurosciences (M.T., H.S.M.), University of Cambridge, UK; Department of Neurology (S.L.P.), Brain Centre Rudolf Magnus, University Medical Center Utrecht, the Netherlands; Boston University Schools of Medicine and Public Health (S.S.); Framingham Heart Study (S.S.), Framingham, MA; Departments of Neurology and Public Health Sciences (B.B.W.), University of Virginia, Charlottesville; Department of Neurology (D.W.), University of Cincinnati College of Medicine, OH; Geriatrics Research and Education Clinical Center (B.D.M.), Baltimore Veterans Administration Medical Center, MD; and Munich Cluster for Systems Neurology (SyNergy) (M.D.), Germany
| | - Christopher D Anderson
- From the Centre for Clinical Brain Sciences (K.R., C.L.M.S.), College of Medicine and Veterinary Medicine (V.S., H.M.), and Institute for Genetics and Molecular Medicine (C.L.M.S.), University of Edinburgh, UK; Institute for Stroke and Dementia Research (R.M., M.D.), Klinikum der Universität München, Munich, Germany; Center for Human Genetic Research (C.D.A., F.R., J.R.) and J. Philip Kistler Stroke Research Center (C.D.A., F.R., N.S.R., J.R.) and Division of Neurocritical Care and Emergency Neurology (C.D.A., F.R., J.R.), Department of Neurology, Massachusetts General Hospital, Boston; Program in Medical and Population Genetics (C.D.A., F.R., J.R.), Broad Institute, Cambridge, MA; Population Health Research Institute (M.C., M.O., G.P.), McMaster University, Hamilton Health Sciences Centre, Ontario, Canada; Department of Medicine (T.D., B.D.M.), University of Maryland School of Medicine, Baltimore; Division of Neurocritical Care and Emergency Neurology (G.J.F.), Department of Neurology, Yale University School of Medicine, New Haven, CT; Stroke Pharmacogenomics and Genetics (I.F.-C.), Fundació Docència i Recerca Mutua Terrassa, Mutua de Terrassa Hospital; Neurovascular Research Unit (J.J.-C.), Department of Neurology, and Program in Inflammation and Cardiovascular Disorders (J.J.-C.), Institut Municipal d'Investigacio´Medica-Hospital del Mar, Universitat Autonoma de Barcelona, Spain; Department of Clinical Sciences Lund (A.L.), Neurology, Lund University; Department of Neurology and Rehabilitation Medicine (A.L., M.S.), Neurology, Skåne University Hospital, Lund, Sweden; Neurovascular Research Laboratory and Neurovascular Unit (J.M.), Institut de Recerca, Hospital Vall d'Hebron, Universitat Autonoma de Barcelona, Spain; HRB Clinical Research Facility (M.O.), NUI Galway, and University Hospital Galway, Ireland; Department of Neurology (A.S.), Jagiellonian University Medical College, Krakow, Poland; Cardiovascular Epidemiology Research Group (M.S.), Department of Clinical Sciences, Lund University, Malmö, Sweden; Department of Clinical Neurosciences (M.T., H.S.M.), University of Cambridge, UK; Department of Neurology (S.L.P.), Brain Centre Rudolf Magnus, University Medical Center Utrecht, the Netherlands; Boston University Schools of Medicine and Public Health (S.S.); Framingham Heart Study (S.S.), Framingham, MA; Departments of Neurology and Public Health Sciences (B.B.W.), University of Virginia, Charlottesville; Department of Neurology (D.W.), University of Cincinnati College of Medicine, OH; Geriatrics Research and Education Clinical Center (B.D.M.), Baltimore Veterans Administration Medical Center, MD; and Munich Cluster for Systems Neurology (SyNergy) (M.D.), Germany
| | - Mike Chong
- From the Centre for Clinical Brain Sciences (K.R., C.L.M.S.), College of Medicine and Veterinary Medicine (V.S., H.M.), and Institute for Genetics and Molecular Medicine (C.L.M.S.), University of Edinburgh, UK; Institute for Stroke and Dementia Research (R.M., M.D.), Klinikum der Universität München, Munich, Germany; Center for Human Genetic Research (C.D.A., F.R., J.R.) and J. Philip Kistler Stroke Research Center (C.D.A., F.R., N.S.R., J.R.) and Division of Neurocritical Care and Emergency Neurology (C.D.A., F.R., J.R.), Department of Neurology, Massachusetts General Hospital, Boston; Program in Medical and Population Genetics (C.D.A., F.R., J.R.), Broad Institute, Cambridge, MA; Population Health Research Institute (M.C., M.O., G.P.), McMaster University, Hamilton Health Sciences Centre, Ontario, Canada; Department of Medicine (T.D., B.D.M.), University of Maryland School of Medicine, Baltimore; Division of Neurocritical Care and Emergency Neurology (G.J.F.), Department of Neurology, Yale University School of Medicine, New Haven, CT; Stroke Pharmacogenomics and Genetics (I.F.-C.), Fundació Docència i Recerca Mutua Terrassa, Mutua de Terrassa Hospital; Neurovascular Research Unit (J.J.-C.), Department of Neurology, and Program in Inflammation and Cardiovascular Disorders (J.J.-C.), Institut Municipal d'Investigacio´Medica-Hospital del Mar, Universitat Autonoma de Barcelona, Spain; Department of Clinical Sciences Lund (A.L.), Neurology, Lund University; Department of Neurology and Rehabilitation Medicine (A.L., M.S.), Neurology, Skåne University Hospital, Lund, Sweden; Neurovascular Research Laboratory and Neurovascular Unit (J.M.), Institut de Recerca, Hospital Vall d'Hebron, Universitat Autonoma de Barcelona, Spain; HRB Clinical Research Facility (M.O.), NUI Galway, and University Hospital Galway, Ireland; Department of Neurology (A.S.), Jagiellonian University Medical College, Krakow, Poland; Cardiovascular Epidemiology Research Group (M.S.), Department of Clinical Sciences, Lund University, Malmö, Sweden; Department of Clinical Neurosciences (M.T., H.S.M.), University of Cambridge, UK; Department of Neurology (S.L.P.), Brain Centre Rudolf Magnus, University Medical Center Utrecht, the Netherlands; Boston University Schools of Medicine and Public Health (S.S.); Framingham Heart Study (S.S.), Framingham, MA; Departments of Neurology and Public Health Sciences (B.B.W.), University of Virginia, Charlottesville; Department of Neurology (D.W.), University of Cincinnati College of Medicine, OH; Geriatrics Research and Education Clinical Center (B.D.M.), Baltimore Veterans Administration Medical Center, MD; and Munich Cluster for Systems Neurology (SyNergy) (M.D.), Germany
| | - Tushar Dave
- From the Centre for Clinical Brain Sciences (K.R., C.L.M.S.), College of Medicine and Veterinary Medicine (V.S., H.M.), and Institute for Genetics and Molecular Medicine (C.L.M.S.), University of Edinburgh, UK; Institute for Stroke and Dementia Research (R.M., M.D.), Klinikum der Universität München, Munich, Germany; Center for Human Genetic Research (C.D.A., F.R., J.R.) and J. Philip Kistler Stroke Research Center (C.D.A., F.R., N.S.R., J.R.) and Division of Neurocritical Care and Emergency Neurology (C.D.A., F.R., J.R.), Department of Neurology, Massachusetts General Hospital, Boston; Program in Medical and Population Genetics (C.D.A., F.R., J.R.), Broad Institute, Cambridge, MA; Population Health Research Institute (M.C., M.O., G.P.), McMaster University, Hamilton Health Sciences Centre, Ontario, Canada; Department of Medicine (T.D., B.D.M.), University of Maryland School of Medicine, Baltimore; Division of Neurocritical Care and Emergency Neurology (G.J.F.), Department of Neurology, Yale University School of Medicine, New Haven, CT; Stroke Pharmacogenomics and Genetics (I.F.-C.), Fundació Docència i Recerca Mutua Terrassa, Mutua de Terrassa Hospital; Neurovascular Research Unit (J.J.-C.), Department of Neurology, and Program in Inflammation and Cardiovascular Disorders (J.J.-C.), Institut Municipal d'Investigacio´Medica-Hospital del Mar, Universitat Autonoma de Barcelona, Spain; Department of Clinical Sciences Lund (A.L.), Neurology, Lund University; Department of Neurology and Rehabilitation Medicine (A.L., M.S.), Neurology, Skåne University Hospital, Lund, Sweden; Neurovascular Research Laboratory and Neurovascular Unit (J.M.), Institut de Recerca, Hospital Vall d'Hebron, Universitat Autonoma de Barcelona, Spain; HRB Clinical Research Facility (M.O.), NUI Galway, and University Hospital Galway, Ireland; Department of Neurology (A.S.), Jagiellonian University Medical College, Krakow, Poland; Cardiovascular Epidemiology Research Group (M.S.), Department of Clinical Sciences, Lund University, Malmö, Sweden; Department of Clinical Neurosciences (M.T., H.S.M.), University of Cambridge, UK; Department of Neurology (S.L.P.), Brain Centre Rudolf Magnus, University Medical Center Utrecht, the Netherlands; Boston University Schools of Medicine and Public Health (S.S.); Framingham Heart Study (S.S.), Framingham, MA; Departments of Neurology and Public Health Sciences (B.B.W.), University of Virginia, Charlottesville; Department of Neurology (D.W.), University of Cincinnati College of Medicine, OH; Geriatrics Research and Education Clinical Center (B.D.M.), Baltimore Veterans Administration Medical Center, MD; and Munich Cluster for Systems Neurology (SyNergy) (M.D.), Germany
| | - Guido J Falcone
- From the Centre for Clinical Brain Sciences (K.R., C.L.M.S.), College of Medicine and Veterinary Medicine (V.S., H.M.), and Institute for Genetics and Molecular Medicine (C.L.M.S.), University of Edinburgh, UK; Institute for Stroke and Dementia Research (R.M., M.D.), Klinikum der Universität München, Munich, Germany; Center for Human Genetic Research (C.D.A., F.R., J.R.) and J. Philip Kistler Stroke Research Center (C.D.A., F.R., N.S.R., J.R.) and Division of Neurocritical Care and Emergency Neurology (C.D.A., F.R., J.R.), Department of Neurology, Massachusetts General Hospital, Boston; Program in Medical and Population Genetics (C.D.A., F.R., J.R.), Broad Institute, Cambridge, MA; Population Health Research Institute (M.C., M.O., G.P.), McMaster University, Hamilton Health Sciences Centre, Ontario, Canada; Department of Medicine (T.D., B.D.M.), University of Maryland School of Medicine, Baltimore; Division of Neurocritical Care and Emergency Neurology (G.J.F.), Department of Neurology, Yale University School of Medicine, New Haven, CT; Stroke Pharmacogenomics and Genetics (I.F.-C.), Fundació Docència i Recerca Mutua Terrassa, Mutua de Terrassa Hospital; Neurovascular Research Unit (J.J.-C.), Department of Neurology, and Program in Inflammation and Cardiovascular Disorders (J.J.-C.), Institut Municipal d'Investigacio´Medica-Hospital del Mar, Universitat Autonoma de Barcelona, Spain; Department of Clinical Sciences Lund (A.L.), Neurology, Lund University; Department of Neurology and Rehabilitation Medicine (A.L., M.S.), Neurology, Skåne University Hospital, Lund, Sweden; Neurovascular Research Laboratory and Neurovascular Unit (J.M.), Institut de Recerca, Hospital Vall d'Hebron, Universitat Autonoma de Barcelona, Spain; HRB Clinical Research Facility (M.O.), NUI Galway, and University Hospital Galway, Ireland; Department of Neurology (A.S.), Jagiellonian University Medical College, Krakow, Poland; Cardiovascular Epidemiology Research Group (M.S.), Department of Clinical Sciences, Lund University, Malmö, Sweden; Department of Clinical Neurosciences (M.T., H.S.M.), University of Cambridge, UK; Department of Neurology (S.L.P.), Brain Centre Rudolf Magnus, University Medical Center Utrecht, the Netherlands; Boston University Schools of Medicine and Public Health (S.S.); Framingham Heart Study (S.S.), Framingham, MA; Departments of Neurology and Public Health Sciences (B.B.W.), University of Virginia, Charlottesville; Department of Neurology (D.W.), University of Cincinnati College of Medicine, OH; Geriatrics Research and Education Clinical Center (B.D.M.), Baltimore Veterans Administration Medical Center, MD; and Munich Cluster for Systems Neurology (SyNergy) (M.D.), Germany
| | - Israel Fernandez-Cadenas
- From the Centre for Clinical Brain Sciences (K.R., C.L.M.S.), College of Medicine and Veterinary Medicine (V.S., H.M.), and Institute for Genetics and Molecular Medicine (C.L.M.S.), University of Edinburgh, UK; Institute for Stroke and Dementia Research (R.M., M.D.), Klinikum der Universität München, Munich, Germany; Center for Human Genetic Research (C.D.A., F.R., J.R.) and J. Philip Kistler Stroke Research Center (C.D.A., F.R., N.S.R., J.R.) and Division of Neurocritical Care and Emergency Neurology (C.D.A., F.R., J.R.), Department of Neurology, Massachusetts General Hospital, Boston; Program in Medical and Population Genetics (C.D.A., F.R., J.R.), Broad Institute, Cambridge, MA; Population Health Research Institute (M.C., M.O., G.P.), McMaster University, Hamilton Health Sciences Centre, Ontario, Canada; Department of Medicine (T.D., B.D.M.), University of Maryland School of Medicine, Baltimore; Division of Neurocritical Care and Emergency Neurology (G.J.F.), Department of Neurology, Yale University School of Medicine, New Haven, CT; Stroke Pharmacogenomics and Genetics (I.F.-C.), Fundació Docència i Recerca Mutua Terrassa, Mutua de Terrassa Hospital; Neurovascular Research Unit (J.J.-C.), Department of Neurology, and Program in Inflammation and Cardiovascular Disorders (J.J.-C.), Institut Municipal d'Investigacio´Medica-Hospital del Mar, Universitat Autonoma de Barcelona, Spain; Department of Clinical Sciences Lund (A.L.), Neurology, Lund University; Department of Neurology and Rehabilitation Medicine (A.L., M.S.), Neurology, Skåne University Hospital, Lund, Sweden; Neurovascular Research Laboratory and Neurovascular Unit (J.M.), Institut de Recerca, Hospital Vall d'Hebron, Universitat Autonoma de Barcelona, Spain; HRB Clinical Research Facility (M.O.), NUI Galway, and University Hospital Galway, Ireland; Department of Neurology (A.S.), Jagiellonian University Medical College, Krakow, Poland; Cardiovascular Epidemiology Research Group (M.S.), Department of Clinical Sciences, Lund University, Malmö, Sweden; Department of Clinical Neurosciences (M.T., H.S.M.), University of Cambridge, UK; Department of Neurology (S.L.P.), Brain Centre Rudolf Magnus, University Medical Center Utrecht, the Netherlands; Boston University Schools of Medicine and Public Health (S.S.); Framingham Heart Study (S.S.), Framingham, MA; Departments of Neurology and Public Health Sciences (B.B.W.), University of Virginia, Charlottesville; Department of Neurology (D.W.), University of Cincinnati College of Medicine, OH; Geriatrics Research and Education Clinical Center (B.D.M.), Baltimore Veterans Administration Medical Center, MD; and Munich Cluster for Systems Neurology (SyNergy) (M.D.), Germany
| | - Jordi Jimenez-Conde
- From the Centre for Clinical Brain Sciences (K.R., C.L.M.S.), College of Medicine and Veterinary Medicine (V.S., H.M.), and Institute for Genetics and Molecular Medicine (C.L.M.S.), University of Edinburgh, UK; Institute for Stroke and Dementia Research (R.M., M.D.), Klinikum der Universität München, Munich, Germany; Center for Human Genetic Research (C.D.A., F.R., J.R.) and J. Philip Kistler Stroke Research Center (C.D.A., F.R., N.S.R., J.R.) and Division of Neurocritical Care and Emergency Neurology (C.D.A., F.R., J.R.), Department of Neurology, Massachusetts General Hospital, Boston; Program in Medical and Population Genetics (C.D.A., F.R., J.R.), Broad Institute, Cambridge, MA; Population Health Research Institute (M.C., M.O., G.P.), McMaster University, Hamilton Health Sciences Centre, Ontario, Canada; Department of Medicine (T.D., B.D.M.), University of Maryland School of Medicine, Baltimore; Division of Neurocritical Care and Emergency Neurology (G.J.F.), Department of Neurology, Yale University School of Medicine, New Haven, CT; Stroke Pharmacogenomics and Genetics (I.F.-C.), Fundació Docència i Recerca Mutua Terrassa, Mutua de Terrassa Hospital; Neurovascular Research Unit (J.J.-C.), Department of Neurology, and Program in Inflammation and Cardiovascular Disorders (J.J.-C.), Institut Municipal d'Investigacio´Medica-Hospital del Mar, Universitat Autonoma de Barcelona, Spain; Department of Clinical Sciences Lund (A.L.), Neurology, Lund University; Department of Neurology and Rehabilitation Medicine (A.L., M.S.), Neurology, Skåne University Hospital, Lund, Sweden; Neurovascular Research Laboratory and Neurovascular Unit (J.M.), Institut de Recerca, Hospital Vall d'Hebron, Universitat Autonoma de Barcelona, Spain; HRB Clinical Research Facility (M.O.), NUI Galway, and University Hospital Galway, Ireland; Department of Neurology (A.S.), Jagiellonian University Medical College, Krakow, Poland; Cardiovascular Epidemiology Research Group (M.S.), Department of Clinical Sciences, Lund University, Malmö, Sweden; Department of Clinical Neurosciences (M.T., H.S.M.), University of Cambridge, UK; Department of Neurology (S.L.P.), Brain Centre Rudolf Magnus, University Medical Center Utrecht, the Netherlands; Boston University Schools of Medicine and Public Health (S.S.); Framingham Heart Study (S.S.), Framingham, MA; Departments of Neurology and Public Health Sciences (B.B.W.), University of Virginia, Charlottesville; Department of Neurology (D.W.), University of Cincinnati College of Medicine, OH; Geriatrics Research and Education Clinical Center (B.D.M.), Baltimore Veterans Administration Medical Center, MD; and Munich Cluster for Systems Neurology (SyNergy) (M.D.), Germany
| | - Arne Lindgren
- From the Centre for Clinical Brain Sciences (K.R., C.L.M.S.), College of Medicine and Veterinary Medicine (V.S., H.M.), and Institute for Genetics and Molecular Medicine (C.L.M.S.), University of Edinburgh, UK; Institute for Stroke and Dementia Research (R.M., M.D.), Klinikum der Universität München, Munich, Germany; Center for Human Genetic Research (C.D.A., F.R., J.R.) and J. Philip Kistler Stroke Research Center (C.D.A., F.R., N.S.R., J.R.) and Division of Neurocritical Care and Emergency Neurology (C.D.A., F.R., J.R.), Department of Neurology, Massachusetts General Hospital, Boston; Program in Medical and Population Genetics (C.D.A., F.R., J.R.), Broad Institute, Cambridge, MA; Population Health Research Institute (M.C., M.O., G.P.), McMaster University, Hamilton Health Sciences Centre, Ontario, Canada; Department of Medicine (T.D., B.D.M.), University of Maryland School of Medicine, Baltimore; Division of Neurocritical Care and Emergency Neurology (G.J.F.), Department of Neurology, Yale University School of Medicine, New Haven, CT; Stroke Pharmacogenomics and Genetics (I.F.-C.), Fundació Docència i Recerca Mutua Terrassa, Mutua de Terrassa Hospital; Neurovascular Research Unit (J.J.-C.), Department of Neurology, and Program in Inflammation and Cardiovascular Disorders (J.J.-C.), Institut Municipal d'Investigacio´Medica-Hospital del Mar, Universitat Autonoma de Barcelona, Spain; Department of Clinical Sciences Lund (A.L.), Neurology, Lund University; Department of Neurology and Rehabilitation Medicine (A.L., M.S.), Neurology, Skåne University Hospital, Lund, Sweden; Neurovascular Research Laboratory and Neurovascular Unit (J.M.), Institut de Recerca, Hospital Vall d'Hebron, Universitat Autonoma de Barcelona, Spain; HRB Clinical Research Facility (M.O.), NUI Galway, and University Hospital Galway, Ireland; Department of Neurology (A.S.), Jagiellonian University Medical College, Krakow, Poland; Cardiovascular Epidemiology Research Group (M.S.), Department of Clinical Sciences, Lund University, Malmö, Sweden; Department of Clinical Neurosciences (M.T., H.S.M.), University of Cambridge, UK; Department of Neurology (S.L.P.), Brain Centre Rudolf Magnus, University Medical Center Utrecht, the Netherlands; Boston University Schools of Medicine and Public Health (S.S.); Framingham Heart Study (S.S.), Framingham, MA; Departments of Neurology and Public Health Sciences (B.B.W.), University of Virginia, Charlottesville; Department of Neurology (D.W.), University of Cincinnati College of Medicine, OH; Geriatrics Research and Education Clinical Center (B.D.M.), Baltimore Veterans Administration Medical Center, MD; and Munich Cluster for Systems Neurology (SyNergy) (M.D.), Germany
| | - Joan Montaner
- From the Centre for Clinical Brain Sciences (K.R., C.L.M.S.), College of Medicine and Veterinary Medicine (V.S., H.M.), and Institute for Genetics and Molecular Medicine (C.L.M.S.), University of Edinburgh, UK; Institute for Stroke and Dementia Research (R.M., M.D.), Klinikum der Universität München, Munich, Germany; Center for Human Genetic Research (C.D.A., F.R., J.R.) and J. Philip Kistler Stroke Research Center (C.D.A., F.R., N.S.R., J.R.) and Division of Neurocritical Care and Emergency Neurology (C.D.A., F.R., J.R.), Department of Neurology, Massachusetts General Hospital, Boston; Program in Medical and Population Genetics (C.D.A., F.R., J.R.), Broad Institute, Cambridge, MA; Population Health Research Institute (M.C., M.O., G.P.), McMaster University, Hamilton Health Sciences Centre, Ontario, Canada; Department of Medicine (T.D., B.D.M.), University of Maryland School of Medicine, Baltimore; Division of Neurocritical Care and Emergency Neurology (G.J.F.), Department of Neurology, Yale University School of Medicine, New Haven, CT; Stroke Pharmacogenomics and Genetics (I.F.-C.), Fundació Docència i Recerca Mutua Terrassa, Mutua de Terrassa Hospital; Neurovascular Research Unit (J.J.-C.), Department of Neurology, and Program in Inflammation and Cardiovascular Disorders (J.J.-C.), Institut Municipal d'Investigacio´Medica-Hospital del Mar, Universitat Autonoma de Barcelona, Spain; Department of Clinical Sciences Lund (A.L.), Neurology, Lund University; Department of Neurology and Rehabilitation Medicine (A.L., M.S.), Neurology, Skåne University Hospital, Lund, Sweden; Neurovascular Research Laboratory and Neurovascular Unit (J.M.), Institut de Recerca, Hospital Vall d'Hebron, Universitat Autonoma de Barcelona, Spain; HRB Clinical Research Facility (M.O.), NUI Galway, and University Hospital Galway, Ireland; Department of Neurology (A.S.), Jagiellonian University Medical College, Krakow, Poland; Cardiovascular Epidemiology Research Group (M.S.), Department of Clinical Sciences, Lund University, Malmö, Sweden; Department of Clinical Neurosciences (M.T., H.S.M.), University of Cambridge, UK; Department of Neurology (S.L.P.), Brain Centre Rudolf Magnus, University Medical Center Utrecht, the Netherlands; Boston University Schools of Medicine and Public Health (S.S.); Framingham Heart Study (S.S.), Framingham, MA; Departments of Neurology and Public Health Sciences (B.B.W.), University of Virginia, Charlottesville; Department of Neurology (D.W.), University of Cincinnati College of Medicine, OH; Geriatrics Research and Education Clinical Center (B.D.M.), Baltimore Veterans Administration Medical Center, MD; and Munich Cluster for Systems Neurology (SyNergy) (M.D.), Germany
| | - Martin O'Donnell
- From the Centre for Clinical Brain Sciences (K.R., C.L.M.S.), College of Medicine and Veterinary Medicine (V.S., H.M.), and Institute for Genetics and Molecular Medicine (C.L.M.S.), University of Edinburgh, UK; Institute for Stroke and Dementia Research (R.M., M.D.), Klinikum der Universität München, Munich, Germany; Center for Human Genetic Research (C.D.A., F.R., J.R.) and J. Philip Kistler Stroke Research Center (C.D.A., F.R., N.S.R., J.R.) and Division of Neurocritical Care and Emergency Neurology (C.D.A., F.R., J.R.), Department of Neurology, Massachusetts General Hospital, Boston; Program in Medical and Population Genetics (C.D.A., F.R., J.R.), Broad Institute, Cambridge, MA; Population Health Research Institute (M.C., M.O., G.P.), McMaster University, Hamilton Health Sciences Centre, Ontario, Canada; Department of Medicine (T.D., B.D.M.), University of Maryland School of Medicine, Baltimore; Division of Neurocritical Care and Emergency Neurology (G.J.F.), Department of Neurology, Yale University School of Medicine, New Haven, CT; Stroke Pharmacogenomics and Genetics (I.F.-C.), Fundació Docència i Recerca Mutua Terrassa, Mutua de Terrassa Hospital; Neurovascular Research Unit (J.J.-C.), Department of Neurology, and Program in Inflammation and Cardiovascular Disorders (J.J.-C.), Institut Municipal d'Investigacio´Medica-Hospital del Mar, Universitat Autonoma de Barcelona, Spain; Department of Clinical Sciences Lund (A.L.), Neurology, Lund University; Department of Neurology and Rehabilitation Medicine (A.L., M.S.), Neurology, Skåne University Hospital, Lund, Sweden; Neurovascular Research Laboratory and Neurovascular Unit (J.M.), Institut de Recerca, Hospital Vall d'Hebron, Universitat Autonoma de Barcelona, Spain; HRB Clinical Research Facility (M.O.), NUI Galway, and University Hospital Galway, Ireland; Department of Neurology (A.S.), Jagiellonian University Medical College, Krakow, Poland; Cardiovascular Epidemiology Research Group (M.S.), Department of Clinical Sciences, Lund University, Malmö, Sweden; Department of Clinical Neurosciences (M.T., H.S.M.), University of Cambridge, UK; Department of Neurology (S.L.P.), Brain Centre Rudolf Magnus, University Medical Center Utrecht, the Netherlands; Boston University Schools of Medicine and Public Health (S.S.); Framingham Heart Study (S.S.), Framingham, MA; Departments of Neurology and Public Health Sciences (B.B.W.), University of Virginia, Charlottesville; Department of Neurology (D.W.), University of Cincinnati College of Medicine, OH; Geriatrics Research and Education Clinical Center (B.D.M.), Baltimore Veterans Administration Medical Center, MD; and Munich Cluster for Systems Neurology (SyNergy) (M.D.), Germany
| | - Guillaume Paré
- From the Centre for Clinical Brain Sciences (K.R., C.L.M.S.), College of Medicine and Veterinary Medicine (V.S., H.M.), and Institute for Genetics and Molecular Medicine (C.L.M.S.), University of Edinburgh, UK; Institute for Stroke and Dementia Research (R.M., M.D.), Klinikum der Universität München, Munich, Germany; Center for Human Genetic Research (C.D.A., F.R., J.R.) and J. Philip Kistler Stroke Research Center (C.D.A., F.R., N.S.R., J.R.) and Division of Neurocritical Care and Emergency Neurology (C.D.A., F.R., J.R.), Department of Neurology, Massachusetts General Hospital, Boston; Program in Medical and Population Genetics (C.D.A., F.R., J.R.), Broad Institute, Cambridge, MA; Population Health Research Institute (M.C., M.O., G.P.), McMaster University, Hamilton Health Sciences Centre, Ontario, Canada; Department of Medicine (T.D., B.D.M.), University of Maryland School of Medicine, Baltimore; Division of Neurocritical Care and Emergency Neurology (G.J.F.), Department of Neurology, Yale University School of Medicine, New Haven, CT; Stroke Pharmacogenomics and Genetics (I.F.-C.), Fundació Docència i Recerca Mutua Terrassa, Mutua de Terrassa Hospital; Neurovascular Research Unit (J.J.-C.), Department of Neurology, and Program in Inflammation and Cardiovascular Disorders (J.J.-C.), Institut Municipal d'Investigacio´Medica-Hospital del Mar, Universitat Autonoma de Barcelona, Spain; Department of Clinical Sciences Lund (A.L.), Neurology, Lund University; Department of Neurology and Rehabilitation Medicine (A.L., M.S.), Neurology, Skåne University Hospital, Lund, Sweden; Neurovascular Research Laboratory and Neurovascular Unit (J.M.), Institut de Recerca, Hospital Vall d'Hebron, Universitat Autonoma de Barcelona, Spain; HRB Clinical Research Facility (M.O.), NUI Galway, and University Hospital Galway, Ireland; Department of Neurology (A.S.), Jagiellonian University Medical College, Krakow, Poland; Cardiovascular Epidemiology Research Group (M.S.), Department of Clinical Sciences, Lund University, Malmö, Sweden; Department of Clinical Neurosciences (M.T., H.S.M.), University of Cambridge, UK; Department of Neurology (S.L.P.), Brain Centre Rudolf Magnus, University Medical Center Utrecht, the Netherlands; Boston University Schools of Medicine and Public Health (S.S.); Framingham Heart Study (S.S.), Framingham, MA; Departments of Neurology and Public Health Sciences (B.B.W.), University of Virginia, Charlottesville; Department of Neurology (D.W.), University of Cincinnati College of Medicine, OH; Geriatrics Research and Education Clinical Center (B.D.M.), Baltimore Veterans Administration Medical Center, MD; and Munich Cluster for Systems Neurology (SyNergy) (M.D.), Germany
| | - Farid Radmanesh
- From the Centre for Clinical Brain Sciences (K.R., C.L.M.S.), College of Medicine and Veterinary Medicine (V.S., H.M.), and Institute for Genetics and Molecular Medicine (C.L.M.S.), University of Edinburgh, UK; Institute for Stroke and Dementia Research (R.M., M.D.), Klinikum der Universität München, Munich, Germany; Center for Human Genetic Research (C.D.A., F.R., J.R.) and J. Philip Kistler Stroke Research Center (C.D.A., F.R., N.S.R., J.R.) and Division of Neurocritical Care and Emergency Neurology (C.D.A., F.R., J.R.), Department of Neurology, Massachusetts General Hospital, Boston; Program in Medical and Population Genetics (C.D.A., F.R., J.R.), Broad Institute, Cambridge, MA; Population Health Research Institute (M.C., M.O., G.P.), McMaster University, Hamilton Health Sciences Centre, Ontario, Canada; Department of Medicine (T.D., B.D.M.), University of Maryland School of Medicine, Baltimore; Division of Neurocritical Care and Emergency Neurology (G.J.F.), Department of Neurology, Yale University School of Medicine, New Haven, CT; Stroke Pharmacogenomics and Genetics (I.F.-C.), Fundació Docència i Recerca Mutua Terrassa, Mutua de Terrassa Hospital; Neurovascular Research Unit (J.J.-C.), Department of Neurology, and Program in Inflammation and Cardiovascular Disorders (J.J.-C.), Institut Municipal d'Investigacio´Medica-Hospital del Mar, Universitat Autonoma de Barcelona, Spain; Department of Clinical Sciences Lund (A.L.), Neurology, Lund University; Department of Neurology and Rehabilitation Medicine (A.L., M.S.), Neurology, Skåne University Hospital, Lund, Sweden; Neurovascular Research Laboratory and Neurovascular Unit (J.M.), Institut de Recerca, Hospital Vall d'Hebron, Universitat Autonoma de Barcelona, Spain; HRB Clinical Research Facility (M.O.), NUI Galway, and University Hospital Galway, Ireland; Department of Neurology (A.S.), Jagiellonian University Medical College, Krakow, Poland; Cardiovascular Epidemiology Research Group (M.S.), Department of Clinical Sciences, Lund University, Malmö, Sweden; Department of Clinical Neurosciences (M.T., H.S.M.), University of Cambridge, UK; Department of Neurology (S.L.P.), Brain Centre Rudolf Magnus, University Medical Center Utrecht, the Netherlands; Boston University Schools of Medicine and Public Health (S.S.); Framingham Heart Study (S.S.), Framingham, MA; Departments of Neurology and Public Health Sciences (B.B.W.), University of Virginia, Charlottesville; Department of Neurology (D.W.), University of Cincinnati College of Medicine, OH; Geriatrics Research and Education Clinical Center (B.D.M.), Baltimore Veterans Administration Medical Center, MD; and Munich Cluster for Systems Neurology (SyNergy) (M.D.), Germany
| | - Natalia S Rost
- From the Centre for Clinical Brain Sciences (K.R., C.L.M.S.), College of Medicine and Veterinary Medicine (V.S., H.M.), and Institute for Genetics and Molecular Medicine (C.L.M.S.), University of Edinburgh, UK; Institute for Stroke and Dementia Research (R.M., M.D.), Klinikum der Universität München, Munich, Germany; Center for Human Genetic Research (C.D.A., F.R., J.R.) and J. Philip Kistler Stroke Research Center (C.D.A., F.R., N.S.R., J.R.) and Division of Neurocritical Care and Emergency Neurology (C.D.A., F.R., J.R.), Department of Neurology, Massachusetts General Hospital, Boston; Program in Medical and Population Genetics (C.D.A., F.R., J.R.), Broad Institute, Cambridge, MA; Population Health Research Institute (M.C., M.O., G.P.), McMaster University, Hamilton Health Sciences Centre, Ontario, Canada; Department of Medicine (T.D., B.D.M.), University of Maryland School of Medicine, Baltimore; Division of Neurocritical Care and Emergency Neurology (G.J.F.), Department of Neurology, Yale University School of Medicine, New Haven, CT; Stroke Pharmacogenomics and Genetics (I.F.-C.), Fundació Docència i Recerca Mutua Terrassa, Mutua de Terrassa Hospital; Neurovascular Research Unit (J.J.-C.), Department of Neurology, and Program in Inflammation and Cardiovascular Disorders (J.J.-C.), Institut Municipal d'Investigacio´Medica-Hospital del Mar, Universitat Autonoma de Barcelona, Spain; Department of Clinical Sciences Lund (A.L.), Neurology, Lund University; Department of Neurology and Rehabilitation Medicine (A.L., M.S.), Neurology, Skåne University Hospital, Lund, Sweden; Neurovascular Research Laboratory and Neurovascular Unit (J.M.), Institut de Recerca, Hospital Vall d'Hebron, Universitat Autonoma de Barcelona, Spain; HRB Clinical Research Facility (M.O.), NUI Galway, and University Hospital Galway, Ireland; Department of Neurology (A.S.), Jagiellonian University Medical College, Krakow, Poland; Cardiovascular Epidemiology Research Group (M.S.), Department of Clinical Sciences, Lund University, Malmö, Sweden; Department of Clinical Neurosciences (M.T., H.S.M.), University of Cambridge, UK; Department of Neurology (S.L.P.), Brain Centre Rudolf Magnus, University Medical Center Utrecht, the Netherlands; Boston University Schools of Medicine and Public Health (S.S.); Framingham Heart Study (S.S.), Framingham, MA; Departments of Neurology and Public Health Sciences (B.B.W.), University of Virginia, Charlottesville; Department of Neurology (D.W.), University of Cincinnati College of Medicine, OH; Geriatrics Research and Education Clinical Center (B.D.M.), Baltimore Veterans Administration Medical Center, MD; and Munich Cluster for Systems Neurology (SyNergy) (M.D.), Germany
| | - Agnieszka Slowik
- From the Centre for Clinical Brain Sciences (K.R., C.L.M.S.), College of Medicine and Veterinary Medicine (V.S., H.M.), and Institute for Genetics and Molecular Medicine (C.L.M.S.), University of Edinburgh, UK; Institute for Stroke and Dementia Research (R.M., M.D.), Klinikum der Universität München, Munich, Germany; Center for Human Genetic Research (C.D.A., F.R., J.R.) and J. Philip Kistler Stroke Research Center (C.D.A., F.R., N.S.R., J.R.) and Division of Neurocritical Care and Emergency Neurology (C.D.A., F.R., J.R.), Department of Neurology, Massachusetts General Hospital, Boston; Program in Medical and Population Genetics (C.D.A., F.R., J.R.), Broad Institute, Cambridge, MA; Population Health Research Institute (M.C., M.O., G.P.), McMaster University, Hamilton Health Sciences Centre, Ontario, Canada; Department of Medicine (T.D., B.D.M.), University of Maryland School of Medicine, Baltimore; Division of Neurocritical Care and Emergency Neurology (G.J.F.), Department of Neurology, Yale University School of Medicine, New Haven, CT; Stroke Pharmacogenomics and Genetics (I.F.-C.), Fundació Docència i Recerca Mutua Terrassa, Mutua de Terrassa Hospital; Neurovascular Research Unit (J.J.-C.), Department of Neurology, and Program in Inflammation and Cardiovascular Disorders (J.J.-C.), Institut Municipal d'Investigacio´Medica-Hospital del Mar, Universitat Autonoma de Barcelona, Spain; Department of Clinical Sciences Lund (A.L.), Neurology, Lund University; Department of Neurology and Rehabilitation Medicine (A.L., M.S.), Neurology, Skåne University Hospital, Lund, Sweden; Neurovascular Research Laboratory and Neurovascular Unit (J.M.), Institut de Recerca, Hospital Vall d'Hebron, Universitat Autonoma de Barcelona, Spain; HRB Clinical Research Facility (M.O.), NUI Galway, and University Hospital Galway, Ireland; Department of Neurology (A.S.), Jagiellonian University Medical College, Krakow, Poland; Cardiovascular Epidemiology Research Group (M.S.), Department of Clinical Sciences, Lund University, Malmö, Sweden; Department of Clinical Neurosciences (M.T., H.S.M.), University of Cambridge, UK; Department of Neurology (S.L.P.), Brain Centre Rudolf Magnus, University Medical Center Utrecht, the Netherlands; Boston University Schools of Medicine and Public Health (S.S.); Framingham Heart Study (S.S.), Framingham, MA; Departments of Neurology and Public Health Sciences (B.B.W.), University of Virginia, Charlottesville; Department of Neurology (D.W.), University of Cincinnati College of Medicine, OH; Geriatrics Research and Education Clinical Center (B.D.M.), Baltimore Veterans Administration Medical Center, MD; and Munich Cluster for Systems Neurology (SyNergy) (M.D.), Germany
| | - Martin Söderholm
- From the Centre for Clinical Brain Sciences (K.R., C.L.M.S.), College of Medicine and Veterinary Medicine (V.S., H.M.), and Institute for Genetics and Molecular Medicine (C.L.M.S.), University of Edinburgh, UK; Institute for Stroke and Dementia Research (R.M., M.D.), Klinikum der Universität München, Munich, Germany; Center for Human Genetic Research (C.D.A., F.R., J.R.) and J. Philip Kistler Stroke Research Center (C.D.A., F.R., N.S.R., J.R.) and Division of Neurocritical Care and Emergency Neurology (C.D.A., F.R., J.R.), Department of Neurology, Massachusetts General Hospital, Boston; Program in Medical and Population Genetics (C.D.A., F.R., J.R.), Broad Institute, Cambridge, MA; Population Health Research Institute (M.C., M.O., G.P.), McMaster University, Hamilton Health Sciences Centre, Ontario, Canada; Department of Medicine (T.D., B.D.M.), University of Maryland School of Medicine, Baltimore; Division of Neurocritical Care and Emergency Neurology (G.J.F.), Department of Neurology, Yale University School of Medicine, New Haven, CT; Stroke Pharmacogenomics and Genetics (I.F.-C.), Fundació Docència i Recerca Mutua Terrassa, Mutua de Terrassa Hospital; Neurovascular Research Unit (J.J.-C.), Department of Neurology, and Program in Inflammation and Cardiovascular Disorders (J.J.-C.), Institut Municipal d'Investigacio´Medica-Hospital del Mar, Universitat Autonoma de Barcelona, Spain; Department of Clinical Sciences Lund (A.L.), Neurology, Lund University; Department of Neurology and Rehabilitation Medicine (A.L., M.S.), Neurology, Skåne University Hospital, Lund, Sweden; Neurovascular Research Laboratory and Neurovascular Unit (J.M.), Institut de Recerca, Hospital Vall d'Hebron, Universitat Autonoma de Barcelona, Spain; HRB Clinical Research Facility (M.O.), NUI Galway, and University Hospital Galway, Ireland; Department of Neurology (A.S.), Jagiellonian University Medical College, Krakow, Poland; Cardiovascular Epidemiology Research Group (M.S.), Department of Clinical Sciences, Lund University, Malmö, Sweden; Department of Clinical Neurosciences (M.T., H.S.M.), University of Cambridge, UK; Department of Neurology (S.L.P.), Brain Centre Rudolf Magnus, University Medical Center Utrecht, the Netherlands; Boston University Schools of Medicine and Public Health (S.S.); Framingham Heart Study (S.S.), Framingham, MA; Departments of Neurology and Public Health Sciences (B.B.W.), University of Virginia, Charlottesville; Department of Neurology (D.W.), University of Cincinnati College of Medicine, OH; Geriatrics Research and Education Clinical Center (B.D.M.), Baltimore Veterans Administration Medical Center, MD; and Munich Cluster for Systems Neurology (SyNergy) (M.D.), Germany
| | - Matthew Traylor
- From the Centre for Clinical Brain Sciences (K.R., C.L.M.S.), College of Medicine and Veterinary Medicine (V.S., H.M.), and Institute for Genetics and Molecular Medicine (C.L.M.S.), University of Edinburgh, UK; Institute for Stroke and Dementia Research (R.M., M.D.), Klinikum der Universität München, Munich, Germany; Center for Human Genetic Research (C.D.A., F.R., J.R.) and J. Philip Kistler Stroke Research Center (C.D.A., F.R., N.S.R., J.R.) and Division of Neurocritical Care and Emergency Neurology (C.D.A., F.R., J.R.), Department of Neurology, Massachusetts General Hospital, Boston; Program in Medical and Population Genetics (C.D.A., F.R., J.R.), Broad Institute, Cambridge, MA; Population Health Research Institute (M.C., M.O., G.P.), McMaster University, Hamilton Health Sciences Centre, Ontario, Canada; Department of Medicine (T.D., B.D.M.), University of Maryland School of Medicine, Baltimore; Division of Neurocritical Care and Emergency Neurology (G.J.F.), Department of Neurology, Yale University School of Medicine, New Haven, CT; Stroke Pharmacogenomics and Genetics (I.F.-C.), Fundació Docència i Recerca Mutua Terrassa, Mutua de Terrassa Hospital; Neurovascular Research Unit (J.J.-C.), Department of Neurology, and Program in Inflammation and Cardiovascular Disorders (J.J.-C.), Institut Municipal d'Investigacio´Medica-Hospital del Mar, Universitat Autonoma de Barcelona, Spain; Department of Clinical Sciences Lund (A.L.), Neurology, Lund University; Department of Neurology and Rehabilitation Medicine (A.L., M.S.), Neurology, Skåne University Hospital, Lund, Sweden; Neurovascular Research Laboratory and Neurovascular Unit (J.M.), Institut de Recerca, Hospital Vall d'Hebron, Universitat Autonoma de Barcelona, Spain; HRB Clinical Research Facility (M.O.), NUI Galway, and University Hospital Galway, Ireland; Department of Neurology (A.S.), Jagiellonian University Medical College, Krakow, Poland; Cardiovascular Epidemiology Research Group (M.S.), Department of Clinical Sciences, Lund University, Malmö, Sweden; Department of Clinical Neurosciences (M.T., H.S.M.), University of Cambridge, UK; Department of Neurology (S.L.P.), Brain Centre Rudolf Magnus, University Medical Center Utrecht, the Netherlands; Boston University Schools of Medicine and Public Health (S.S.); Framingham Heart Study (S.S.), Framingham, MA; Departments of Neurology and Public Health Sciences (B.B.W.), University of Virginia, Charlottesville; Department of Neurology (D.W.), University of Cincinnati College of Medicine, OH; Geriatrics Research and Education Clinical Center (B.D.M.), Baltimore Veterans Administration Medical Center, MD; and Munich Cluster for Systems Neurology (SyNergy) (M.D.), Germany
| | - Sara L Pulit
- From the Centre for Clinical Brain Sciences (K.R., C.L.M.S.), College of Medicine and Veterinary Medicine (V.S., H.M.), and Institute for Genetics and Molecular Medicine (C.L.M.S.), University of Edinburgh, UK; Institute for Stroke and Dementia Research (R.M., M.D.), Klinikum der Universität München, Munich, Germany; Center for Human Genetic Research (C.D.A., F.R., J.R.) and J. Philip Kistler Stroke Research Center (C.D.A., F.R., N.S.R., J.R.) and Division of Neurocritical Care and Emergency Neurology (C.D.A., F.R., J.R.), Department of Neurology, Massachusetts General Hospital, Boston; Program in Medical and Population Genetics (C.D.A., F.R., J.R.), Broad Institute, Cambridge, MA; Population Health Research Institute (M.C., M.O., G.P.), McMaster University, Hamilton Health Sciences Centre, Ontario, Canada; Department of Medicine (T.D., B.D.M.), University of Maryland School of Medicine, Baltimore; Division of Neurocritical Care and Emergency Neurology (G.J.F.), Department of Neurology, Yale University School of Medicine, New Haven, CT; Stroke Pharmacogenomics and Genetics (I.F.-C.), Fundació Docència i Recerca Mutua Terrassa, Mutua de Terrassa Hospital; Neurovascular Research Unit (J.J.-C.), Department of Neurology, and Program in Inflammation and Cardiovascular Disorders (J.J.-C.), Institut Municipal d'Investigacio´Medica-Hospital del Mar, Universitat Autonoma de Barcelona, Spain; Department of Clinical Sciences Lund (A.L.), Neurology, Lund University; Department of Neurology and Rehabilitation Medicine (A.L., M.S.), Neurology, Skåne University Hospital, Lund, Sweden; Neurovascular Research Laboratory and Neurovascular Unit (J.M.), Institut de Recerca, Hospital Vall d'Hebron, Universitat Autonoma de Barcelona, Spain; HRB Clinical Research Facility (M.O.), NUI Galway, and University Hospital Galway, Ireland; Department of Neurology (A.S.), Jagiellonian University Medical College, Krakow, Poland; Cardiovascular Epidemiology Research Group (M.S.), Department of Clinical Sciences, Lund University, Malmö, Sweden; Department of Clinical Neurosciences (M.T., H.S.M.), University of Cambridge, UK; Department of Neurology (S.L.P.), Brain Centre Rudolf Magnus, University Medical Center Utrecht, the Netherlands; Boston University Schools of Medicine and Public Health (S.S.); Framingham Heart Study (S.S.), Framingham, MA; Departments of Neurology and Public Health Sciences (B.B.W.), University of Virginia, Charlottesville; Department of Neurology (D.W.), University of Cincinnati College of Medicine, OH; Geriatrics Research and Education Clinical Center (B.D.M.), Baltimore Veterans Administration Medical Center, MD; and Munich Cluster for Systems Neurology (SyNergy) (M.D.), Germany
| | - Sudha Seshadri
- From the Centre for Clinical Brain Sciences (K.R., C.L.M.S.), College of Medicine and Veterinary Medicine (V.S., H.M.), and Institute for Genetics and Molecular Medicine (C.L.M.S.), University of Edinburgh, UK; Institute for Stroke and Dementia Research (R.M., M.D.), Klinikum der Universität München, Munich, Germany; Center for Human Genetic Research (C.D.A., F.R., J.R.) and J. Philip Kistler Stroke Research Center (C.D.A., F.R., N.S.R., J.R.) and Division of Neurocritical Care and Emergency Neurology (C.D.A., F.R., J.R.), Department of Neurology, Massachusetts General Hospital, Boston; Program in Medical and Population Genetics (C.D.A., F.R., J.R.), Broad Institute, Cambridge, MA; Population Health Research Institute (M.C., M.O., G.P.), McMaster University, Hamilton Health Sciences Centre, Ontario, Canada; Department of Medicine (T.D., B.D.M.), University of Maryland School of Medicine, Baltimore; Division of Neurocritical Care and Emergency Neurology (G.J.F.), Department of Neurology, Yale University School of Medicine, New Haven, CT; Stroke Pharmacogenomics and Genetics (I.F.-C.), Fundació Docència i Recerca Mutua Terrassa, Mutua de Terrassa Hospital; Neurovascular Research Unit (J.J.-C.), Department of Neurology, and Program in Inflammation and Cardiovascular Disorders (J.J.-C.), Institut Municipal d'Investigacio´Medica-Hospital del Mar, Universitat Autonoma de Barcelona, Spain; Department of Clinical Sciences Lund (A.L.), Neurology, Lund University; Department of Neurology and Rehabilitation Medicine (A.L., M.S.), Neurology, Skåne University Hospital, Lund, Sweden; Neurovascular Research Laboratory and Neurovascular Unit (J.M.), Institut de Recerca, Hospital Vall d'Hebron, Universitat Autonoma de Barcelona, Spain; HRB Clinical Research Facility (M.O.), NUI Galway, and University Hospital Galway, Ireland; Department of Neurology (A.S.), Jagiellonian University Medical College, Krakow, Poland; Cardiovascular Epidemiology Research Group (M.S.), Department of Clinical Sciences, Lund University, Malmö, Sweden; Department of Clinical Neurosciences (M.T., H.S.M.), University of Cambridge, UK; Department of Neurology (S.L.P.), Brain Centre Rudolf Magnus, University Medical Center Utrecht, the Netherlands; Boston University Schools of Medicine and Public Health (S.S.); Framingham Heart Study (S.S.), Framingham, MA; Departments of Neurology and Public Health Sciences (B.B.W.), University of Virginia, Charlottesville; Department of Neurology (D.W.), University of Cincinnati College of Medicine, OH; Geriatrics Research and Education Clinical Center (B.D.M.), Baltimore Veterans Administration Medical Center, MD; and Munich Cluster for Systems Neurology (SyNergy) (M.D.), Germany
| | - Brad B Worrall
- From the Centre for Clinical Brain Sciences (K.R., C.L.M.S.), College of Medicine and Veterinary Medicine (V.S., H.M.), and Institute for Genetics and Molecular Medicine (C.L.M.S.), University of Edinburgh, UK; Institute for Stroke and Dementia Research (R.M., M.D.), Klinikum der Universität München, Munich, Germany; Center for Human Genetic Research (C.D.A., F.R., J.R.) and J. Philip Kistler Stroke Research Center (C.D.A., F.R., N.S.R., J.R.) and Division of Neurocritical Care and Emergency Neurology (C.D.A., F.R., J.R.), Department of Neurology, Massachusetts General Hospital, Boston; Program in Medical and Population Genetics (C.D.A., F.R., J.R.), Broad Institute, Cambridge, MA; Population Health Research Institute (M.C., M.O., G.P.), McMaster University, Hamilton Health Sciences Centre, Ontario, Canada; Department of Medicine (T.D., B.D.M.), University of Maryland School of Medicine, Baltimore; Division of Neurocritical Care and Emergency Neurology (G.J.F.), Department of Neurology, Yale University School of Medicine, New Haven, CT; Stroke Pharmacogenomics and Genetics (I.F.-C.), Fundació Docència i Recerca Mutua Terrassa, Mutua de Terrassa Hospital; Neurovascular Research Unit (J.J.-C.), Department of Neurology, and Program in Inflammation and Cardiovascular Disorders (J.J.-C.), Institut Municipal d'Investigacio´Medica-Hospital del Mar, Universitat Autonoma de Barcelona, Spain; Department of Clinical Sciences Lund (A.L.), Neurology, Lund University; Department of Neurology and Rehabilitation Medicine (A.L., M.S.), Neurology, Skåne University Hospital, Lund, Sweden; Neurovascular Research Laboratory and Neurovascular Unit (J.M.), Institut de Recerca, Hospital Vall d'Hebron, Universitat Autonoma de Barcelona, Spain; HRB Clinical Research Facility (M.O.), NUI Galway, and University Hospital Galway, Ireland; Department of Neurology (A.S.), Jagiellonian University Medical College, Krakow, Poland; Cardiovascular Epidemiology Research Group (M.S.), Department of Clinical Sciences, Lund University, Malmö, Sweden; Department of Clinical Neurosciences (M.T., H.S.M.), University of Cambridge, UK; Department of Neurology (S.L.P.), Brain Centre Rudolf Magnus, University Medical Center Utrecht, the Netherlands; Boston University Schools of Medicine and Public Health (S.S.); Framingham Heart Study (S.S.), Framingham, MA; Departments of Neurology and Public Health Sciences (B.B.W.), University of Virginia, Charlottesville; Department of Neurology (D.W.), University of Cincinnati College of Medicine, OH; Geriatrics Research and Education Clinical Center (B.D.M.), Baltimore Veterans Administration Medical Center, MD; and Munich Cluster for Systems Neurology (SyNergy) (M.D.), Germany
| | - Daniel Woo
- From the Centre for Clinical Brain Sciences (K.R., C.L.M.S.), College of Medicine and Veterinary Medicine (V.S., H.M.), and Institute for Genetics and Molecular Medicine (C.L.M.S.), University of Edinburgh, UK; Institute for Stroke and Dementia Research (R.M., M.D.), Klinikum der Universität München, Munich, Germany; Center for Human Genetic Research (C.D.A., F.R., J.R.) and J. Philip Kistler Stroke Research Center (C.D.A., F.R., N.S.R., J.R.) and Division of Neurocritical Care and Emergency Neurology (C.D.A., F.R., J.R.), Department of Neurology, Massachusetts General Hospital, Boston; Program in Medical and Population Genetics (C.D.A., F.R., J.R.), Broad Institute, Cambridge, MA; Population Health Research Institute (M.C., M.O., G.P.), McMaster University, Hamilton Health Sciences Centre, Ontario, Canada; Department of Medicine (T.D., B.D.M.), University of Maryland School of Medicine, Baltimore; Division of Neurocritical Care and Emergency Neurology (G.J.F.), Department of Neurology, Yale University School of Medicine, New Haven, CT; Stroke Pharmacogenomics and Genetics (I.F.-C.), Fundació Docència i Recerca Mutua Terrassa, Mutua de Terrassa Hospital; Neurovascular Research Unit (J.J.-C.), Department of Neurology, and Program in Inflammation and Cardiovascular Disorders (J.J.-C.), Institut Municipal d'Investigacio´Medica-Hospital del Mar, Universitat Autonoma de Barcelona, Spain; Department of Clinical Sciences Lund (A.L.), Neurology, Lund University; Department of Neurology and Rehabilitation Medicine (A.L., M.S.), Neurology, Skåne University Hospital, Lund, Sweden; Neurovascular Research Laboratory and Neurovascular Unit (J.M.), Institut de Recerca, Hospital Vall d'Hebron, Universitat Autonoma de Barcelona, Spain; HRB Clinical Research Facility (M.O.), NUI Galway, and University Hospital Galway, Ireland; Department of Neurology (A.S.), Jagiellonian University Medical College, Krakow, Poland; Cardiovascular Epidemiology Research Group (M.S.), Department of Clinical Sciences, Lund University, Malmö, Sweden; Department of Clinical Neurosciences (M.T., H.S.M.), University of Cambridge, UK; Department of Neurology (S.L.P.), Brain Centre Rudolf Magnus, University Medical Center Utrecht, the Netherlands; Boston University Schools of Medicine and Public Health (S.S.); Framingham Heart Study (S.S.), Framingham, MA; Departments of Neurology and Public Health Sciences (B.B.W.), University of Virginia, Charlottesville; Department of Neurology (D.W.), University of Cincinnati College of Medicine, OH; Geriatrics Research and Education Clinical Center (B.D.M.), Baltimore Veterans Administration Medical Center, MD; and Munich Cluster for Systems Neurology (SyNergy) (M.D.), Germany
| | - Hugh S Markus
- From the Centre for Clinical Brain Sciences (K.R., C.L.M.S.), College of Medicine and Veterinary Medicine (V.S., H.M.), and Institute for Genetics and Molecular Medicine (C.L.M.S.), University of Edinburgh, UK; Institute for Stroke and Dementia Research (R.M., M.D.), Klinikum der Universität München, Munich, Germany; Center for Human Genetic Research (C.D.A., F.R., J.R.) and J. Philip Kistler Stroke Research Center (C.D.A., F.R., N.S.R., J.R.) and Division of Neurocritical Care and Emergency Neurology (C.D.A., F.R., J.R.), Department of Neurology, Massachusetts General Hospital, Boston; Program in Medical and Population Genetics (C.D.A., F.R., J.R.), Broad Institute, Cambridge, MA; Population Health Research Institute (M.C., M.O., G.P.), McMaster University, Hamilton Health Sciences Centre, Ontario, Canada; Department of Medicine (T.D., B.D.M.), University of Maryland School of Medicine, Baltimore; Division of Neurocritical Care and Emergency Neurology (G.J.F.), Department of Neurology, Yale University School of Medicine, New Haven, CT; Stroke Pharmacogenomics and Genetics (I.F.-C.), Fundació Docència i Recerca Mutua Terrassa, Mutua de Terrassa Hospital; Neurovascular Research Unit (J.J.-C.), Department of Neurology, and Program in Inflammation and Cardiovascular Disorders (J.J.-C.), Institut Municipal d'Investigacio´Medica-Hospital del Mar, Universitat Autonoma de Barcelona, Spain; Department of Clinical Sciences Lund (A.L.), Neurology, Lund University; Department of Neurology and Rehabilitation Medicine (A.L., M.S.), Neurology, Skåne University Hospital, Lund, Sweden; Neurovascular Research Laboratory and Neurovascular Unit (J.M.), Institut de Recerca, Hospital Vall d'Hebron, Universitat Autonoma de Barcelona, Spain; HRB Clinical Research Facility (M.O.), NUI Galway, and University Hospital Galway, Ireland; Department of Neurology (A.S.), Jagiellonian University Medical College, Krakow, Poland; Cardiovascular Epidemiology Research Group (M.S.), Department of Clinical Sciences, Lund University, Malmö, Sweden; Department of Clinical Neurosciences (M.T., H.S.M.), University of Cambridge, UK; Department of Neurology (S.L.P.), Brain Centre Rudolf Magnus, University Medical Center Utrecht, the Netherlands; Boston University Schools of Medicine and Public Health (S.S.); Framingham Heart Study (S.S.), Framingham, MA; Departments of Neurology and Public Health Sciences (B.B.W.), University of Virginia, Charlottesville; Department of Neurology (D.W.), University of Cincinnati College of Medicine, OH; Geriatrics Research and Education Clinical Center (B.D.M.), Baltimore Veterans Administration Medical Center, MD; and Munich Cluster for Systems Neurology (SyNergy) (M.D.), Germany
| | - Braxton D Mitchell
- From the Centre for Clinical Brain Sciences (K.R., C.L.M.S.), College of Medicine and Veterinary Medicine (V.S., H.M.), and Institute for Genetics and Molecular Medicine (C.L.M.S.), University of Edinburgh, UK; Institute for Stroke and Dementia Research (R.M., M.D.), Klinikum der Universität München, Munich, Germany; Center for Human Genetic Research (C.D.A., F.R., J.R.) and J. Philip Kistler Stroke Research Center (C.D.A., F.R., N.S.R., J.R.) and Division of Neurocritical Care and Emergency Neurology (C.D.A., F.R., J.R.), Department of Neurology, Massachusetts General Hospital, Boston; Program in Medical and Population Genetics (C.D.A., F.R., J.R.), Broad Institute, Cambridge, MA; Population Health Research Institute (M.C., M.O., G.P.), McMaster University, Hamilton Health Sciences Centre, Ontario, Canada; Department of Medicine (T.D., B.D.M.), University of Maryland School of Medicine, Baltimore; Division of Neurocritical Care and Emergency Neurology (G.J.F.), Department of Neurology, Yale University School of Medicine, New Haven, CT; Stroke Pharmacogenomics and Genetics (I.F.-C.), Fundació Docència i Recerca Mutua Terrassa, Mutua de Terrassa Hospital; Neurovascular Research Unit (J.J.-C.), Department of Neurology, and Program in Inflammation and Cardiovascular Disorders (J.J.-C.), Institut Municipal d'Investigacio´Medica-Hospital del Mar, Universitat Autonoma de Barcelona, Spain; Department of Clinical Sciences Lund (A.L.), Neurology, Lund University; Department of Neurology and Rehabilitation Medicine (A.L., M.S.), Neurology, Skåne University Hospital, Lund, Sweden; Neurovascular Research Laboratory and Neurovascular Unit (J.M.), Institut de Recerca, Hospital Vall d'Hebron, Universitat Autonoma de Barcelona, Spain; HRB Clinical Research Facility (M.O.), NUI Galway, and University Hospital Galway, Ireland; Department of Neurology (A.S.), Jagiellonian University Medical College, Krakow, Poland; Cardiovascular Epidemiology Research Group (M.S.), Department of Clinical Sciences, Lund University, Malmö, Sweden; Department of Clinical Neurosciences (M.T., H.S.M.), University of Cambridge, UK; Department of Neurology (S.L.P.), Brain Centre Rudolf Magnus, University Medical Center Utrecht, the Netherlands; Boston University Schools of Medicine and Public Health (S.S.); Framingham Heart Study (S.S.), Framingham, MA; Departments of Neurology and Public Health Sciences (B.B.W.), University of Virginia, Charlottesville; Department of Neurology (D.W.), University of Cincinnati College of Medicine, OH; Geriatrics Research and Education Clinical Center (B.D.M.), Baltimore Veterans Administration Medical Center, MD; and Munich Cluster for Systems Neurology (SyNergy) (M.D.), Germany
| | - Martin Dichgans
- From the Centre for Clinical Brain Sciences (K.R., C.L.M.S.), College of Medicine and Veterinary Medicine (V.S., H.M.), and Institute for Genetics and Molecular Medicine (C.L.M.S.), University of Edinburgh, UK; Institute for Stroke and Dementia Research (R.M., M.D.), Klinikum der Universität München, Munich, Germany; Center for Human Genetic Research (C.D.A., F.R., J.R.) and J. Philip Kistler Stroke Research Center (C.D.A., F.R., N.S.R., J.R.) and Division of Neurocritical Care and Emergency Neurology (C.D.A., F.R., J.R.), Department of Neurology, Massachusetts General Hospital, Boston; Program in Medical and Population Genetics (C.D.A., F.R., J.R.), Broad Institute, Cambridge, MA; Population Health Research Institute (M.C., M.O., G.P.), McMaster University, Hamilton Health Sciences Centre, Ontario, Canada; Department of Medicine (T.D., B.D.M.), University of Maryland School of Medicine, Baltimore; Division of Neurocritical Care and Emergency Neurology (G.J.F.), Department of Neurology, Yale University School of Medicine, New Haven, CT; Stroke Pharmacogenomics and Genetics (I.F.-C.), Fundació Docència i Recerca Mutua Terrassa, Mutua de Terrassa Hospital; Neurovascular Research Unit (J.J.-C.), Department of Neurology, and Program in Inflammation and Cardiovascular Disorders (J.J.-C.), Institut Municipal d'Investigacio´Medica-Hospital del Mar, Universitat Autonoma de Barcelona, Spain; Department of Clinical Sciences Lund (A.L.), Neurology, Lund University; Department of Neurology and Rehabilitation Medicine (A.L., M.S.), Neurology, Skåne University Hospital, Lund, Sweden; Neurovascular Research Laboratory and Neurovascular Unit (J.M.), Institut de Recerca, Hospital Vall d'Hebron, Universitat Autonoma de Barcelona, Spain; HRB Clinical Research Facility (M.O.), NUI Galway, and University Hospital Galway, Ireland; Department of Neurology (A.S.), Jagiellonian University Medical College, Krakow, Poland; Cardiovascular Epidemiology Research Group (M.S.), Department of Clinical Sciences, Lund University, Malmö, Sweden; Department of Clinical Neurosciences (M.T., H.S.M.), University of Cambridge, UK; Department of Neurology (S.L.P.), Brain Centre Rudolf Magnus, University Medical Center Utrecht, the Netherlands; Boston University Schools of Medicine and Public Health (S.S.); Framingham Heart Study (S.S.), Framingham, MA; Departments of Neurology and Public Health Sciences (B.B.W.), University of Virginia, Charlottesville; Department of Neurology (D.W.), University of Cincinnati College of Medicine, OH; Geriatrics Research and Education Clinical Center (B.D.M.), Baltimore Veterans Administration Medical Center, MD; and Munich Cluster for Systems Neurology (SyNergy) (M.D.), Germany
| | - Jonathan Rosand
- From the Centre for Clinical Brain Sciences (K.R., C.L.M.S.), College of Medicine and Veterinary Medicine (V.S., H.M.), and Institute for Genetics and Molecular Medicine (C.L.M.S.), University of Edinburgh, UK; Institute for Stroke and Dementia Research (R.M., M.D.), Klinikum der Universität München, Munich, Germany; Center for Human Genetic Research (C.D.A., F.R., J.R.) and J. Philip Kistler Stroke Research Center (C.D.A., F.R., N.S.R., J.R.) and Division of Neurocritical Care and Emergency Neurology (C.D.A., F.R., J.R.), Department of Neurology, Massachusetts General Hospital, Boston; Program in Medical and Population Genetics (C.D.A., F.R., J.R.), Broad Institute, Cambridge, MA; Population Health Research Institute (M.C., M.O., G.P.), McMaster University, Hamilton Health Sciences Centre, Ontario, Canada; Department of Medicine (T.D., B.D.M.), University of Maryland School of Medicine, Baltimore; Division of Neurocritical Care and Emergency Neurology (G.J.F.), Department of Neurology, Yale University School of Medicine, New Haven, CT; Stroke Pharmacogenomics and Genetics (I.F.-C.), Fundació Docència i Recerca Mutua Terrassa, Mutua de Terrassa Hospital; Neurovascular Research Unit (J.J.-C.), Department of Neurology, and Program in Inflammation and Cardiovascular Disorders (J.J.-C.), Institut Municipal d'Investigacio´Medica-Hospital del Mar, Universitat Autonoma de Barcelona, Spain; Department of Clinical Sciences Lund (A.L.), Neurology, Lund University; Department of Neurology and Rehabilitation Medicine (A.L., M.S.), Neurology, Skåne University Hospital, Lund, Sweden; Neurovascular Research Laboratory and Neurovascular Unit (J.M.), Institut de Recerca, Hospital Vall d'Hebron, Universitat Autonoma de Barcelona, Spain; HRB Clinical Research Facility (M.O.), NUI Galway, and University Hospital Galway, Ireland; Department of Neurology (A.S.), Jagiellonian University Medical College, Krakow, Poland; Cardiovascular Epidemiology Research Group (M.S.), Department of Clinical Sciences, Lund University, Malmö, Sweden; Department of Clinical Neurosciences (M.T., H.S.M.), University of Cambridge, UK; Department of Neurology (S.L.P.), Brain Centre Rudolf Magnus, University Medical Center Utrecht, the Netherlands; Boston University Schools of Medicine and Public Health (S.S.); Framingham Heart Study (S.S.), Framingham, MA; Departments of Neurology and Public Health Sciences (B.B.W.), University of Virginia, Charlottesville; Department of Neurology (D.W.), University of Cincinnati College of Medicine, OH; Geriatrics Research and Education Clinical Center (B.D.M.), Baltimore Veterans Administration Medical Center, MD; and Munich Cluster for Systems Neurology (SyNergy) (M.D.), Germany
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Wilkinson T, Ly A, Schnier C, Rannikmäe K, Quinn T, Sudlow C. [P1–558]: IDENTIFYING DEMENTIA CASES IN PROSPECTIVE COHORT STUDIES USING ROUTINELY COLLECTED HEALTH DATASETS. Alzheimers Dement 2017. [DOI: 10.1016/j.jalz.2017.06.574] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Affiliation(s)
| | - Amanda Ly
- University of EdinburghEdinburghUnited Kingdom
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Horrocks S, Wilkinson T, Schnier C, Ly A, Woodfield R, Rannikmäe K, Quinn TJ, Sudlow CLM. Accuracy of routinely-collected healthcare data for identifying motor neurone disease cases: A systematic review. PLoS One 2017; 12:e0172639. [PMID: 28245254 PMCID: PMC5330471 DOI: 10.1371/journal.pone.0172639] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/05/2016] [Accepted: 02/07/2017] [Indexed: 11/19/2022] Open
Abstract
Background Motor neurone disease (MND) is a rare neurodegenerative condition, with poorly understood aetiology. Large, population-based, prospective cohorts will enable powerful studies of the determinants of MND, provided identification of disease cases is sufficiently accurate. Follow-up in many such studies relies on linkage to routinely-collected health datasets. We systematically evaluated the accuracy of such datasets in identifying MND cases. Methods We performed an electronic search of MEDLINE, EMBASE, Cochrane Library and Web of Science for studies published between 01/01/1990-16/11/2015 that compared MND cases identified in routinely-collected, coded datasets to a reference standard. We recorded study characteristics and two key measures of diagnostic accuracy—positive predictive value (PPV) and sensitivity. We conducted descriptive analyses and quality assessments of included studies. Results Thirteen eligible studies provided 13 estimates of PPV and five estimates of sensitivity. Twelve studies assessed hospital and/or death certificate-derived datasets; one evaluated a primary care dataset. All studies were from high income countries (UK, Europe, USA, Hong Kong). Study methods varied widely, but quality was generally good. PPV estimates ranged from 55–92% and sensitivities from 75–93%. The single (UK-based) study of primary care data reported a PPV of 85%. Conclusions Diagnostic accuracy of routinely-collected health datasets is likely to be sufficient for identifying cases of MND in large-scale prospective epidemiological studies in high income country settings. Primary care datasets, particularly from countries with a widely-accessible national healthcare system, are potentially valuable data sources warranting further investigation.
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Affiliation(s)
- Sophie Horrocks
- Centre for Clinical Brain Sciences, University of Edinburgh, Edinburgh, United Kingdom
| | - Tim Wilkinson
- Centre for Clinical Brain Sciences, University of Edinburgh, Edinburgh, United Kingdom
- * E-mail:
| | - Christian Schnier
- Centre for Clinical Brain Sciences, University of Edinburgh, Edinburgh, United Kingdom
| | - Amanda Ly
- Centre for Clinical Brain Sciences, University of Edinburgh, Edinburgh, United Kingdom
| | - Rebecca Woodfield
- Centre for Clinical Brain Sciences, University of Edinburgh, Edinburgh, United Kingdom
| | - Kristiina Rannikmäe
- Centre for Clinical Brain Sciences, University of Edinburgh, Edinburgh, United Kingdom
| | - Terence J. Quinn
- Institute of Cardiovascular and Medical Sciences, University of Glasgow, Glasgow, United Kingdom
| | - Cathie L. M. Sudlow
- Centre for Clinical Brain Sciences, University of Edinburgh, Edinburgh, United Kingdom
- UK Biobank, Stockport, United Kingdom
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Rannikmäe K, Woodfield R, Anderson CS, Charidimou A, Chiewvit P, Greenberg SM, Jeng JS, Meretoja A, Palm F, Putaala J, Rinkel GJ, Rosand J, Rost NS, Strbian D, Tatlisumak T, Tsai CF, Wermer MJ, Werring D, Yeh SJ, Al-Shahi Salman R, Sudlow CL. Reliability of intracerebral hemorrhage classification systems: A systematic review. Int J Stroke 2016; 11:626-36. [PMID: 27091144 DOI: 10.1177/1747493016641962] [Citation(s) in RCA: 25] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/09/2015] [Accepted: 02/04/2016] [Indexed: 11/17/2022]
Abstract
BACKGROUND Accurately distinguishing non-traumatic intracerebral hemorrhage (ICH) subtypes is important since they may have different risk factors, causal pathways, management, and prognosis. We systematically assessed the inter- and intra-rater reliability of ICH classification systems. METHODS We sought all available reliability assessments of anatomical and mechanistic ICH classification systems from electronic databases and personal contacts until October 2014. We assessed included studies' characteristics, reporting quality and potential for bias; summarized reliability with kappa value forest plots; and performed meta-analyses of the proportion of cases classified into each subtype. SUMMARY OF REVIEW We included 8 of 2152 studies identified. Inter- and intra-rater reliabilities were substantial to perfect for anatomical and mechanistic systems (inter-rater kappa values: anatomical 0.78-0.97 [six studies, 518 cases], mechanistic 0.89-0.93 [three studies, 510 cases]; intra-rater kappas: anatomical 0.80-1 [three studies, 137 cases], mechanistic 0.92-0.93 [two studies, 368 cases]). Reporting quality varied but no study fulfilled all criteria and none was free from potential bias. All reliability studies were performed with experienced raters in specialist centers. Proportions of ICH subtypes were largely consistent with previous reports suggesting that included studies are appropriately representative. CONCLUSIONS Reliability of existing classification systems appears excellent but is unknown outside specialist centers with experienced raters. Future reliability comparisons should be facilitated by studies following recently published reporting guidelines.
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Affiliation(s)
| | | | - Craig S Anderson
- The George Institute for Global Health, Royal Prince Alfred Hospital and the University of Sydney, Australia
| | - Andreas Charidimou
- Stroke Research Group, Department of Brain Repair and Rehabilitation, UCL Institute of Neurology and National Hospital for Neurology and Neurosurgery, UK
| | - Pipat Chiewvit
- Department of Radiology, Faculty of Medicine, Siriraj Hospital, Mahidol University, Thailand
| | | | - Jiann-Shing Jeng
- Stroke Center and Department of Neurology, National Taiwan University Hospital, Taiwan
| | - Atte Meretoja
- Department of Neurology, Helsinki University Central Hospital, Finland Departments of Medicine and the Florey, Royal Melbourne Hospital, University of Melbourne, Australia
| | - Frederic Palm
- Department of Neurology, Städtisches Klinikum Ludwigshafen, Germany
| | - Jukka Putaala
- Department of Neurology, Helsinki University Central Hospital, Finland
| | - Gabriel Je Rinkel
- Department of Neurology and Neurosurgery, Brain Center Rudolf Magnus, University Medical Center Utrecht, The Netherlands
| | - Jonathan Rosand
- Department of Neurology, Massachusetts General Hospital, USA Center for Human Genetic Research, Massachusetts General Hospital, USA Program in Medical and Population Genetics, Broad Institute, USA
| | - Natalia S Rost
- Center for Human Genetic Research, Massachusetts General Hospital, USA
| | - Daniel Strbian
- Department of Neurology, Helsinki University Central Hospital, Finland
| | - Turgut Tatlisumak
- Department of Neurology, Helsinki University Central Hospital, Finland Institute of Neuroscience and Physiology, Sahlgrenska Academy, University of Gothenburg, Sweden Department of Neurology, Sahlgrenska University Hospital, Sweden
| | - Chung-Fen Tsai
- Department of Neurology, Cardinal Tien Hospital, School of Medicine, Fu-Jen Catholic University, Taiwan
| | - Marieke Jh Wermer
- Department of Neurology, Leiden University Medical Center, The Netherlands
| | - David Werring
- Stroke Research Group, Department of Brain Repair and Rehabilitation, UCL Institute of Neurology and National Hospital for Neurology and Neurosurgery, UK
| | - Shin-Joe Yeh
- Stroke Center and Department of Neurology, National Taiwan University Hospital, Taiwan
| | | | - Cathie Lm Sudlow
- Centre for Clinical Brain Sciences, University of Edinburgh, UK Institute for Genetics and Molecular Medicine, University of Edinburgh, UK UK Biobank, UK
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31
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Rannikmäe K, Davies G, Thomson PA, Bevan S, Devan WJ, Falcone GJ, Traylor M, Anderson CD, Battey TWK, Radmanesh F, Deka R, Woo JG, Martin LJ, Jimenez-Conde J, Selim M, Brown DL, Silliman SL, Kidwell CS, Montaner J, Langefeld CD, Slowik A, Hansen BM, Lindgren AG, Meschia JF, Fornage M, Bis JC, Debette S, Ikram MA, Longstreth WT, Schmidt R, Zhang CR, Yang Q, Sharma P, Kittner SJ, Mitchell BD, Holliday EG, Levi CR, Attia J, Rothwell PM, Poole DL, Boncoraglio GB, Psaty BM, Malik R, Rost N, Worrall BB, Dichgans M, Van Agtmael T, Woo D, Markus HS, Seshadri S, Rosand J, Sudlow CLM. Common variation in COL4A1/COL4A2 is associated with sporadic cerebral small vessel disease. Neurology 2015; 84:918-26. [PMID: 25653287 DOI: 10.1212/wnl.0000000000001309] [Citation(s) in RCA: 93] [Impact Index Per Article: 10.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/08/2023] Open
Abstract
OBJECTIVES We hypothesized that common variants in the collagen genes COL4A1/COL4A2 are associated with sporadic forms of cerebral small vessel disease. METHODS We conducted meta-analyses of existing genotype data among individuals of European ancestry to determine associations of 1,070 common single nucleotide polymorphisms (SNPs) in the COL4A1/COL4A2 genomic region with the following: intracerebral hemorrhage and its subtypes (deep, lobar) (1,545 cases, 1,485 controls); ischemic stroke and its subtypes (cardioembolic, large vessel disease, lacunar) (12,389 cases, 62,004 controls); and white matter hyperintensities (2,733 individuals with ischemic stroke and 9,361 from population-based cohorts with brain MRI data). We calculated a statistical significance threshold that accounted for multiple testing and linkage disequilibrium between SNPs (p < 0.000084). RESULTS Three intronic SNPs in COL4A2 were significantly associated with deep intracerebral hemorrhage (lead SNP odds ratio [OR] 1.29, 95% confidence interval [CI] 1.14-1.46, p = 0.00003; r(2) > 0.9 between SNPs). Although SNPs associated with deep intracerebral hemorrhage did not reach our significance threshold for association with lacunar ischemic stroke (lead SNP OR 1.10, 95% CI 1.03-1.18, p = 0.0073), and with white matter hyperintensity volume in symptomatic ischemic stroke patients (lead SNP OR 1.07, 95% CI 1.01-1.13, p = 0.016), the direction of association was the same. There was no convincing evidence of association with white matter hyperintensities in population-based studies or with non-small vessel disease cerebrovascular phenotypes. CONCLUSIONS Our results indicate an association between common variation in the COL4A2 gene and symptomatic small vessel disease, particularly deep intracerebral hemorrhage. These findings merit replication studies, including in ethnic groups of non-European ancestry.
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Affiliation(s)
| | - Gail Davies
- Authors' affiliations are listed at the end of the article
| | | | - Steve Bevan
- Authors' affiliations are listed at the end of the article
| | | | | | | | | | | | | | - Ranjan Deka
- Authors' affiliations are listed at the end of the article
| | - Jessica G Woo
- Authors' affiliations are listed at the end of the article
| | - Lisa J Martin
- Authors' affiliations are listed at the end of the article
| | | | - Magdy Selim
- Authors' affiliations are listed at the end of the article
| | - Devin L Brown
- Authors' affiliations are listed at the end of the article
| | | | | | - Joan Montaner
- Authors' affiliations are listed at the end of the article
| | | | | | - Björn M Hansen
- Authors' affiliations are listed at the end of the article
| | | | | | - Myriam Fornage
- Authors' affiliations are listed at the end of the article
| | - Joshua C Bis
- Authors' affiliations are listed at the end of the article
| | | | | | | | | | - Cathy R Zhang
- Authors' affiliations are listed at the end of the article
| | - Qiong Yang
- Authors' affiliations are listed at the end of the article
| | - Pankaj Sharma
- Authors' affiliations are listed at the end of the article
| | | | | | | | | | - John Attia
- Authors' affiliations are listed at the end of the article
| | | | | | | | - Bruce M Psaty
- Authors' affiliations are listed at the end of the article
| | - Rainer Malik
- Authors' affiliations are listed at the end of the article
| | - Natalia Rost
- Authors' affiliations are listed at the end of the article
| | | | | | | | - Daniel Woo
- Authors' affiliations are listed at the end of the article
| | - Hugh S Markus
- Authors' affiliations are listed at the end of the article
| | - Sudha Seshadri
- Authors' affiliations are listed at the end of the article
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Ay H, Arsava EM, Andsberg G, Benner T, Brown RD, Chapman SN, Cole JW, Delavaran H, Dichgans M, Engström G, Giralt-Steinhauer E, Grewal RP, Gwinn K, Jern C, Jimenez-Conde J, Jood K, Katsnelson M, Kissela B, Kittner SJ, Kleindorfer DO, Labovitz DL, Lanfranconi S, Lee JM, Lehm M, Lemmens R, Levi C, Li L, Lindgren A, Markus HS, McArdle PF, Melander O, Norrving B, Peddareddygari LR, Pedersén A, Pera J, Rannikmäe K, Rexrode KM, Rhodes D, Rich SS, Roquer J, Rosand J, Rothwell PM, Rundek T, Sacco RL, Schmidt R, Schürks M, Seiler S, Sharma P, Slowik A, Sudlow C, Thijs V, Woodfield R, Worrall BB, Meschia JF. Pathogenic ischemic stroke phenotypes in the NINDS-stroke genetics network. Stroke 2014; 45:3589-96. [PMID: 25378430 DOI: 10.1161/strokeaha.114.007362] [Citation(s) in RCA: 36] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/13/2023]
Abstract
BACKGROUND AND PURPOSE NINDS (National Institute of Neurological Disorders and Stroke)-SiGN (Stroke Genetics Network) is an international consortium of ischemic stroke studies that aims to generate high-quality phenotype data to identify the genetic basis of pathogenic stroke subtypes. This analysis characterizes the etiopathogenetic basis of ischemic stroke and reliability of stroke classification in the consortium. METHODS Fifty-two trained and certified adjudicators determined both phenotypic (abnormal test findings categorized in major pathogenic groups without weighting toward the most likely cause) and causative ischemic stroke subtypes in 16 954 subjects with imaging-confirmed ischemic stroke from 12 US studies and 11 studies from 8 European countries using the web-based Causative Classification of Stroke System. Classification reliability was assessed with blinded readjudication of 1509 randomly selected cases. RESULTS The distribution of pathogenic categories varied by study, age, sex, and race (P<0.001 for each). Overall, only 40% to 54% of cases with a given major ischemic stroke pathogenesis (phenotypic subtype) were classified into the same final causative category with high confidence. There was good agreement for both causative (κ 0.72; 95% confidence interval, 0.69-0.75) and phenotypic classifications (κ 0.73; 95% confidence interval, 0.70-0.75). CONCLUSIONS This study demonstrates that pathogenic subtypes can be determined with good reliability in studies that include investigators with different expertise and background, institutions with different stroke evaluation protocols and geographic location, and patient populations with different epidemiological characteristics. The discordance between phenotypic and causative stroke subtypes highlights the fact that the presence of an abnormality in a patient with stroke does not necessarily mean that it is the cause of stroke.
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Affiliation(s)
- Hakan Ay
- From the Department of Radiology, AA Martinos Center for Biomedical Imaging (H.A., E.M.A., T.B.), Stroke Service, Department of Neurology (H.A., J.R.), and Center for Human Genetic Research (J.R.), Massachusetts General Hospital, Harvard Medical School, Boston; Department of Neurology and Rehabilitation Medicine, Skåne University Hospital, Lund, Sweden (G.A., H.D., A.L., O.M., B.N.); Department of Neurology, Mayo Clinic Rochester, MN (R.D.B.); Department of Neurology (S.N.C., B.B.W.), Center for Public Health Genomics (S.S.R.), and Department of Public Health Sciences (B.B.W.), University of Virginia, Charlottesville; Department of Neurology (J.W.C., S.J.K.) and Division of Endocrinology, Diabetes, and Nutrition, Department of Medicine (P.F.M.), University of Maryland School of Medicine, Baltimore; Institute for Stroke and Dementia Research (ISD), Klinikum der Universität München, Ludwig-Maximilians-University, München, Germany (M.D., M.L.); Department of Clinical Science, Lund University, Malmö, Sweden (G.E., B.N.); Department of Neurology, Neurovascular Research Group, IMIM-Hospital del Mar, Universitat Autonoma de Barcelona/DCEXS-Universitat Pompeu Fabra, Spain (E.G.-S., J.J.-C., J.R.); Neuroscience Institute, Saint Francis Medical Center, Trenton, NJ (R.P.G., L.R.P.); National Institute of Neurological Disorders and Stroke, National Institutes of Health, Bethesda, MD (K.G.); Institute of Biomedicine (C.J., A.P.) and Institute of Neuroscience and Physiology (K.J.), Sahlgrenska Academy at University of Gothenburg, Sweden; Department of Neurology, University of Miami Miller School of Medicine, FL (M.K., T.R., R.L.S.); Department of Neurology, University of Cincinnati College of Medicine, OH (B.K., D.O.K.); Department of Neurology, Stern Stroke Center, Albert Einstein College of Medicine, Bronx, NY (D.L.L.); Department of Neuroscience and Sensory Organs, Policlinico Hospital Foundation IRCCS Cà Granda, Milan, Italy (S.L.); Department of Neurology, Washington U
| | - Ethem Murat Arsava
- From the Department of Radiology, AA Martinos Center for Biomedical Imaging (H.A., E.M.A., T.B.), Stroke Service, Department of Neurology (H.A., J.R.), and Center for Human Genetic Research (J.R.), Massachusetts General Hospital, Harvard Medical School, Boston; Department of Neurology and Rehabilitation Medicine, Skåne University Hospital, Lund, Sweden (G.A., H.D., A.L., O.M., B.N.); Department of Neurology, Mayo Clinic Rochester, MN (R.D.B.); Department of Neurology (S.N.C., B.B.W.), Center for Public Health Genomics (S.S.R.), and Department of Public Health Sciences (B.B.W.), University of Virginia, Charlottesville; Department of Neurology (J.W.C., S.J.K.) and Division of Endocrinology, Diabetes, and Nutrition, Department of Medicine (P.F.M.), University of Maryland School of Medicine, Baltimore; Institute for Stroke and Dementia Research (ISD), Klinikum der Universität München, Ludwig-Maximilians-University, München, Germany (M.D., M.L.); Department of Clinical Science, Lund University, Malmö, Sweden (G.E., B.N.); Department of Neurology, Neurovascular Research Group, IMIM-Hospital del Mar, Universitat Autonoma de Barcelona/DCEXS-Universitat Pompeu Fabra, Spain (E.G.-S., J.J.-C., J.R.); Neuroscience Institute, Saint Francis Medical Center, Trenton, NJ (R.P.G., L.R.P.); National Institute of Neurological Disorders and Stroke, National Institutes of Health, Bethesda, MD (K.G.); Institute of Biomedicine (C.J., A.P.) and Institute of Neuroscience and Physiology (K.J.), Sahlgrenska Academy at University of Gothenburg, Sweden; Department of Neurology, University of Miami Miller School of Medicine, FL (M.K., T.R., R.L.S.); Department of Neurology, University of Cincinnati College of Medicine, OH (B.K., D.O.K.); Department of Neurology, Stern Stroke Center, Albert Einstein College of Medicine, Bronx, NY (D.L.L.); Department of Neuroscience and Sensory Organs, Policlinico Hospital Foundation IRCCS Cà Granda, Milan, Italy (S.L.); Department of Neurology, Washington U
| | - Gunnar Andsberg
- From the Department of Radiology, AA Martinos Center for Biomedical Imaging (H.A., E.M.A., T.B.), Stroke Service, Department of Neurology (H.A., J.R.), and Center for Human Genetic Research (J.R.), Massachusetts General Hospital, Harvard Medical School, Boston; Department of Neurology and Rehabilitation Medicine, Skåne University Hospital, Lund, Sweden (G.A., H.D., A.L., O.M., B.N.); Department of Neurology, Mayo Clinic Rochester, MN (R.D.B.); Department of Neurology (S.N.C., B.B.W.), Center for Public Health Genomics (S.S.R.), and Department of Public Health Sciences (B.B.W.), University of Virginia, Charlottesville; Department of Neurology (J.W.C., S.J.K.) and Division of Endocrinology, Diabetes, and Nutrition, Department of Medicine (P.F.M.), University of Maryland School of Medicine, Baltimore; Institute for Stroke and Dementia Research (ISD), Klinikum der Universität München, Ludwig-Maximilians-University, München, Germany (M.D., M.L.); Department of Clinical Science, Lund University, Malmö, Sweden (G.E., B.N.); Department of Neurology, Neurovascular Research Group, IMIM-Hospital del Mar, Universitat Autonoma de Barcelona/DCEXS-Universitat Pompeu Fabra, Spain (E.G.-S., J.J.-C., J.R.); Neuroscience Institute, Saint Francis Medical Center, Trenton, NJ (R.P.G., L.R.P.); National Institute of Neurological Disorders and Stroke, National Institutes of Health, Bethesda, MD (K.G.); Institute of Biomedicine (C.J., A.P.) and Institute of Neuroscience and Physiology (K.J.), Sahlgrenska Academy at University of Gothenburg, Sweden; Department of Neurology, University of Miami Miller School of Medicine, FL (M.K., T.R., R.L.S.); Department of Neurology, University of Cincinnati College of Medicine, OH (B.K., D.O.K.); Department of Neurology, Stern Stroke Center, Albert Einstein College of Medicine, Bronx, NY (D.L.L.); Department of Neuroscience and Sensory Organs, Policlinico Hospital Foundation IRCCS Cà Granda, Milan, Italy (S.L.); Department of Neurology, Washington U
| | - Thomas Benner
- From the Department of Radiology, AA Martinos Center for Biomedical Imaging (H.A., E.M.A., T.B.), Stroke Service, Department of Neurology (H.A., J.R.), and Center for Human Genetic Research (J.R.), Massachusetts General Hospital, Harvard Medical School, Boston; Department of Neurology and Rehabilitation Medicine, Skåne University Hospital, Lund, Sweden (G.A., H.D., A.L., O.M., B.N.); Department of Neurology, Mayo Clinic Rochester, MN (R.D.B.); Department of Neurology (S.N.C., B.B.W.), Center for Public Health Genomics (S.S.R.), and Department of Public Health Sciences (B.B.W.), University of Virginia, Charlottesville; Department of Neurology (J.W.C., S.J.K.) and Division of Endocrinology, Diabetes, and Nutrition, Department of Medicine (P.F.M.), University of Maryland School of Medicine, Baltimore; Institute for Stroke and Dementia Research (ISD), Klinikum der Universität München, Ludwig-Maximilians-University, München, Germany (M.D., M.L.); Department of Clinical Science, Lund University, Malmö, Sweden (G.E., B.N.); Department of Neurology, Neurovascular Research Group, IMIM-Hospital del Mar, Universitat Autonoma de Barcelona/DCEXS-Universitat Pompeu Fabra, Spain (E.G.-S., J.J.-C., J.R.); Neuroscience Institute, Saint Francis Medical Center, Trenton, NJ (R.P.G., L.R.P.); National Institute of Neurological Disorders and Stroke, National Institutes of Health, Bethesda, MD (K.G.); Institute of Biomedicine (C.J., A.P.) and Institute of Neuroscience and Physiology (K.J.), Sahlgrenska Academy at University of Gothenburg, Sweden; Department of Neurology, University of Miami Miller School of Medicine, FL (M.K., T.R., R.L.S.); Department of Neurology, University of Cincinnati College of Medicine, OH (B.K., D.O.K.); Department of Neurology, Stern Stroke Center, Albert Einstein College of Medicine, Bronx, NY (D.L.L.); Department of Neuroscience and Sensory Organs, Policlinico Hospital Foundation IRCCS Cà Granda, Milan, Italy (S.L.); Department of Neurology, Washington U
| | - Robert D Brown
- From the Department of Radiology, AA Martinos Center for Biomedical Imaging (H.A., E.M.A., T.B.), Stroke Service, Department of Neurology (H.A., J.R.), and Center for Human Genetic Research (J.R.), Massachusetts General Hospital, Harvard Medical School, Boston; Department of Neurology and Rehabilitation Medicine, Skåne University Hospital, Lund, Sweden (G.A., H.D., A.L., O.M., B.N.); Department of Neurology, Mayo Clinic Rochester, MN (R.D.B.); Department of Neurology (S.N.C., B.B.W.), Center for Public Health Genomics (S.S.R.), and Department of Public Health Sciences (B.B.W.), University of Virginia, Charlottesville; Department of Neurology (J.W.C., S.J.K.) and Division of Endocrinology, Diabetes, and Nutrition, Department of Medicine (P.F.M.), University of Maryland School of Medicine, Baltimore; Institute for Stroke and Dementia Research (ISD), Klinikum der Universität München, Ludwig-Maximilians-University, München, Germany (M.D., M.L.); Department of Clinical Science, Lund University, Malmö, Sweden (G.E., B.N.); Department of Neurology, Neurovascular Research Group, IMIM-Hospital del Mar, Universitat Autonoma de Barcelona/DCEXS-Universitat Pompeu Fabra, Spain (E.G.-S., J.J.-C., J.R.); Neuroscience Institute, Saint Francis Medical Center, Trenton, NJ (R.P.G., L.R.P.); National Institute of Neurological Disorders and Stroke, National Institutes of Health, Bethesda, MD (K.G.); Institute of Biomedicine (C.J., A.P.) and Institute of Neuroscience and Physiology (K.J.), Sahlgrenska Academy at University of Gothenburg, Sweden; Department of Neurology, University of Miami Miller School of Medicine, FL (M.K., T.R., R.L.S.); Department of Neurology, University of Cincinnati College of Medicine, OH (B.K., D.O.K.); Department of Neurology, Stern Stroke Center, Albert Einstein College of Medicine, Bronx, NY (D.L.L.); Department of Neuroscience and Sensory Organs, Policlinico Hospital Foundation IRCCS Cà Granda, Milan, Italy (S.L.); Department of Neurology, Washington U
| | - Sherita N Chapman
- From the Department of Radiology, AA Martinos Center for Biomedical Imaging (H.A., E.M.A., T.B.), Stroke Service, Department of Neurology (H.A., J.R.), and Center for Human Genetic Research (J.R.), Massachusetts General Hospital, Harvard Medical School, Boston; Department of Neurology and Rehabilitation Medicine, Skåne University Hospital, Lund, Sweden (G.A., H.D., A.L., O.M., B.N.); Department of Neurology, Mayo Clinic Rochester, MN (R.D.B.); Department of Neurology (S.N.C., B.B.W.), Center for Public Health Genomics (S.S.R.), and Department of Public Health Sciences (B.B.W.), University of Virginia, Charlottesville; Department of Neurology (J.W.C., S.J.K.) and Division of Endocrinology, Diabetes, and Nutrition, Department of Medicine (P.F.M.), University of Maryland School of Medicine, Baltimore; Institute for Stroke and Dementia Research (ISD), Klinikum der Universität München, Ludwig-Maximilians-University, München, Germany (M.D., M.L.); Department of Clinical Science, Lund University, Malmö, Sweden (G.E., B.N.); Department of Neurology, Neurovascular Research Group, IMIM-Hospital del Mar, Universitat Autonoma de Barcelona/DCEXS-Universitat Pompeu Fabra, Spain (E.G.-S., J.J.-C., J.R.); Neuroscience Institute, Saint Francis Medical Center, Trenton, NJ (R.P.G., L.R.P.); National Institute of Neurological Disorders and Stroke, National Institutes of Health, Bethesda, MD (K.G.); Institute of Biomedicine (C.J., A.P.) and Institute of Neuroscience and Physiology (K.J.), Sahlgrenska Academy at University of Gothenburg, Sweden; Department of Neurology, University of Miami Miller School of Medicine, FL (M.K., T.R., R.L.S.); Department of Neurology, University of Cincinnati College of Medicine, OH (B.K., D.O.K.); Department of Neurology, Stern Stroke Center, Albert Einstein College of Medicine, Bronx, NY (D.L.L.); Department of Neuroscience and Sensory Organs, Policlinico Hospital Foundation IRCCS Cà Granda, Milan, Italy (S.L.); Department of Neurology, Washington U
| | - John W Cole
- From the Department of Radiology, AA Martinos Center for Biomedical Imaging (H.A., E.M.A., T.B.), Stroke Service, Department of Neurology (H.A., J.R.), and Center for Human Genetic Research (J.R.), Massachusetts General Hospital, Harvard Medical School, Boston; Department of Neurology and Rehabilitation Medicine, Skåne University Hospital, Lund, Sweden (G.A., H.D., A.L., O.M., B.N.); Department of Neurology, Mayo Clinic Rochester, MN (R.D.B.); Department of Neurology (S.N.C., B.B.W.), Center for Public Health Genomics (S.S.R.), and Department of Public Health Sciences (B.B.W.), University of Virginia, Charlottesville; Department of Neurology (J.W.C., S.J.K.) and Division of Endocrinology, Diabetes, and Nutrition, Department of Medicine (P.F.M.), University of Maryland School of Medicine, Baltimore; Institute for Stroke and Dementia Research (ISD), Klinikum der Universität München, Ludwig-Maximilians-University, München, Germany (M.D., M.L.); Department of Clinical Science, Lund University, Malmö, Sweden (G.E., B.N.); Department of Neurology, Neurovascular Research Group, IMIM-Hospital del Mar, Universitat Autonoma de Barcelona/DCEXS-Universitat Pompeu Fabra, Spain (E.G.-S., J.J.-C., J.R.); Neuroscience Institute, Saint Francis Medical Center, Trenton, NJ (R.P.G., L.R.P.); National Institute of Neurological Disorders and Stroke, National Institutes of Health, Bethesda, MD (K.G.); Institute of Biomedicine (C.J., A.P.) and Institute of Neuroscience and Physiology (K.J.), Sahlgrenska Academy at University of Gothenburg, Sweden; Department of Neurology, University of Miami Miller School of Medicine, FL (M.K., T.R., R.L.S.); Department of Neurology, University of Cincinnati College of Medicine, OH (B.K., D.O.K.); Department of Neurology, Stern Stroke Center, Albert Einstein College of Medicine, Bronx, NY (D.L.L.); Department of Neuroscience and Sensory Organs, Policlinico Hospital Foundation IRCCS Cà Granda, Milan, Italy (S.L.); Department of Neurology, Washington U
| | - Hossein Delavaran
- From the Department of Radiology, AA Martinos Center for Biomedical Imaging (H.A., E.M.A., T.B.), Stroke Service, Department of Neurology (H.A., J.R.), and Center for Human Genetic Research (J.R.), Massachusetts General Hospital, Harvard Medical School, Boston; Department of Neurology and Rehabilitation Medicine, Skåne University Hospital, Lund, Sweden (G.A., H.D., A.L., O.M., B.N.); Department of Neurology, Mayo Clinic Rochester, MN (R.D.B.); Department of Neurology (S.N.C., B.B.W.), Center for Public Health Genomics (S.S.R.), and Department of Public Health Sciences (B.B.W.), University of Virginia, Charlottesville; Department of Neurology (J.W.C., S.J.K.) and Division of Endocrinology, Diabetes, and Nutrition, Department of Medicine (P.F.M.), University of Maryland School of Medicine, Baltimore; Institute for Stroke and Dementia Research (ISD), Klinikum der Universität München, Ludwig-Maximilians-University, München, Germany (M.D., M.L.); Department of Clinical Science, Lund University, Malmö, Sweden (G.E., B.N.); Department of Neurology, Neurovascular Research Group, IMIM-Hospital del Mar, Universitat Autonoma de Barcelona/DCEXS-Universitat Pompeu Fabra, Spain (E.G.-S., J.J.-C., J.R.); Neuroscience Institute, Saint Francis Medical Center, Trenton, NJ (R.P.G., L.R.P.); National Institute of Neurological Disorders and Stroke, National Institutes of Health, Bethesda, MD (K.G.); Institute of Biomedicine (C.J., A.P.) and Institute of Neuroscience and Physiology (K.J.), Sahlgrenska Academy at University of Gothenburg, Sweden; Department of Neurology, University of Miami Miller School of Medicine, FL (M.K., T.R., R.L.S.); Department of Neurology, University of Cincinnati College of Medicine, OH (B.K., D.O.K.); Department of Neurology, Stern Stroke Center, Albert Einstein College of Medicine, Bronx, NY (D.L.L.); Department of Neuroscience and Sensory Organs, Policlinico Hospital Foundation IRCCS Cà Granda, Milan, Italy (S.L.); Department of Neurology, Washington U
| | - Martin Dichgans
- From the Department of Radiology, AA Martinos Center for Biomedical Imaging (H.A., E.M.A., T.B.), Stroke Service, Department of Neurology (H.A., J.R.), and Center for Human Genetic Research (J.R.), Massachusetts General Hospital, Harvard Medical School, Boston; Department of Neurology and Rehabilitation Medicine, Skåne University Hospital, Lund, Sweden (G.A., H.D., A.L., O.M., B.N.); Department of Neurology, Mayo Clinic Rochester, MN (R.D.B.); Department of Neurology (S.N.C., B.B.W.), Center for Public Health Genomics (S.S.R.), and Department of Public Health Sciences (B.B.W.), University of Virginia, Charlottesville; Department of Neurology (J.W.C., S.J.K.) and Division of Endocrinology, Diabetes, and Nutrition, Department of Medicine (P.F.M.), University of Maryland School of Medicine, Baltimore; Institute for Stroke and Dementia Research (ISD), Klinikum der Universität München, Ludwig-Maximilians-University, München, Germany (M.D., M.L.); Department of Clinical Science, Lund University, Malmö, Sweden (G.E., B.N.); Department of Neurology, Neurovascular Research Group, IMIM-Hospital del Mar, Universitat Autonoma de Barcelona/DCEXS-Universitat Pompeu Fabra, Spain (E.G.-S., J.J.-C., J.R.); Neuroscience Institute, Saint Francis Medical Center, Trenton, NJ (R.P.G., L.R.P.); National Institute of Neurological Disorders and Stroke, National Institutes of Health, Bethesda, MD (K.G.); Institute of Biomedicine (C.J., A.P.) and Institute of Neuroscience and Physiology (K.J.), Sahlgrenska Academy at University of Gothenburg, Sweden; Department of Neurology, University of Miami Miller School of Medicine, FL (M.K., T.R., R.L.S.); Department of Neurology, University of Cincinnati College of Medicine, OH (B.K., D.O.K.); Department of Neurology, Stern Stroke Center, Albert Einstein College of Medicine, Bronx, NY (D.L.L.); Department of Neuroscience and Sensory Organs, Policlinico Hospital Foundation IRCCS Cà Granda, Milan, Italy (S.L.); Department of Neurology, Washington U
| | - Gunnar Engström
- From the Department of Radiology, AA Martinos Center for Biomedical Imaging (H.A., E.M.A., T.B.), Stroke Service, Department of Neurology (H.A., J.R.), and Center for Human Genetic Research (J.R.), Massachusetts General Hospital, Harvard Medical School, Boston; Department of Neurology and Rehabilitation Medicine, Skåne University Hospital, Lund, Sweden (G.A., H.D., A.L., O.M., B.N.); Department of Neurology, Mayo Clinic Rochester, MN (R.D.B.); Department of Neurology (S.N.C., B.B.W.), Center for Public Health Genomics (S.S.R.), and Department of Public Health Sciences (B.B.W.), University of Virginia, Charlottesville; Department of Neurology (J.W.C., S.J.K.) and Division of Endocrinology, Diabetes, and Nutrition, Department of Medicine (P.F.M.), University of Maryland School of Medicine, Baltimore; Institute for Stroke and Dementia Research (ISD), Klinikum der Universität München, Ludwig-Maximilians-University, München, Germany (M.D., M.L.); Department of Clinical Science, Lund University, Malmö, Sweden (G.E., B.N.); Department of Neurology, Neurovascular Research Group, IMIM-Hospital del Mar, Universitat Autonoma de Barcelona/DCEXS-Universitat Pompeu Fabra, Spain (E.G.-S., J.J.-C., J.R.); Neuroscience Institute, Saint Francis Medical Center, Trenton, NJ (R.P.G., L.R.P.); National Institute of Neurological Disorders and Stroke, National Institutes of Health, Bethesda, MD (K.G.); Institute of Biomedicine (C.J., A.P.) and Institute of Neuroscience and Physiology (K.J.), Sahlgrenska Academy at University of Gothenburg, Sweden; Department of Neurology, University of Miami Miller School of Medicine, FL (M.K., T.R., R.L.S.); Department of Neurology, University of Cincinnati College of Medicine, OH (B.K., D.O.K.); Department of Neurology, Stern Stroke Center, Albert Einstein College of Medicine, Bronx, NY (D.L.L.); Department of Neuroscience and Sensory Organs, Policlinico Hospital Foundation IRCCS Cà Granda, Milan, Italy (S.L.); Department of Neurology, Washington U
| | - Eva Giralt-Steinhauer
- From the Department of Radiology, AA Martinos Center for Biomedical Imaging (H.A., E.M.A., T.B.), Stroke Service, Department of Neurology (H.A., J.R.), and Center for Human Genetic Research (J.R.), Massachusetts General Hospital, Harvard Medical School, Boston; Department of Neurology and Rehabilitation Medicine, Skåne University Hospital, Lund, Sweden (G.A., H.D., A.L., O.M., B.N.); Department of Neurology, Mayo Clinic Rochester, MN (R.D.B.); Department of Neurology (S.N.C., B.B.W.), Center for Public Health Genomics (S.S.R.), and Department of Public Health Sciences (B.B.W.), University of Virginia, Charlottesville; Department of Neurology (J.W.C., S.J.K.) and Division of Endocrinology, Diabetes, and Nutrition, Department of Medicine (P.F.M.), University of Maryland School of Medicine, Baltimore; Institute for Stroke and Dementia Research (ISD), Klinikum der Universität München, Ludwig-Maximilians-University, München, Germany (M.D., M.L.); Department of Clinical Science, Lund University, Malmö, Sweden (G.E., B.N.); Department of Neurology, Neurovascular Research Group, IMIM-Hospital del Mar, Universitat Autonoma de Barcelona/DCEXS-Universitat Pompeu Fabra, Spain (E.G.-S., J.J.-C., J.R.); Neuroscience Institute, Saint Francis Medical Center, Trenton, NJ (R.P.G., L.R.P.); National Institute of Neurological Disorders and Stroke, National Institutes of Health, Bethesda, MD (K.G.); Institute of Biomedicine (C.J., A.P.) and Institute of Neuroscience and Physiology (K.J.), Sahlgrenska Academy at University of Gothenburg, Sweden; Department of Neurology, University of Miami Miller School of Medicine, FL (M.K., T.R., R.L.S.); Department of Neurology, University of Cincinnati College of Medicine, OH (B.K., D.O.K.); Department of Neurology, Stern Stroke Center, Albert Einstein College of Medicine, Bronx, NY (D.L.L.); Department of Neuroscience and Sensory Organs, Policlinico Hospital Foundation IRCCS Cà Granda, Milan, Italy (S.L.); Department of Neurology, Washington U
| | - Raji P Grewal
- From the Department of Radiology, AA Martinos Center for Biomedical Imaging (H.A., E.M.A., T.B.), Stroke Service, Department of Neurology (H.A., J.R.), and Center for Human Genetic Research (J.R.), Massachusetts General Hospital, Harvard Medical School, Boston; Department of Neurology and Rehabilitation Medicine, Skåne University Hospital, Lund, Sweden (G.A., H.D., A.L., O.M., B.N.); Department of Neurology, Mayo Clinic Rochester, MN (R.D.B.); Department of Neurology (S.N.C., B.B.W.), Center for Public Health Genomics (S.S.R.), and Department of Public Health Sciences (B.B.W.), University of Virginia, Charlottesville; Department of Neurology (J.W.C., S.J.K.) and Division of Endocrinology, Diabetes, and Nutrition, Department of Medicine (P.F.M.), University of Maryland School of Medicine, Baltimore; Institute for Stroke and Dementia Research (ISD), Klinikum der Universität München, Ludwig-Maximilians-University, München, Germany (M.D., M.L.); Department of Clinical Science, Lund University, Malmö, Sweden (G.E., B.N.); Department of Neurology, Neurovascular Research Group, IMIM-Hospital del Mar, Universitat Autonoma de Barcelona/DCEXS-Universitat Pompeu Fabra, Spain (E.G.-S., J.J.-C., J.R.); Neuroscience Institute, Saint Francis Medical Center, Trenton, NJ (R.P.G., L.R.P.); National Institute of Neurological Disorders and Stroke, National Institutes of Health, Bethesda, MD (K.G.); Institute of Biomedicine (C.J., A.P.) and Institute of Neuroscience and Physiology (K.J.), Sahlgrenska Academy at University of Gothenburg, Sweden; Department of Neurology, University of Miami Miller School of Medicine, FL (M.K., T.R., R.L.S.); Department of Neurology, University of Cincinnati College of Medicine, OH (B.K., D.O.K.); Department of Neurology, Stern Stroke Center, Albert Einstein College of Medicine, Bronx, NY (D.L.L.); Department of Neuroscience and Sensory Organs, Policlinico Hospital Foundation IRCCS Cà Granda, Milan, Italy (S.L.); Department of Neurology, Washington U
| | - Katrina Gwinn
- From the Department of Radiology, AA Martinos Center for Biomedical Imaging (H.A., E.M.A., T.B.), Stroke Service, Department of Neurology (H.A., J.R.), and Center for Human Genetic Research (J.R.), Massachusetts General Hospital, Harvard Medical School, Boston; Department of Neurology and Rehabilitation Medicine, Skåne University Hospital, Lund, Sweden (G.A., H.D., A.L., O.M., B.N.); Department of Neurology, Mayo Clinic Rochester, MN (R.D.B.); Department of Neurology (S.N.C., B.B.W.), Center for Public Health Genomics (S.S.R.), and Department of Public Health Sciences (B.B.W.), University of Virginia, Charlottesville; Department of Neurology (J.W.C., S.J.K.) and Division of Endocrinology, Diabetes, and Nutrition, Department of Medicine (P.F.M.), University of Maryland School of Medicine, Baltimore; Institute for Stroke and Dementia Research (ISD), Klinikum der Universität München, Ludwig-Maximilians-University, München, Germany (M.D., M.L.); Department of Clinical Science, Lund University, Malmö, Sweden (G.E., B.N.); Department of Neurology, Neurovascular Research Group, IMIM-Hospital del Mar, Universitat Autonoma de Barcelona/DCEXS-Universitat Pompeu Fabra, Spain (E.G.-S., J.J.-C., J.R.); Neuroscience Institute, Saint Francis Medical Center, Trenton, NJ (R.P.G., L.R.P.); National Institute of Neurological Disorders and Stroke, National Institutes of Health, Bethesda, MD (K.G.); Institute of Biomedicine (C.J., A.P.) and Institute of Neuroscience and Physiology (K.J.), Sahlgrenska Academy at University of Gothenburg, Sweden; Department of Neurology, University of Miami Miller School of Medicine, FL (M.K., T.R., R.L.S.); Department of Neurology, University of Cincinnati College of Medicine, OH (B.K., D.O.K.); Department of Neurology, Stern Stroke Center, Albert Einstein College of Medicine, Bronx, NY (D.L.L.); Department of Neuroscience and Sensory Organs, Policlinico Hospital Foundation IRCCS Cà Granda, Milan, Italy (S.L.); Department of Neurology, Washington U
| | - Christina Jern
- From the Department of Radiology, AA Martinos Center for Biomedical Imaging (H.A., E.M.A., T.B.), Stroke Service, Department of Neurology (H.A., J.R.), and Center for Human Genetic Research (J.R.), Massachusetts General Hospital, Harvard Medical School, Boston; Department of Neurology and Rehabilitation Medicine, Skåne University Hospital, Lund, Sweden (G.A., H.D., A.L., O.M., B.N.); Department of Neurology, Mayo Clinic Rochester, MN (R.D.B.); Department of Neurology (S.N.C., B.B.W.), Center for Public Health Genomics (S.S.R.), and Department of Public Health Sciences (B.B.W.), University of Virginia, Charlottesville; Department of Neurology (J.W.C., S.J.K.) and Division of Endocrinology, Diabetes, and Nutrition, Department of Medicine (P.F.M.), University of Maryland School of Medicine, Baltimore; Institute for Stroke and Dementia Research (ISD), Klinikum der Universität München, Ludwig-Maximilians-University, München, Germany (M.D., M.L.); Department of Clinical Science, Lund University, Malmö, Sweden (G.E., B.N.); Department of Neurology, Neurovascular Research Group, IMIM-Hospital del Mar, Universitat Autonoma de Barcelona/DCEXS-Universitat Pompeu Fabra, Spain (E.G.-S., J.J.-C., J.R.); Neuroscience Institute, Saint Francis Medical Center, Trenton, NJ (R.P.G., L.R.P.); National Institute of Neurological Disorders and Stroke, National Institutes of Health, Bethesda, MD (K.G.); Institute of Biomedicine (C.J., A.P.) and Institute of Neuroscience and Physiology (K.J.), Sahlgrenska Academy at University of Gothenburg, Sweden; Department of Neurology, University of Miami Miller School of Medicine, FL (M.K., T.R., R.L.S.); Department of Neurology, University of Cincinnati College of Medicine, OH (B.K., D.O.K.); Department of Neurology, Stern Stroke Center, Albert Einstein College of Medicine, Bronx, NY (D.L.L.); Department of Neuroscience and Sensory Organs, Policlinico Hospital Foundation IRCCS Cà Granda, Milan, Italy (S.L.); Department of Neurology, Washington U
| | - Jordi Jimenez-Conde
- From the Department of Radiology, AA Martinos Center for Biomedical Imaging (H.A., E.M.A., T.B.), Stroke Service, Department of Neurology (H.A., J.R.), and Center for Human Genetic Research (J.R.), Massachusetts General Hospital, Harvard Medical School, Boston; Department of Neurology and Rehabilitation Medicine, Skåne University Hospital, Lund, Sweden (G.A., H.D., A.L., O.M., B.N.); Department of Neurology, Mayo Clinic Rochester, MN (R.D.B.); Department of Neurology (S.N.C., B.B.W.), Center for Public Health Genomics (S.S.R.), and Department of Public Health Sciences (B.B.W.), University of Virginia, Charlottesville; Department of Neurology (J.W.C., S.J.K.) and Division of Endocrinology, Diabetes, and Nutrition, Department of Medicine (P.F.M.), University of Maryland School of Medicine, Baltimore; Institute for Stroke and Dementia Research (ISD), Klinikum der Universität München, Ludwig-Maximilians-University, München, Germany (M.D., M.L.); Department of Clinical Science, Lund University, Malmö, Sweden (G.E., B.N.); Department of Neurology, Neurovascular Research Group, IMIM-Hospital del Mar, Universitat Autonoma de Barcelona/DCEXS-Universitat Pompeu Fabra, Spain (E.G.-S., J.J.-C., J.R.); Neuroscience Institute, Saint Francis Medical Center, Trenton, NJ (R.P.G., L.R.P.); National Institute of Neurological Disorders and Stroke, National Institutes of Health, Bethesda, MD (K.G.); Institute of Biomedicine (C.J., A.P.) and Institute of Neuroscience and Physiology (K.J.), Sahlgrenska Academy at University of Gothenburg, Sweden; Department of Neurology, University of Miami Miller School of Medicine, FL (M.K., T.R., R.L.S.); Department of Neurology, University of Cincinnati College of Medicine, OH (B.K., D.O.K.); Department of Neurology, Stern Stroke Center, Albert Einstein College of Medicine, Bronx, NY (D.L.L.); Department of Neuroscience and Sensory Organs, Policlinico Hospital Foundation IRCCS Cà Granda, Milan, Italy (S.L.); Department of Neurology, Washington U
| | - Katarina Jood
- From the Department of Radiology, AA Martinos Center for Biomedical Imaging (H.A., E.M.A., T.B.), Stroke Service, Department of Neurology (H.A., J.R.), and Center for Human Genetic Research (J.R.), Massachusetts General Hospital, Harvard Medical School, Boston; Department of Neurology and Rehabilitation Medicine, Skåne University Hospital, Lund, Sweden (G.A., H.D., A.L., O.M., B.N.); Department of Neurology, Mayo Clinic Rochester, MN (R.D.B.); Department of Neurology (S.N.C., B.B.W.), Center for Public Health Genomics (S.S.R.), and Department of Public Health Sciences (B.B.W.), University of Virginia, Charlottesville; Department of Neurology (J.W.C., S.J.K.) and Division of Endocrinology, Diabetes, and Nutrition, Department of Medicine (P.F.M.), University of Maryland School of Medicine, Baltimore; Institute for Stroke and Dementia Research (ISD), Klinikum der Universität München, Ludwig-Maximilians-University, München, Germany (M.D., M.L.); Department of Clinical Science, Lund University, Malmö, Sweden (G.E., B.N.); Department of Neurology, Neurovascular Research Group, IMIM-Hospital del Mar, Universitat Autonoma de Barcelona/DCEXS-Universitat Pompeu Fabra, Spain (E.G.-S., J.J.-C., J.R.); Neuroscience Institute, Saint Francis Medical Center, Trenton, NJ (R.P.G., L.R.P.); National Institute of Neurological Disorders and Stroke, National Institutes of Health, Bethesda, MD (K.G.); Institute of Biomedicine (C.J., A.P.) and Institute of Neuroscience and Physiology (K.J.), Sahlgrenska Academy at University of Gothenburg, Sweden; Department of Neurology, University of Miami Miller School of Medicine, FL (M.K., T.R., R.L.S.); Department of Neurology, University of Cincinnati College of Medicine, OH (B.K., D.O.K.); Department of Neurology, Stern Stroke Center, Albert Einstein College of Medicine, Bronx, NY (D.L.L.); Department of Neuroscience and Sensory Organs, Policlinico Hospital Foundation IRCCS Cà Granda, Milan, Italy (S.L.); Department of Neurology, Washington U
| | - Michael Katsnelson
- From the Department of Radiology, AA Martinos Center for Biomedical Imaging (H.A., E.M.A., T.B.), Stroke Service, Department of Neurology (H.A., J.R.), and Center for Human Genetic Research (J.R.), Massachusetts General Hospital, Harvard Medical School, Boston; Department of Neurology and Rehabilitation Medicine, Skåne University Hospital, Lund, Sweden (G.A., H.D., A.L., O.M., B.N.); Department of Neurology, Mayo Clinic Rochester, MN (R.D.B.); Department of Neurology (S.N.C., B.B.W.), Center for Public Health Genomics (S.S.R.), and Department of Public Health Sciences (B.B.W.), University of Virginia, Charlottesville; Department of Neurology (J.W.C., S.J.K.) and Division of Endocrinology, Diabetes, and Nutrition, Department of Medicine (P.F.M.), University of Maryland School of Medicine, Baltimore; Institute for Stroke and Dementia Research (ISD), Klinikum der Universität München, Ludwig-Maximilians-University, München, Germany (M.D., M.L.); Department of Clinical Science, Lund University, Malmö, Sweden (G.E., B.N.); Department of Neurology, Neurovascular Research Group, IMIM-Hospital del Mar, Universitat Autonoma de Barcelona/DCEXS-Universitat Pompeu Fabra, Spain (E.G.-S., J.J.-C., J.R.); Neuroscience Institute, Saint Francis Medical Center, Trenton, NJ (R.P.G., L.R.P.); National Institute of Neurological Disorders and Stroke, National Institutes of Health, Bethesda, MD (K.G.); Institute of Biomedicine (C.J., A.P.) and Institute of Neuroscience and Physiology (K.J.), Sahlgrenska Academy at University of Gothenburg, Sweden; Department of Neurology, University of Miami Miller School of Medicine, FL (M.K., T.R., R.L.S.); Department of Neurology, University of Cincinnati College of Medicine, OH (B.K., D.O.K.); Department of Neurology, Stern Stroke Center, Albert Einstein College of Medicine, Bronx, NY (D.L.L.); Department of Neuroscience and Sensory Organs, Policlinico Hospital Foundation IRCCS Cà Granda, Milan, Italy (S.L.); Department of Neurology, Washington U
| | - Brett Kissela
- From the Department of Radiology, AA Martinos Center for Biomedical Imaging (H.A., E.M.A., T.B.), Stroke Service, Department of Neurology (H.A., J.R.), and Center for Human Genetic Research (J.R.), Massachusetts General Hospital, Harvard Medical School, Boston; Department of Neurology and Rehabilitation Medicine, Skåne University Hospital, Lund, Sweden (G.A., H.D., A.L., O.M., B.N.); Department of Neurology, Mayo Clinic Rochester, MN (R.D.B.); Department of Neurology (S.N.C., B.B.W.), Center for Public Health Genomics (S.S.R.), and Department of Public Health Sciences (B.B.W.), University of Virginia, Charlottesville; Department of Neurology (J.W.C., S.J.K.) and Division of Endocrinology, Diabetes, and Nutrition, Department of Medicine (P.F.M.), University of Maryland School of Medicine, Baltimore; Institute for Stroke and Dementia Research (ISD), Klinikum der Universität München, Ludwig-Maximilians-University, München, Germany (M.D., M.L.); Department of Clinical Science, Lund University, Malmö, Sweden (G.E., B.N.); Department of Neurology, Neurovascular Research Group, IMIM-Hospital del Mar, Universitat Autonoma de Barcelona/DCEXS-Universitat Pompeu Fabra, Spain (E.G.-S., J.J.-C., J.R.); Neuroscience Institute, Saint Francis Medical Center, Trenton, NJ (R.P.G., L.R.P.); National Institute of Neurological Disorders and Stroke, National Institutes of Health, Bethesda, MD (K.G.); Institute of Biomedicine (C.J., A.P.) and Institute of Neuroscience and Physiology (K.J.), Sahlgrenska Academy at University of Gothenburg, Sweden; Department of Neurology, University of Miami Miller School of Medicine, FL (M.K., T.R., R.L.S.); Department of Neurology, University of Cincinnati College of Medicine, OH (B.K., D.O.K.); Department of Neurology, Stern Stroke Center, Albert Einstein College of Medicine, Bronx, NY (D.L.L.); Department of Neuroscience and Sensory Organs, Policlinico Hospital Foundation IRCCS Cà Granda, Milan, Italy (S.L.); Department of Neurology, Washington U
| | - Steven J Kittner
- From the Department of Radiology, AA Martinos Center for Biomedical Imaging (H.A., E.M.A., T.B.), Stroke Service, Department of Neurology (H.A., J.R.), and Center for Human Genetic Research (J.R.), Massachusetts General Hospital, Harvard Medical School, Boston; Department of Neurology and Rehabilitation Medicine, Skåne University Hospital, Lund, Sweden (G.A., H.D., A.L., O.M., B.N.); Department of Neurology, Mayo Clinic Rochester, MN (R.D.B.); Department of Neurology (S.N.C., B.B.W.), Center for Public Health Genomics (S.S.R.), and Department of Public Health Sciences (B.B.W.), University of Virginia, Charlottesville; Department of Neurology (J.W.C., S.J.K.) and Division of Endocrinology, Diabetes, and Nutrition, Department of Medicine (P.F.M.), University of Maryland School of Medicine, Baltimore; Institute for Stroke and Dementia Research (ISD), Klinikum der Universität München, Ludwig-Maximilians-University, München, Germany (M.D., M.L.); Department of Clinical Science, Lund University, Malmö, Sweden (G.E., B.N.); Department of Neurology, Neurovascular Research Group, IMIM-Hospital del Mar, Universitat Autonoma de Barcelona/DCEXS-Universitat Pompeu Fabra, Spain (E.G.-S., J.J.-C., J.R.); Neuroscience Institute, Saint Francis Medical Center, Trenton, NJ (R.P.G., L.R.P.); National Institute of Neurological Disorders and Stroke, National Institutes of Health, Bethesda, MD (K.G.); Institute of Biomedicine (C.J., A.P.) and Institute of Neuroscience and Physiology (K.J.), Sahlgrenska Academy at University of Gothenburg, Sweden; Department of Neurology, University of Miami Miller School of Medicine, FL (M.K., T.R., R.L.S.); Department of Neurology, University of Cincinnati College of Medicine, OH (B.K., D.O.K.); Department of Neurology, Stern Stroke Center, Albert Einstein College of Medicine, Bronx, NY (D.L.L.); Department of Neuroscience and Sensory Organs, Policlinico Hospital Foundation IRCCS Cà Granda, Milan, Italy (S.L.); Department of Neurology, Washington U
| | - Dawn O Kleindorfer
- From the Department of Radiology, AA Martinos Center for Biomedical Imaging (H.A., E.M.A., T.B.), Stroke Service, Department of Neurology (H.A., J.R.), and Center for Human Genetic Research (J.R.), Massachusetts General Hospital, Harvard Medical School, Boston; Department of Neurology and Rehabilitation Medicine, Skåne University Hospital, Lund, Sweden (G.A., H.D., A.L., O.M., B.N.); Department of Neurology, Mayo Clinic Rochester, MN (R.D.B.); Department of Neurology (S.N.C., B.B.W.), Center for Public Health Genomics (S.S.R.), and Department of Public Health Sciences (B.B.W.), University of Virginia, Charlottesville; Department of Neurology (J.W.C., S.J.K.) and Division of Endocrinology, Diabetes, and Nutrition, Department of Medicine (P.F.M.), University of Maryland School of Medicine, Baltimore; Institute for Stroke and Dementia Research (ISD), Klinikum der Universität München, Ludwig-Maximilians-University, München, Germany (M.D., M.L.); Department of Clinical Science, Lund University, Malmö, Sweden (G.E., B.N.); Department of Neurology, Neurovascular Research Group, IMIM-Hospital del Mar, Universitat Autonoma de Barcelona/DCEXS-Universitat Pompeu Fabra, Spain (E.G.-S., J.J.-C., J.R.); Neuroscience Institute, Saint Francis Medical Center, Trenton, NJ (R.P.G., L.R.P.); National Institute of Neurological Disorders and Stroke, National Institutes of Health, Bethesda, MD (K.G.); Institute of Biomedicine (C.J., A.P.) and Institute of Neuroscience and Physiology (K.J.), Sahlgrenska Academy at University of Gothenburg, Sweden; Department of Neurology, University of Miami Miller School of Medicine, FL (M.K., T.R., R.L.S.); Department of Neurology, University of Cincinnati College of Medicine, OH (B.K., D.O.K.); Department of Neurology, Stern Stroke Center, Albert Einstein College of Medicine, Bronx, NY (D.L.L.); Department of Neuroscience and Sensory Organs, Policlinico Hospital Foundation IRCCS Cà Granda, Milan, Italy (S.L.); Department of Neurology, Washington U
| | - Daniel L Labovitz
- From the Department of Radiology, AA Martinos Center for Biomedical Imaging (H.A., E.M.A., T.B.), Stroke Service, Department of Neurology (H.A., J.R.), and Center for Human Genetic Research (J.R.), Massachusetts General Hospital, Harvard Medical School, Boston; Department of Neurology and Rehabilitation Medicine, Skåne University Hospital, Lund, Sweden (G.A., H.D., A.L., O.M., B.N.); Department of Neurology, Mayo Clinic Rochester, MN (R.D.B.); Department of Neurology (S.N.C., B.B.W.), Center for Public Health Genomics (S.S.R.), and Department of Public Health Sciences (B.B.W.), University of Virginia, Charlottesville; Department of Neurology (J.W.C., S.J.K.) and Division of Endocrinology, Diabetes, and Nutrition, Department of Medicine (P.F.M.), University of Maryland School of Medicine, Baltimore; Institute for Stroke and Dementia Research (ISD), Klinikum der Universität München, Ludwig-Maximilians-University, München, Germany (M.D., M.L.); Department of Clinical Science, Lund University, Malmö, Sweden (G.E., B.N.); Department of Neurology, Neurovascular Research Group, IMIM-Hospital del Mar, Universitat Autonoma de Barcelona/DCEXS-Universitat Pompeu Fabra, Spain (E.G.-S., J.J.-C., J.R.); Neuroscience Institute, Saint Francis Medical Center, Trenton, NJ (R.P.G., L.R.P.); National Institute of Neurological Disorders and Stroke, National Institutes of Health, Bethesda, MD (K.G.); Institute of Biomedicine (C.J., A.P.) and Institute of Neuroscience and Physiology (K.J.), Sahlgrenska Academy at University of Gothenburg, Sweden; Department of Neurology, University of Miami Miller School of Medicine, FL (M.K., T.R., R.L.S.); Department of Neurology, University of Cincinnati College of Medicine, OH (B.K., D.O.K.); Department of Neurology, Stern Stroke Center, Albert Einstein College of Medicine, Bronx, NY (D.L.L.); Department of Neuroscience and Sensory Organs, Policlinico Hospital Foundation IRCCS Cà Granda, Milan, Italy (S.L.); Department of Neurology, Washington U
| | - Silvia Lanfranconi
- From the Department of Radiology, AA Martinos Center for Biomedical Imaging (H.A., E.M.A., T.B.), Stroke Service, Department of Neurology (H.A., J.R.), and Center for Human Genetic Research (J.R.), Massachusetts General Hospital, Harvard Medical School, Boston; Department of Neurology and Rehabilitation Medicine, Skåne University Hospital, Lund, Sweden (G.A., H.D., A.L., O.M., B.N.); Department of Neurology, Mayo Clinic Rochester, MN (R.D.B.); Department of Neurology (S.N.C., B.B.W.), Center for Public Health Genomics (S.S.R.), and Department of Public Health Sciences (B.B.W.), University of Virginia, Charlottesville; Department of Neurology (J.W.C., S.J.K.) and Division of Endocrinology, Diabetes, and Nutrition, Department of Medicine (P.F.M.), University of Maryland School of Medicine, Baltimore; Institute for Stroke and Dementia Research (ISD), Klinikum der Universität München, Ludwig-Maximilians-University, München, Germany (M.D., M.L.); Department of Clinical Science, Lund University, Malmö, Sweden (G.E., B.N.); Department of Neurology, Neurovascular Research Group, IMIM-Hospital del Mar, Universitat Autonoma de Barcelona/DCEXS-Universitat Pompeu Fabra, Spain (E.G.-S., J.J.-C., J.R.); Neuroscience Institute, Saint Francis Medical Center, Trenton, NJ (R.P.G., L.R.P.); National Institute of Neurological Disorders and Stroke, National Institutes of Health, Bethesda, MD (K.G.); Institute of Biomedicine (C.J., A.P.) and Institute of Neuroscience and Physiology (K.J.), Sahlgrenska Academy at University of Gothenburg, Sweden; Department of Neurology, University of Miami Miller School of Medicine, FL (M.K., T.R., R.L.S.); Department of Neurology, University of Cincinnati College of Medicine, OH (B.K., D.O.K.); Department of Neurology, Stern Stroke Center, Albert Einstein College of Medicine, Bronx, NY (D.L.L.); Department of Neuroscience and Sensory Organs, Policlinico Hospital Foundation IRCCS Cà Granda, Milan, Italy (S.L.); Department of Neurology, Washington U
| | - Jin-Moo Lee
- From the Department of Radiology, AA Martinos Center for Biomedical Imaging (H.A., E.M.A., T.B.), Stroke Service, Department of Neurology (H.A., J.R.), and Center for Human Genetic Research (J.R.), Massachusetts General Hospital, Harvard Medical School, Boston; Department of Neurology and Rehabilitation Medicine, Skåne University Hospital, Lund, Sweden (G.A., H.D., A.L., O.M., B.N.); Department of Neurology, Mayo Clinic Rochester, MN (R.D.B.); Department of Neurology (S.N.C., B.B.W.), Center for Public Health Genomics (S.S.R.), and Department of Public Health Sciences (B.B.W.), University of Virginia, Charlottesville; Department of Neurology (J.W.C., S.J.K.) and Division of Endocrinology, Diabetes, and Nutrition, Department of Medicine (P.F.M.), University of Maryland School of Medicine, Baltimore; Institute for Stroke and Dementia Research (ISD), Klinikum der Universität München, Ludwig-Maximilians-University, München, Germany (M.D., M.L.); Department of Clinical Science, Lund University, Malmö, Sweden (G.E., B.N.); Department of Neurology, Neurovascular Research Group, IMIM-Hospital del Mar, Universitat Autonoma de Barcelona/DCEXS-Universitat Pompeu Fabra, Spain (E.G.-S., J.J.-C., J.R.); Neuroscience Institute, Saint Francis Medical Center, Trenton, NJ (R.P.G., L.R.P.); National Institute of Neurological Disorders and Stroke, National Institutes of Health, Bethesda, MD (K.G.); Institute of Biomedicine (C.J., A.P.) and Institute of Neuroscience and Physiology (K.J.), Sahlgrenska Academy at University of Gothenburg, Sweden; Department of Neurology, University of Miami Miller School of Medicine, FL (M.K., T.R., R.L.S.); Department of Neurology, University of Cincinnati College of Medicine, OH (B.K., D.O.K.); Department of Neurology, Stern Stroke Center, Albert Einstein College of Medicine, Bronx, NY (D.L.L.); Department of Neuroscience and Sensory Organs, Policlinico Hospital Foundation IRCCS Cà Granda, Milan, Italy (S.L.); Department of Neurology, Washington U
| | - Manuel Lehm
- From the Department of Radiology, AA Martinos Center for Biomedical Imaging (H.A., E.M.A., T.B.), Stroke Service, Department of Neurology (H.A., J.R.), and Center for Human Genetic Research (J.R.), Massachusetts General Hospital, Harvard Medical School, Boston; Department of Neurology and Rehabilitation Medicine, Skåne University Hospital, Lund, Sweden (G.A., H.D., A.L., O.M., B.N.); Department of Neurology, Mayo Clinic Rochester, MN (R.D.B.); Department of Neurology (S.N.C., B.B.W.), Center for Public Health Genomics (S.S.R.), and Department of Public Health Sciences (B.B.W.), University of Virginia, Charlottesville; Department of Neurology (J.W.C., S.J.K.) and Division of Endocrinology, Diabetes, and Nutrition, Department of Medicine (P.F.M.), University of Maryland School of Medicine, Baltimore; Institute for Stroke and Dementia Research (ISD), Klinikum der Universität München, Ludwig-Maximilians-University, München, Germany (M.D., M.L.); Department of Clinical Science, Lund University, Malmö, Sweden (G.E., B.N.); Department of Neurology, Neurovascular Research Group, IMIM-Hospital del Mar, Universitat Autonoma de Barcelona/DCEXS-Universitat Pompeu Fabra, Spain (E.G.-S., J.J.-C., J.R.); Neuroscience Institute, Saint Francis Medical Center, Trenton, NJ (R.P.G., L.R.P.); National Institute of Neurological Disorders and Stroke, National Institutes of Health, Bethesda, MD (K.G.); Institute of Biomedicine (C.J., A.P.) and Institute of Neuroscience and Physiology (K.J.), Sahlgrenska Academy at University of Gothenburg, Sweden; Department of Neurology, University of Miami Miller School of Medicine, FL (M.K., T.R., R.L.S.); Department of Neurology, University of Cincinnati College of Medicine, OH (B.K., D.O.K.); Department of Neurology, Stern Stroke Center, Albert Einstein College of Medicine, Bronx, NY (D.L.L.); Department of Neuroscience and Sensory Organs, Policlinico Hospital Foundation IRCCS Cà Granda, Milan, Italy (S.L.); Department of Neurology, Washington U
| | - Robin Lemmens
- From the Department of Radiology, AA Martinos Center for Biomedical Imaging (H.A., E.M.A., T.B.), Stroke Service, Department of Neurology (H.A., J.R.), and Center for Human Genetic Research (J.R.), Massachusetts General Hospital, Harvard Medical School, Boston; Department of Neurology and Rehabilitation Medicine, Skåne University Hospital, Lund, Sweden (G.A., H.D., A.L., O.M., B.N.); Department of Neurology, Mayo Clinic Rochester, MN (R.D.B.); Department of Neurology (S.N.C., B.B.W.), Center for Public Health Genomics (S.S.R.), and Department of Public Health Sciences (B.B.W.), University of Virginia, Charlottesville; Department of Neurology (J.W.C., S.J.K.) and Division of Endocrinology, Diabetes, and Nutrition, Department of Medicine (P.F.M.), University of Maryland School of Medicine, Baltimore; Institute for Stroke and Dementia Research (ISD), Klinikum der Universität München, Ludwig-Maximilians-University, München, Germany (M.D., M.L.); Department of Clinical Science, Lund University, Malmö, Sweden (G.E., B.N.); Department of Neurology, Neurovascular Research Group, IMIM-Hospital del Mar, Universitat Autonoma de Barcelona/DCEXS-Universitat Pompeu Fabra, Spain (E.G.-S., J.J.-C., J.R.); Neuroscience Institute, Saint Francis Medical Center, Trenton, NJ (R.P.G., L.R.P.); National Institute of Neurological Disorders and Stroke, National Institutes of Health, Bethesda, MD (K.G.); Institute of Biomedicine (C.J., A.P.) and Institute of Neuroscience and Physiology (K.J.), Sahlgrenska Academy at University of Gothenburg, Sweden; Department of Neurology, University of Miami Miller School of Medicine, FL (M.K., T.R., R.L.S.); Department of Neurology, University of Cincinnati College of Medicine, OH (B.K., D.O.K.); Department of Neurology, Stern Stroke Center, Albert Einstein College of Medicine, Bronx, NY (D.L.L.); Department of Neuroscience and Sensory Organs, Policlinico Hospital Foundation IRCCS Cà Granda, Milan, Italy (S.L.); Department of Neurology, Washington U
| | - Chris Levi
- From the Department of Radiology, AA Martinos Center for Biomedical Imaging (H.A., E.M.A., T.B.), Stroke Service, Department of Neurology (H.A., J.R.), and Center for Human Genetic Research (J.R.), Massachusetts General Hospital, Harvard Medical School, Boston; Department of Neurology and Rehabilitation Medicine, Skåne University Hospital, Lund, Sweden (G.A., H.D., A.L., O.M., B.N.); Department of Neurology, Mayo Clinic Rochester, MN (R.D.B.); Department of Neurology (S.N.C., B.B.W.), Center for Public Health Genomics (S.S.R.), and Department of Public Health Sciences (B.B.W.), University of Virginia, Charlottesville; Department of Neurology (J.W.C., S.J.K.) and Division of Endocrinology, Diabetes, and Nutrition, Department of Medicine (P.F.M.), University of Maryland School of Medicine, Baltimore; Institute for Stroke and Dementia Research (ISD), Klinikum der Universität München, Ludwig-Maximilians-University, München, Germany (M.D., M.L.); Department of Clinical Science, Lund University, Malmö, Sweden (G.E., B.N.); Department of Neurology, Neurovascular Research Group, IMIM-Hospital del Mar, Universitat Autonoma de Barcelona/DCEXS-Universitat Pompeu Fabra, Spain (E.G.-S., J.J.-C., J.R.); Neuroscience Institute, Saint Francis Medical Center, Trenton, NJ (R.P.G., L.R.P.); National Institute of Neurological Disorders and Stroke, National Institutes of Health, Bethesda, MD (K.G.); Institute of Biomedicine (C.J., A.P.) and Institute of Neuroscience and Physiology (K.J.), Sahlgrenska Academy at University of Gothenburg, Sweden; Department of Neurology, University of Miami Miller School of Medicine, FL (M.K., T.R., R.L.S.); Department of Neurology, University of Cincinnati College of Medicine, OH (B.K., D.O.K.); Department of Neurology, Stern Stroke Center, Albert Einstein College of Medicine, Bronx, NY (D.L.L.); Department of Neuroscience and Sensory Organs, Policlinico Hospital Foundation IRCCS Cà Granda, Milan, Italy (S.L.); Department of Neurology, Washington U
| | - Linxin Li
- From the Department of Radiology, AA Martinos Center for Biomedical Imaging (H.A., E.M.A., T.B.), Stroke Service, Department of Neurology (H.A., J.R.), and Center for Human Genetic Research (J.R.), Massachusetts General Hospital, Harvard Medical School, Boston; Department of Neurology and Rehabilitation Medicine, Skåne University Hospital, Lund, Sweden (G.A., H.D., A.L., O.M., B.N.); Department of Neurology, Mayo Clinic Rochester, MN (R.D.B.); Department of Neurology (S.N.C., B.B.W.), Center for Public Health Genomics (S.S.R.), and Department of Public Health Sciences (B.B.W.), University of Virginia, Charlottesville; Department of Neurology (J.W.C., S.J.K.) and Division of Endocrinology, Diabetes, and Nutrition, Department of Medicine (P.F.M.), University of Maryland School of Medicine, Baltimore; Institute for Stroke and Dementia Research (ISD), Klinikum der Universität München, Ludwig-Maximilians-University, München, Germany (M.D., M.L.); Department of Clinical Science, Lund University, Malmö, Sweden (G.E., B.N.); Department of Neurology, Neurovascular Research Group, IMIM-Hospital del Mar, Universitat Autonoma de Barcelona/DCEXS-Universitat Pompeu Fabra, Spain (E.G.-S., J.J.-C., J.R.); Neuroscience Institute, Saint Francis Medical Center, Trenton, NJ (R.P.G., L.R.P.); National Institute of Neurological Disorders and Stroke, National Institutes of Health, Bethesda, MD (K.G.); Institute of Biomedicine (C.J., A.P.) and Institute of Neuroscience and Physiology (K.J.), Sahlgrenska Academy at University of Gothenburg, Sweden; Department of Neurology, University of Miami Miller School of Medicine, FL (M.K., T.R., R.L.S.); Department of Neurology, University of Cincinnati College of Medicine, OH (B.K., D.O.K.); Department of Neurology, Stern Stroke Center, Albert Einstein College of Medicine, Bronx, NY (D.L.L.); Department of Neuroscience and Sensory Organs, Policlinico Hospital Foundation IRCCS Cà Granda, Milan, Italy (S.L.); Department of Neurology, Washington U
| | - Arne Lindgren
- From the Department of Radiology, AA Martinos Center for Biomedical Imaging (H.A., E.M.A., T.B.), Stroke Service, Department of Neurology (H.A., J.R.), and Center for Human Genetic Research (J.R.), Massachusetts General Hospital, Harvard Medical School, Boston; Department of Neurology and Rehabilitation Medicine, Skåne University Hospital, Lund, Sweden (G.A., H.D., A.L., O.M., B.N.); Department of Neurology, Mayo Clinic Rochester, MN (R.D.B.); Department of Neurology (S.N.C., B.B.W.), Center for Public Health Genomics (S.S.R.), and Department of Public Health Sciences (B.B.W.), University of Virginia, Charlottesville; Department of Neurology (J.W.C., S.J.K.) and Division of Endocrinology, Diabetes, and Nutrition, Department of Medicine (P.F.M.), University of Maryland School of Medicine, Baltimore; Institute for Stroke and Dementia Research (ISD), Klinikum der Universität München, Ludwig-Maximilians-University, München, Germany (M.D., M.L.); Department of Clinical Science, Lund University, Malmö, Sweden (G.E., B.N.); Department of Neurology, Neurovascular Research Group, IMIM-Hospital del Mar, Universitat Autonoma de Barcelona/DCEXS-Universitat Pompeu Fabra, Spain (E.G.-S., J.J.-C., J.R.); Neuroscience Institute, Saint Francis Medical Center, Trenton, NJ (R.P.G., L.R.P.); National Institute of Neurological Disorders and Stroke, National Institutes of Health, Bethesda, MD (K.G.); Institute of Biomedicine (C.J., A.P.) and Institute of Neuroscience and Physiology (K.J.), Sahlgrenska Academy at University of Gothenburg, Sweden; Department of Neurology, University of Miami Miller School of Medicine, FL (M.K., T.R., R.L.S.); Department of Neurology, University of Cincinnati College of Medicine, OH (B.K., D.O.K.); Department of Neurology, Stern Stroke Center, Albert Einstein College of Medicine, Bronx, NY (D.L.L.); Department of Neuroscience and Sensory Organs, Policlinico Hospital Foundation IRCCS Cà Granda, Milan, Italy (S.L.); Department of Neurology, Washington U
| | - Hugh S Markus
- From the Department of Radiology, AA Martinos Center for Biomedical Imaging (H.A., E.M.A., T.B.), Stroke Service, Department of Neurology (H.A., J.R.), and Center for Human Genetic Research (J.R.), Massachusetts General Hospital, Harvard Medical School, Boston; Department of Neurology and Rehabilitation Medicine, Skåne University Hospital, Lund, Sweden (G.A., H.D., A.L., O.M., B.N.); Department of Neurology, Mayo Clinic Rochester, MN (R.D.B.); Department of Neurology (S.N.C., B.B.W.), Center for Public Health Genomics (S.S.R.), and Department of Public Health Sciences (B.B.W.), University of Virginia, Charlottesville; Department of Neurology (J.W.C., S.J.K.) and Division of Endocrinology, Diabetes, and Nutrition, Department of Medicine (P.F.M.), University of Maryland School of Medicine, Baltimore; Institute for Stroke and Dementia Research (ISD), Klinikum der Universität München, Ludwig-Maximilians-University, München, Germany (M.D., M.L.); Department of Clinical Science, Lund University, Malmö, Sweden (G.E., B.N.); Department of Neurology, Neurovascular Research Group, IMIM-Hospital del Mar, Universitat Autonoma de Barcelona/DCEXS-Universitat Pompeu Fabra, Spain (E.G.-S., J.J.-C., J.R.); Neuroscience Institute, Saint Francis Medical Center, Trenton, NJ (R.P.G., L.R.P.); National Institute of Neurological Disorders and Stroke, National Institutes of Health, Bethesda, MD (K.G.); Institute of Biomedicine (C.J., A.P.) and Institute of Neuroscience and Physiology (K.J.), Sahlgrenska Academy at University of Gothenburg, Sweden; Department of Neurology, University of Miami Miller School of Medicine, FL (M.K., T.R., R.L.S.); Department of Neurology, University of Cincinnati College of Medicine, OH (B.K., D.O.K.); Department of Neurology, Stern Stroke Center, Albert Einstein College of Medicine, Bronx, NY (D.L.L.); Department of Neuroscience and Sensory Organs, Policlinico Hospital Foundation IRCCS Cà Granda, Milan, Italy (S.L.); Department of Neurology, Washington U
| | - Patrick F McArdle
- From the Department of Radiology, AA Martinos Center for Biomedical Imaging (H.A., E.M.A., T.B.), Stroke Service, Department of Neurology (H.A., J.R.), and Center for Human Genetic Research (J.R.), Massachusetts General Hospital, Harvard Medical School, Boston; Department of Neurology and Rehabilitation Medicine, Skåne University Hospital, Lund, Sweden (G.A., H.D., A.L., O.M., B.N.); Department of Neurology, Mayo Clinic Rochester, MN (R.D.B.); Department of Neurology (S.N.C., B.B.W.), Center for Public Health Genomics (S.S.R.), and Department of Public Health Sciences (B.B.W.), University of Virginia, Charlottesville; Department of Neurology (J.W.C., S.J.K.) and Division of Endocrinology, Diabetes, and Nutrition, Department of Medicine (P.F.M.), University of Maryland School of Medicine, Baltimore; Institute for Stroke and Dementia Research (ISD), Klinikum der Universität München, Ludwig-Maximilians-University, München, Germany (M.D., M.L.); Department of Clinical Science, Lund University, Malmö, Sweden (G.E., B.N.); Department of Neurology, Neurovascular Research Group, IMIM-Hospital del Mar, Universitat Autonoma de Barcelona/DCEXS-Universitat Pompeu Fabra, Spain (E.G.-S., J.J.-C., J.R.); Neuroscience Institute, Saint Francis Medical Center, Trenton, NJ (R.P.G., L.R.P.); National Institute of Neurological Disorders and Stroke, National Institutes of Health, Bethesda, MD (K.G.); Institute of Biomedicine (C.J., A.P.) and Institute of Neuroscience and Physiology (K.J.), Sahlgrenska Academy at University of Gothenburg, Sweden; Department of Neurology, University of Miami Miller School of Medicine, FL (M.K., T.R., R.L.S.); Department of Neurology, University of Cincinnati College of Medicine, OH (B.K., D.O.K.); Department of Neurology, Stern Stroke Center, Albert Einstein College of Medicine, Bronx, NY (D.L.L.); Department of Neuroscience and Sensory Organs, Policlinico Hospital Foundation IRCCS Cà Granda, Milan, Italy (S.L.); Department of Neurology, Washington U
| | - Olle Melander
- From the Department of Radiology, AA Martinos Center for Biomedical Imaging (H.A., E.M.A., T.B.), Stroke Service, Department of Neurology (H.A., J.R.), and Center for Human Genetic Research (J.R.), Massachusetts General Hospital, Harvard Medical School, Boston; Department of Neurology and Rehabilitation Medicine, Skåne University Hospital, Lund, Sweden (G.A., H.D., A.L., O.M., B.N.); Department of Neurology, Mayo Clinic Rochester, MN (R.D.B.); Department of Neurology (S.N.C., B.B.W.), Center for Public Health Genomics (S.S.R.), and Department of Public Health Sciences (B.B.W.), University of Virginia, Charlottesville; Department of Neurology (J.W.C., S.J.K.) and Division of Endocrinology, Diabetes, and Nutrition, Department of Medicine (P.F.M.), University of Maryland School of Medicine, Baltimore; Institute for Stroke and Dementia Research (ISD), Klinikum der Universität München, Ludwig-Maximilians-University, München, Germany (M.D., M.L.); Department of Clinical Science, Lund University, Malmö, Sweden (G.E., B.N.); Department of Neurology, Neurovascular Research Group, IMIM-Hospital del Mar, Universitat Autonoma de Barcelona/DCEXS-Universitat Pompeu Fabra, Spain (E.G.-S., J.J.-C., J.R.); Neuroscience Institute, Saint Francis Medical Center, Trenton, NJ (R.P.G., L.R.P.); National Institute of Neurological Disorders and Stroke, National Institutes of Health, Bethesda, MD (K.G.); Institute of Biomedicine (C.J., A.P.) and Institute of Neuroscience and Physiology (K.J.), Sahlgrenska Academy at University of Gothenburg, Sweden; Department of Neurology, University of Miami Miller School of Medicine, FL (M.K., T.R., R.L.S.); Department of Neurology, University of Cincinnati College of Medicine, OH (B.K., D.O.K.); Department of Neurology, Stern Stroke Center, Albert Einstein College of Medicine, Bronx, NY (D.L.L.); Department of Neuroscience and Sensory Organs, Policlinico Hospital Foundation IRCCS Cà Granda, Milan, Italy (S.L.); Department of Neurology, Washington U
| | - Bo Norrving
- From the Department of Radiology, AA Martinos Center for Biomedical Imaging (H.A., E.M.A., T.B.), Stroke Service, Department of Neurology (H.A., J.R.), and Center for Human Genetic Research (J.R.), Massachusetts General Hospital, Harvard Medical School, Boston; Department of Neurology and Rehabilitation Medicine, Skåne University Hospital, Lund, Sweden (G.A., H.D., A.L., O.M., B.N.); Department of Neurology, Mayo Clinic Rochester, MN (R.D.B.); Department of Neurology (S.N.C., B.B.W.), Center for Public Health Genomics (S.S.R.), and Department of Public Health Sciences (B.B.W.), University of Virginia, Charlottesville; Department of Neurology (J.W.C., S.J.K.) and Division of Endocrinology, Diabetes, and Nutrition, Department of Medicine (P.F.M.), University of Maryland School of Medicine, Baltimore; Institute for Stroke and Dementia Research (ISD), Klinikum der Universität München, Ludwig-Maximilians-University, München, Germany (M.D., M.L.); Department of Clinical Science, Lund University, Malmö, Sweden (G.E., B.N.); Department of Neurology, Neurovascular Research Group, IMIM-Hospital del Mar, Universitat Autonoma de Barcelona/DCEXS-Universitat Pompeu Fabra, Spain (E.G.-S., J.J.-C., J.R.); Neuroscience Institute, Saint Francis Medical Center, Trenton, NJ (R.P.G., L.R.P.); National Institute of Neurological Disorders and Stroke, National Institutes of Health, Bethesda, MD (K.G.); Institute of Biomedicine (C.J., A.P.) and Institute of Neuroscience and Physiology (K.J.), Sahlgrenska Academy at University of Gothenburg, Sweden; Department of Neurology, University of Miami Miller School of Medicine, FL (M.K., T.R., R.L.S.); Department of Neurology, University of Cincinnati College of Medicine, OH (B.K., D.O.K.); Department of Neurology, Stern Stroke Center, Albert Einstein College of Medicine, Bronx, NY (D.L.L.); Department of Neuroscience and Sensory Organs, Policlinico Hospital Foundation IRCCS Cà Granda, Milan, Italy (S.L.); Department of Neurology, Washington U
| | - Leema Reddy Peddareddygari
- From the Department of Radiology, AA Martinos Center for Biomedical Imaging (H.A., E.M.A., T.B.), Stroke Service, Department of Neurology (H.A., J.R.), and Center for Human Genetic Research (J.R.), Massachusetts General Hospital, Harvard Medical School, Boston; Department of Neurology and Rehabilitation Medicine, Skåne University Hospital, Lund, Sweden (G.A., H.D., A.L., O.M., B.N.); Department of Neurology, Mayo Clinic Rochester, MN (R.D.B.); Department of Neurology (S.N.C., B.B.W.), Center for Public Health Genomics (S.S.R.), and Department of Public Health Sciences (B.B.W.), University of Virginia, Charlottesville; Department of Neurology (J.W.C., S.J.K.) and Division of Endocrinology, Diabetes, and Nutrition, Department of Medicine (P.F.M.), University of Maryland School of Medicine, Baltimore; Institute for Stroke and Dementia Research (ISD), Klinikum der Universität München, Ludwig-Maximilians-University, München, Germany (M.D., M.L.); Department of Clinical Science, Lund University, Malmö, Sweden (G.E., B.N.); Department of Neurology, Neurovascular Research Group, IMIM-Hospital del Mar, Universitat Autonoma de Barcelona/DCEXS-Universitat Pompeu Fabra, Spain (E.G.-S., J.J.-C., J.R.); Neuroscience Institute, Saint Francis Medical Center, Trenton, NJ (R.P.G., L.R.P.); National Institute of Neurological Disorders and Stroke, National Institutes of Health, Bethesda, MD (K.G.); Institute of Biomedicine (C.J., A.P.) and Institute of Neuroscience and Physiology (K.J.), Sahlgrenska Academy at University of Gothenburg, Sweden; Department of Neurology, University of Miami Miller School of Medicine, FL (M.K., T.R., R.L.S.); Department of Neurology, University of Cincinnati College of Medicine, OH (B.K., D.O.K.); Department of Neurology, Stern Stroke Center, Albert Einstein College of Medicine, Bronx, NY (D.L.L.); Department of Neuroscience and Sensory Organs, Policlinico Hospital Foundation IRCCS Cà Granda, Milan, Italy (S.L.); Department of Neurology, Washington U
| | - Annie Pedersén
- From the Department of Radiology, AA Martinos Center for Biomedical Imaging (H.A., E.M.A., T.B.), Stroke Service, Department of Neurology (H.A., J.R.), and Center for Human Genetic Research (J.R.), Massachusetts General Hospital, Harvard Medical School, Boston; Department of Neurology and Rehabilitation Medicine, Skåne University Hospital, Lund, Sweden (G.A., H.D., A.L., O.M., B.N.); Department of Neurology, Mayo Clinic Rochester, MN (R.D.B.); Department of Neurology (S.N.C., B.B.W.), Center for Public Health Genomics (S.S.R.), and Department of Public Health Sciences (B.B.W.), University of Virginia, Charlottesville; Department of Neurology (J.W.C., S.J.K.) and Division of Endocrinology, Diabetes, and Nutrition, Department of Medicine (P.F.M.), University of Maryland School of Medicine, Baltimore; Institute for Stroke and Dementia Research (ISD), Klinikum der Universität München, Ludwig-Maximilians-University, München, Germany (M.D., M.L.); Department of Clinical Science, Lund University, Malmö, Sweden (G.E., B.N.); Department of Neurology, Neurovascular Research Group, IMIM-Hospital del Mar, Universitat Autonoma de Barcelona/DCEXS-Universitat Pompeu Fabra, Spain (E.G.-S., J.J.-C., J.R.); Neuroscience Institute, Saint Francis Medical Center, Trenton, NJ (R.P.G., L.R.P.); National Institute of Neurological Disorders and Stroke, National Institutes of Health, Bethesda, MD (K.G.); Institute of Biomedicine (C.J., A.P.) and Institute of Neuroscience and Physiology (K.J.), Sahlgrenska Academy at University of Gothenburg, Sweden; Department of Neurology, University of Miami Miller School of Medicine, FL (M.K., T.R., R.L.S.); Department of Neurology, University of Cincinnati College of Medicine, OH (B.K., D.O.K.); Department of Neurology, Stern Stroke Center, Albert Einstein College of Medicine, Bronx, NY (D.L.L.); Department of Neuroscience and Sensory Organs, Policlinico Hospital Foundation IRCCS Cà Granda, Milan, Italy (S.L.); Department of Neurology, Washington U
| | - Joanna Pera
- From the Department of Radiology, AA Martinos Center for Biomedical Imaging (H.A., E.M.A., T.B.), Stroke Service, Department of Neurology (H.A., J.R.), and Center for Human Genetic Research (J.R.), Massachusetts General Hospital, Harvard Medical School, Boston; Department of Neurology and Rehabilitation Medicine, Skåne University Hospital, Lund, Sweden (G.A., H.D., A.L., O.M., B.N.); Department of Neurology, Mayo Clinic Rochester, MN (R.D.B.); Department of Neurology (S.N.C., B.B.W.), Center for Public Health Genomics (S.S.R.), and Department of Public Health Sciences (B.B.W.), University of Virginia, Charlottesville; Department of Neurology (J.W.C., S.J.K.) and Division of Endocrinology, Diabetes, and Nutrition, Department of Medicine (P.F.M.), University of Maryland School of Medicine, Baltimore; Institute for Stroke and Dementia Research (ISD), Klinikum der Universität München, Ludwig-Maximilians-University, München, Germany (M.D., M.L.); Department of Clinical Science, Lund University, Malmö, Sweden (G.E., B.N.); Department of Neurology, Neurovascular Research Group, IMIM-Hospital del Mar, Universitat Autonoma de Barcelona/DCEXS-Universitat Pompeu Fabra, Spain (E.G.-S., J.J.-C., J.R.); Neuroscience Institute, Saint Francis Medical Center, Trenton, NJ (R.P.G., L.R.P.); National Institute of Neurological Disorders and Stroke, National Institutes of Health, Bethesda, MD (K.G.); Institute of Biomedicine (C.J., A.P.) and Institute of Neuroscience and Physiology (K.J.), Sahlgrenska Academy at University of Gothenburg, Sweden; Department of Neurology, University of Miami Miller School of Medicine, FL (M.K., T.R., R.L.S.); Department of Neurology, University of Cincinnati College of Medicine, OH (B.K., D.O.K.); Department of Neurology, Stern Stroke Center, Albert Einstein College of Medicine, Bronx, NY (D.L.L.); Department of Neuroscience and Sensory Organs, Policlinico Hospital Foundation IRCCS Cà Granda, Milan, Italy (S.L.); Department of Neurology, Washington U
| | - Kristiina Rannikmäe
- From the Department of Radiology, AA Martinos Center for Biomedical Imaging (H.A., E.M.A., T.B.), Stroke Service, Department of Neurology (H.A., J.R.), and Center for Human Genetic Research (J.R.), Massachusetts General Hospital, Harvard Medical School, Boston; Department of Neurology and Rehabilitation Medicine, Skåne University Hospital, Lund, Sweden (G.A., H.D., A.L., O.M., B.N.); Department of Neurology, Mayo Clinic Rochester, MN (R.D.B.); Department of Neurology (S.N.C., B.B.W.), Center for Public Health Genomics (S.S.R.), and Department of Public Health Sciences (B.B.W.), University of Virginia, Charlottesville; Department of Neurology (J.W.C., S.J.K.) and Division of Endocrinology, Diabetes, and Nutrition, Department of Medicine (P.F.M.), University of Maryland School of Medicine, Baltimore; Institute for Stroke and Dementia Research (ISD), Klinikum der Universität München, Ludwig-Maximilians-University, München, Germany (M.D., M.L.); Department of Clinical Science, Lund University, Malmö, Sweden (G.E., B.N.); Department of Neurology, Neurovascular Research Group, IMIM-Hospital del Mar, Universitat Autonoma de Barcelona/DCEXS-Universitat Pompeu Fabra, Spain (E.G.-S., J.J.-C., J.R.); Neuroscience Institute, Saint Francis Medical Center, Trenton, NJ (R.P.G., L.R.P.); National Institute of Neurological Disorders and Stroke, National Institutes of Health, Bethesda, MD (K.G.); Institute of Biomedicine (C.J., A.P.) and Institute of Neuroscience and Physiology (K.J.), Sahlgrenska Academy at University of Gothenburg, Sweden; Department of Neurology, University of Miami Miller School of Medicine, FL (M.K., T.R., R.L.S.); Department of Neurology, University of Cincinnati College of Medicine, OH (B.K., D.O.K.); Department of Neurology, Stern Stroke Center, Albert Einstein College of Medicine, Bronx, NY (D.L.L.); Department of Neuroscience and Sensory Organs, Policlinico Hospital Foundation IRCCS Cà Granda, Milan, Italy (S.L.); Department of Neurology, Washington U
| | - Kathryn M Rexrode
- From the Department of Radiology, AA Martinos Center for Biomedical Imaging (H.A., E.M.A., T.B.), Stroke Service, Department of Neurology (H.A., J.R.), and Center for Human Genetic Research (J.R.), Massachusetts General Hospital, Harvard Medical School, Boston; Department of Neurology and Rehabilitation Medicine, Skåne University Hospital, Lund, Sweden (G.A., H.D., A.L., O.M., B.N.); Department of Neurology, Mayo Clinic Rochester, MN (R.D.B.); Department of Neurology (S.N.C., B.B.W.), Center for Public Health Genomics (S.S.R.), and Department of Public Health Sciences (B.B.W.), University of Virginia, Charlottesville; Department of Neurology (J.W.C., S.J.K.) and Division of Endocrinology, Diabetes, and Nutrition, Department of Medicine (P.F.M.), University of Maryland School of Medicine, Baltimore; Institute for Stroke and Dementia Research (ISD), Klinikum der Universität München, Ludwig-Maximilians-University, München, Germany (M.D., M.L.); Department of Clinical Science, Lund University, Malmö, Sweden (G.E., B.N.); Department of Neurology, Neurovascular Research Group, IMIM-Hospital del Mar, Universitat Autonoma de Barcelona/DCEXS-Universitat Pompeu Fabra, Spain (E.G.-S., J.J.-C., J.R.); Neuroscience Institute, Saint Francis Medical Center, Trenton, NJ (R.P.G., L.R.P.); National Institute of Neurological Disorders and Stroke, National Institutes of Health, Bethesda, MD (K.G.); Institute of Biomedicine (C.J., A.P.) and Institute of Neuroscience and Physiology (K.J.), Sahlgrenska Academy at University of Gothenburg, Sweden; Department of Neurology, University of Miami Miller School of Medicine, FL (M.K., T.R., R.L.S.); Department of Neurology, University of Cincinnati College of Medicine, OH (B.K., D.O.K.); Department of Neurology, Stern Stroke Center, Albert Einstein College of Medicine, Bronx, NY (D.L.L.); Department of Neuroscience and Sensory Organs, Policlinico Hospital Foundation IRCCS Cà Granda, Milan, Italy (S.L.); Department of Neurology, Washington U
| | - David Rhodes
- From the Department of Radiology, AA Martinos Center for Biomedical Imaging (H.A., E.M.A., T.B.), Stroke Service, Department of Neurology (H.A., J.R.), and Center for Human Genetic Research (J.R.), Massachusetts General Hospital, Harvard Medical School, Boston; Department of Neurology and Rehabilitation Medicine, Skåne University Hospital, Lund, Sweden (G.A., H.D., A.L., O.M., B.N.); Department of Neurology, Mayo Clinic Rochester, MN (R.D.B.); Department of Neurology (S.N.C., B.B.W.), Center for Public Health Genomics (S.S.R.), and Department of Public Health Sciences (B.B.W.), University of Virginia, Charlottesville; Department of Neurology (J.W.C., S.J.K.) and Division of Endocrinology, Diabetes, and Nutrition, Department of Medicine (P.F.M.), University of Maryland School of Medicine, Baltimore; Institute for Stroke and Dementia Research (ISD), Klinikum der Universität München, Ludwig-Maximilians-University, München, Germany (M.D., M.L.); Department of Clinical Science, Lund University, Malmö, Sweden (G.E., B.N.); Department of Neurology, Neurovascular Research Group, IMIM-Hospital del Mar, Universitat Autonoma de Barcelona/DCEXS-Universitat Pompeu Fabra, Spain (E.G.-S., J.J.-C., J.R.); Neuroscience Institute, Saint Francis Medical Center, Trenton, NJ (R.P.G., L.R.P.); National Institute of Neurological Disorders and Stroke, National Institutes of Health, Bethesda, MD (K.G.); Institute of Biomedicine (C.J., A.P.) and Institute of Neuroscience and Physiology (K.J.), Sahlgrenska Academy at University of Gothenburg, Sweden; Department of Neurology, University of Miami Miller School of Medicine, FL (M.K., T.R., R.L.S.); Department of Neurology, University of Cincinnati College of Medicine, OH (B.K., D.O.K.); Department of Neurology, Stern Stroke Center, Albert Einstein College of Medicine, Bronx, NY (D.L.L.); Department of Neuroscience and Sensory Organs, Policlinico Hospital Foundation IRCCS Cà Granda, Milan, Italy (S.L.); Department of Neurology, Washington U
| | - Stephen S Rich
- From the Department of Radiology, AA Martinos Center for Biomedical Imaging (H.A., E.M.A., T.B.), Stroke Service, Department of Neurology (H.A., J.R.), and Center for Human Genetic Research (J.R.), Massachusetts General Hospital, Harvard Medical School, Boston; Department of Neurology and Rehabilitation Medicine, Skåne University Hospital, Lund, Sweden (G.A., H.D., A.L., O.M., B.N.); Department of Neurology, Mayo Clinic Rochester, MN (R.D.B.); Department of Neurology (S.N.C., B.B.W.), Center for Public Health Genomics (S.S.R.), and Department of Public Health Sciences (B.B.W.), University of Virginia, Charlottesville; Department of Neurology (J.W.C., S.J.K.) and Division of Endocrinology, Diabetes, and Nutrition, Department of Medicine (P.F.M.), University of Maryland School of Medicine, Baltimore; Institute for Stroke and Dementia Research (ISD), Klinikum der Universität München, Ludwig-Maximilians-University, München, Germany (M.D., M.L.); Department of Clinical Science, Lund University, Malmö, Sweden (G.E., B.N.); Department of Neurology, Neurovascular Research Group, IMIM-Hospital del Mar, Universitat Autonoma de Barcelona/DCEXS-Universitat Pompeu Fabra, Spain (E.G.-S., J.J.-C., J.R.); Neuroscience Institute, Saint Francis Medical Center, Trenton, NJ (R.P.G., L.R.P.); National Institute of Neurological Disorders and Stroke, National Institutes of Health, Bethesda, MD (K.G.); Institute of Biomedicine (C.J., A.P.) and Institute of Neuroscience and Physiology (K.J.), Sahlgrenska Academy at University of Gothenburg, Sweden; Department of Neurology, University of Miami Miller School of Medicine, FL (M.K., T.R., R.L.S.); Department of Neurology, University of Cincinnati College of Medicine, OH (B.K., D.O.K.); Department of Neurology, Stern Stroke Center, Albert Einstein College of Medicine, Bronx, NY (D.L.L.); Department of Neuroscience and Sensory Organs, Policlinico Hospital Foundation IRCCS Cà Granda, Milan, Italy (S.L.); Department of Neurology, Washington U
| | - Jaume Roquer
- From the Department of Radiology, AA Martinos Center for Biomedical Imaging (H.A., E.M.A., T.B.), Stroke Service, Department of Neurology (H.A., J.R.), and Center for Human Genetic Research (J.R.), Massachusetts General Hospital, Harvard Medical School, Boston; Department of Neurology and Rehabilitation Medicine, Skåne University Hospital, Lund, Sweden (G.A., H.D., A.L., O.M., B.N.); Department of Neurology, Mayo Clinic Rochester, MN (R.D.B.); Department of Neurology (S.N.C., B.B.W.), Center for Public Health Genomics (S.S.R.), and Department of Public Health Sciences (B.B.W.), University of Virginia, Charlottesville; Department of Neurology (J.W.C., S.J.K.) and Division of Endocrinology, Diabetes, and Nutrition, Department of Medicine (P.F.M.), University of Maryland School of Medicine, Baltimore; Institute for Stroke and Dementia Research (ISD), Klinikum der Universität München, Ludwig-Maximilians-University, München, Germany (M.D., M.L.); Department of Clinical Science, Lund University, Malmö, Sweden (G.E., B.N.); Department of Neurology, Neurovascular Research Group, IMIM-Hospital del Mar, Universitat Autonoma de Barcelona/DCEXS-Universitat Pompeu Fabra, Spain (E.G.-S., J.J.-C., J.R.); Neuroscience Institute, Saint Francis Medical Center, Trenton, NJ (R.P.G., L.R.P.); National Institute of Neurological Disorders and Stroke, National Institutes of Health, Bethesda, MD (K.G.); Institute of Biomedicine (C.J., A.P.) and Institute of Neuroscience and Physiology (K.J.), Sahlgrenska Academy at University of Gothenburg, Sweden; Department of Neurology, University of Miami Miller School of Medicine, FL (M.K., T.R., R.L.S.); Department of Neurology, University of Cincinnati College of Medicine, OH (B.K., D.O.K.); Department of Neurology, Stern Stroke Center, Albert Einstein College of Medicine, Bronx, NY (D.L.L.); Department of Neuroscience and Sensory Organs, Policlinico Hospital Foundation IRCCS Cà Granda, Milan, Italy (S.L.); Department of Neurology, Washington U
| | - Jonathan Rosand
- From the Department of Radiology, AA Martinos Center for Biomedical Imaging (H.A., E.M.A., T.B.), Stroke Service, Department of Neurology (H.A., J.R.), and Center for Human Genetic Research (J.R.), Massachusetts General Hospital, Harvard Medical School, Boston; Department of Neurology and Rehabilitation Medicine, Skåne University Hospital, Lund, Sweden (G.A., H.D., A.L., O.M., B.N.); Department of Neurology, Mayo Clinic Rochester, MN (R.D.B.); Department of Neurology (S.N.C., B.B.W.), Center for Public Health Genomics (S.S.R.), and Department of Public Health Sciences (B.B.W.), University of Virginia, Charlottesville; Department of Neurology (J.W.C., S.J.K.) and Division of Endocrinology, Diabetes, and Nutrition, Department of Medicine (P.F.M.), University of Maryland School of Medicine, Baltimore; Institute for Stroke and Dementia Research (ISD), Klinikum der Universität München, Ludwig-Maximilians-University, München, Germany (M.D., M.L.); Department of Clinical Science, Lund University, Malmö, Sweden (G.E., B.N.); Department of Neurology, Neurovascular Research Group, IMIM-Hospital del Mar, Universitat Autonoma de Barcelona/DCEXS-Universitat Pompeu Fabra, Spain (E.G.-S., J.J.-C., J.R.); Neuroscience Institute, Saint Francis Medical Center, Trenton, NJ (R.P.G., L.R.P.); National Institute of Neurological Disorders and Stroke, National Institutes of Health, Bethesda, MD (K.G.); Institute of Biomedicine (C.J., A.P.) and Institute of Neuroscience and Physiology (K.J.), Sahlgrenska Academy at University of Gothenburg, Sweden; Department of Neurology, University of Miami Miller School of Medicine, FL (M.K., T.R., R.L.S.); Department of Neurology, University of Cincinnati College of Medicine, OH (B.K., D.O.K.); Department of Neurology, Stern Stroke Center, Albert Einstein College of Medicine, Bronx, NY (D.L.L.); Department of Neuroscience and Sensory Organs, Policlinico Hospital Foundation IRCCS Cà Granda, Milan, Italy (S.L.); Department of Neurology, Washington U
| | - Peter M Rothwell
- From the Department of Radiology, AA Martinos Center for Biomedical Imaging (H.A., E.M.A., T.B.), Stroke Service, Department of Neurology (H.A., J.R.), and Center for Human Genetic Research (J.R.), Massachusetts General Hospital, Harvard Medical School, Boston; Department of Neurology and Rehabilitation Medicine, Skåne University Hospital, Lund, Sweden (G.A., H.D., A.L., O.M., B.N.); Department of Neurology, Mayo Clinic Rochester, MN (R.D.B.); Department of Neurology (S.N.C., B.B.W.), Center for Public Health Genomics (S.S.R.), and Department of Public Health Sciences (B.B.W.), University of Virginia, Charlottesville; Department of Neurology (J.W.C., S.J.K.) and Division of Endocrinology, Diabetes, and Nutrition, Department of Medicine (P.F.M.), University of Maryland School of Medicine, Baltimore; Institute for Stroke and Dementia Research (ISD), Klinikum der Universität München, Ludwig-Maximilians-University, München, Germany (M.D., M.L.); Department of Clinical Science, Lund University, Malmö, Sweden (G.E., B.N.); Department of Neurology, Neurovascular Research Group, IMIM-Hospital del Mar, Universitat Autonoma de Barcelona/DCEXS-Universitat Pompeu Fabra, Spain (E.G.-S., J.J.-C., J.R.); Neuroscience Institute, Saint Francis Medical Center, Trenton, NJ (R.P.G., L.R.P.); National Institute of Neurological Disorders and Stroke, National Institutes of Health, Bethesda, MD (K.G.); Institute of Biomedicine (C.J., A.P.) and Institute of Neuroscience and Physiology (K.J.), Sahlgrenska Academy at University of Gothenburg, Sweden; Department of Neurology, University of Miami Miller School of Medicine, FL (M.K., T.R., R.L.S.); Department of Neurology, University of Cincinnati College of Medicine, OH (B.K., D.O.K.); Department of Neurology, Stern Stroke Center, Albert Einstein College of Medicine, Bronx, NY (D.L.L.); Department of Neuroscience and Sensory Organs, Policlinico Hospital Foundation IRCCS Cà Granda, Milan, Italy (S.L.); Department of Neurology, Washington U
| | - Tatjana Rundek
- From the Department of Radiology, AA Martinos Center for Biomedical Imaging (H.A., E.M.A., T.B.), Stroke Service, Department of Neurology (H.A., J.R.), and Center for Human Genetic Research (J.R.), Massachusetts General Hospital, Harvard Medical School, Boston; Department of Neurology and Rehabilitation Medicine, Skåne University Hospital, Lund, Sweden (G.A., H.D., A.L., O.M., B.N.); Department of Neurology, Mayo Clinic Rochester, MN (R.D.B.); Department of Neurology (S.N.C., B.B.W.), Center for Public Health Genomics (S.S.R.), and Department of Public Health Sciences (B.B.W.), University of Virginia, Charlottesville; Department of Neurology (J.W.C., S.J.K.) and Division of Endocrinology, Diabetes, and Nutrition, Department of Medicine (P.F.M.), University of Maryland School of Medicine, Baltimore; Institute for Stroke and Dementia Research (ISD), Klinikum der Universität München, Ludwig-Maximilians-University, München, Germany (M.D., M.L.); Department of Clinical Science, Lund University, Malmö, Sweden (G.E., B.N.); Department of Neurology, Neurovascular Research Group, IMIM-Hospital del Mar, Universitat Autonoma de Barcelona/DCEXS-Universitat Pompeu Fabra, Spain (E.G.-S., J.J.-C., J.R.); Neuroscience Institute, Saint Francis Medical Center, Trenton, NJ (R.P.G., L.R.P.); National Institute of Neurological Disorders and Stroke, National Institutes of Health, Bethesda, MD (K.G.); Institute of Biomedicine (C.J., A.P.) and Institute of Neuroscience and Physiology (K.J.), Sahlgrenska Academy at University of Gothenburg, Sweden; Department of Neurology, University of Miami Miller School of Medicine, FL (M.K., T.R., R.L.S.); Department of Neurology, University of Cincinnati College of Medicine, OH (B.K., D.O.K.); Department of Neurology, Stern Stroke Center, Albert Einstein College of Medicine, Bronx, NY (D.L.L.); Department of Neuroscience and Sensory Organs, Policlinico Hospital Foundation IRCCS Cà Granda, Milan, Italy (S.L.); Department of Neurology, Washington U
| | - Ralph L Sacco
- From the Department of Radiology, AA Martinos Center for Biomedical Imaging (H.A., E.M.A., T.B.), Stroke Service, Department of Neurology (H.A., J.R.), and Center for Human Genetic Research (J.R.), Massachusetts General Hospital, Harvard Medical School, Boston; Department of Neurology and Rehabilitation Medicine, Skåne University Hospital, Lund, Sweden (G.A., H.D., A.L., O.M., B.N.); Department of Neurology, Mayo Clinic Rochester, MN (R.D.B.); Department of Neurology (S.N.C., B.B.W.), Center for Public Health Genomics (S.S.R.), and Department of Public Health Sciences (B.B.W.), University of Virginia, Charlottesville; Department of Neurology (J.W.C., S.J.K.) and Division of Endocrinology, Diabetes, and Nutrition, Department of Medicine (P.F.M.), University of Maryland School of Medicine, Baltimore; Institute for Stroke and Dementia Research (ISD), Klinikum der Universität München, Ludwig-Maximilians-University, München, Germany (M.D., M.L.); Department of Clinical Science, Lund University, Malmö, Sweden (G.E., B.N.); Department of Neurology, Neurovascular Research Group, IMIM-Hospital del Mar, Universitat Autonoma de Barcelona/DCEXS-Universitat Pompeu Fabra, Spain (E.G.-S., J.J.-C., J.R.); Neuroscience Institute, Saint Francis Medical Center, Trenton, NJ (R.P.G., L.R.P.); National Institute of Neurological Disorders and Stroke, National Institutes of Health, Bethesda, MD (K.G.); Institute of Biomedicine (C.J., A.P.) and Institute of Neuroscience and Physiology (K.J.), Sahlgrenska Academy at University of Gothenburg, Sweden; Department of Neurology, University of Miami Miller School of Medicine, FL (M.K., T.R., R.L.S.); Department of Neurology, University of Cincinnati College of Medicine, OH (B.K., D.O.K.); Department of Neurology, Stern Stroke Center, Albert Einstein College of Medicine, Bronx, NY (D.L.L.); Department of Neuroscience and Sensory Organs, Policlinico Hospital Foundation IRCCS Cà Granda, Milan, Italy (S.L.); Department of Neurology, Washington U
| | - Reinhold Schmidt
- From the Department of Radiology, AA Martinos Center for Biomedical Imaging (H.A., E.M.A., T.B.), Stroke Service, Department of Neurology (H.A., J.R.), and Center for Human Genetic Research (J.R.), Massachusetts General Hospital, Harvard Medical School, Boston; Department of Neurology and Rehabilitation Medicine, Skåne University Hospital, Lund, Sweden (G.A., H.D., A.L., O.M., B.N.); Department of Neurology, Mayo Clinic Rochester, MN (R.D.B.); Department of Neurology (S.N.C., B.B.W.), Center for Public Health Genomics (S.S.R.), and Department of Public Health Sciences (B.B.W.), University of Virginia, Charlottesville; Department of Neurology (J.W.C., S.J.K.) and Division of Endocrinology, Diabetes, and Nutrition, Department of Medicine (P.F.M.), University of Maryland School of Medicine, Baltimore; Institute for Stroke and Dementia Research (ISD), Klinikum der Universität München, Ludwig-Maximilians-University, München, Germany (M.D., M.L.); Department of Clinical Science, Lund University, Malmö, Sweden (G.E., B.N.); Department of Neurology, Neurovascular Research Group, IMIM-Hospital del Mar, Universitat Autonoma de Barcelona/DCEXS-Universitat Pompeu Fabra, Spain (E.G.-S., J.J.-C., J.R.); Neuroscience Institute, Saint Francis Medical Center, Trenton, NJ (R.P.G., L.R.P.); National Institute of Neurological Disorders and Stroke, National Institutes of Health, Bethesda, MD (K.G.); Institute of Biomedicine (C.J., A.P.) and Institute of Neuroscience and Physiology (K.J.), Sahlgrenska Academy at University of Gothenburg, Sweden; Department of Neurology, University of Miami Miller School of Medicine, FL (M.K., T.R., R.L.S.); Department of Neurology, University of Cincinnati College of Medicine, OH (B.K., D.O.K.); Department of Neurology, Stern Stroke Center, Albert Einstein College of Medicine, Bronx, NY (D.L.L.); Department of Neuroscience and Sensory Organs, Policlinico Hospital Foundation IRCCS Cà Granda, Milan, Italy (S.L.); Department of Neurology, Washington U
| | - Markus Schürks
- From the Department of Radiology, AA Martinos Center for Biomedical Imaging (H.A., E.M.A., T.B.), Stroke Service, Department of Neurology (H.A., J.R.), and Center for Human Genetic Research (J.R.), Massachusetts General Hospital, Harvard Medical School, Boston; Department of Neurology and Rehabilitation Medicine, Skåne University Hospital, Lund, Sweden (G.A., H.D., A.L., O.M., B.N.); Department of Neurology, Mayo Clinic Rochester, MN (R.D.B.); Department of Neurology (S.N.C., B.B.W.), Center for Public Health Genomics (S.S.R.), and Department of Public Health Sciences (B.B.W.), University of Virginia, Charlottesville; Department of Neurology (J.W.C., S.J.K.) and Division of Endocrinology, Diabetes, and Nutrition, Department of Medicine (P.F.M.), University of Maryland School of Medicine, Baltimore; Institute for Stroke and Dementia Research (ISD), Klinikum der Universität München, Ludwig-Maximilians-University, München, Germany (M.D., M.L.); Department of Clinical Science, Lund University, Malmö, Sweden (G.E., B.N.); Department of Neurology, Neurovascular Research Group, IMIM-Hospital del Mar, Universitat Autonoma de Barcelona/DCEXS-Universitat Pompeu Fabra, Spain (E.G.-S., J.J.-C., J.R.); Neuroscience Institute, Saint Francis Medical Center, Trenton, NJ (R.P.G., L.R.P.); National Institute of Neurological Disorders and Stroke, National Institutes of Health, Bethesda, MD (K.G.); Institute of Biomedicine (C.J., A.P.) and Institute of Neuroscience and Physiology (K.J.), Sahlgrenska Academy at University of Gothenburg, Sweden; Department of Neurology, University of Miami Miller School of Medicine, FL (M.K., T.R., R.L.S.); Department of Neurology, University of Cincinnati College of Medicine, OH (B.K., D.O.K.); Department of Neurology, Stern Stroke Center, Albert Einstein College of Medicine, Bronx, NY (D.L.L.); Department of Neuroscience and Sensory Organs, Policlinico Hospital Foundation IRCCS Cà Granda, Milan, Italy (S.L.); Department of Neurology, Washington U
| | - Stephan Seiler
- From the Department of Radiology, AA Martinos Center for Biomedical Imaging (H.A., E.M.A., T.B.), Stroke Service, Department of Neurology (H.A., J.R.), and Center for Human Genetic Research (J.R.), Massachusetts General Hospital, Harvard Medical School, Boston; Department of Neurology and Rehabilitation Medicine, Skåne University Hospital, Lund, Sweden (G.A., H.D., A.L., O.M., B.N.); Department of Neurology, Mayo Clinic Rochester, MN (R.D.B.); Department of Neurology (S.N.C., B.B.W.), Center for Public Health Genomics (S.S.R.), and Department of Public Health Sciences (B.B.W.), University of Virginia, Charlottesville; Department of Neurology (J.W.C., S.J.K.) and Division of Endocrinology, Diabetes, and Nutrition, Department of Medicine (P.F.M.), University of Maryland School of Medicine, Baltimore; Institute for Stroke and Dementia Research (ISD), Klinikum der Universität München, Ludwig-Maximilians-University, München, Germany (M.D., M.L.); Department of Clinical Science, Lund University, Malmö, Sweden (G.E., B.N.); Department of Neurology, Neurovascular Research Group, IMIM-Hospital del Mar, Universitat Autonoma de Barcelona/DCEXS-Universitat Pompeu Fabra, Spain (E.G.-S., J.J.-C., J.R.); Neuroscience Institute, Saint Francis Medical Center, Trenton, NJ (R.P.G., L.R.P.); National Institute of Neurological Disorders and Stroke, National Institutes of Health, Bethesda, MD (K.G.); Institute of Biomedicine (C.J., A.P.) and Institute of Neuroscience and Physiology (K.J.), Sahlgrenska Academy at University of Gothenburg, Sweden; Department of Neurology, University of Miami Miller School of Medicine, FL (M.K., T.R., R.L.S.); Department of Neurology, University of Cincinnati College of Medicine, OH (B.K., D.O.K.); Department of Neurology, Stern Stroke Center, Albert Einstein College of Medicine, Bronx, NY (D.L.L.); Department of Neuroscience and Sensory Organs, Policlinico Hospital Foundation IRCCS Cà Granda, Milan, Italy (S.L.); Department of Neurology, Washington U
| | - Pankaj Sharma
- From the Department of Radiology, AA Martinos Center for Biomedical Imaging (H.A., E.M.A., T.B.), Stroke Service, Department of Neurology (H.A., J.R.), and Center for Human Genetic Research (J.R.), Massachusetts General Hospital, Harvard Medical School, Boston; Department of Neurology and Rehabilitation Medicine, Skåne University Hospital, Lund, Sweden (G.A., H.D., A.L., O.M., B.N.); Department of Neurology, Mayo Clinic Rochester, MN (R.D.B.); Department of Neurology (S.N.C., B.B.W.), Center for Public Health Genomics (S.S.R.), and Department of Public Health Sciences (B.B.W.), University of Virginia, Charlottesville; Department of Neurology (J.W.C., S.J.K.) and Division of Endocrinology, Diabetes, and Nutrition, Department of Medicine (P.F.M.), University of Maryland School of Medicine, Baltimore; Institute for Stroke and Dementia Research (ISD), Klinikum der Universität München, Ludwig-Maximilians-University, München, Germany (M.D., M.L.); Department of Clinical Science, Lund University, Malmö, Sweden (G.E., B.N.); Department of Neurology, Neurovascular Research Group, IMIM-Hospital del Mar, Universitat Autonoma de Barcelona/DCEXS-Universitat Pompeu Fabra, Spain (E.G.-S., J.J.-C., J.R.); Neuroscience Institute, Saint Francis Medical Center, Trenton, NJ (R.P.G., L.R.P.); National Institute of Neurological Disorders and Stroke, National Institutes of Health, Bethesda, MD (K.G.); Institute of Biomedicine (C.J., A.P.) and Institute of Neuroscience and Physiology (K.J.), Sahlgrenska Academy at University of Gothenburg, Sweden; Department of Neurology, University of Miami Miller School of Medicine, FL (M.K., T.R., R.L.S.); Department of Neurology, University of Cincinnati College of Medicine, OH (B.K., D.O.K.); Department of Neurology, Stern Stroke Center, Albert Einstein College of Medicine, Bronx, NY (D.L.L.); Department of Neuroscience and Sensory Organs, Policlinico Hospital Foundation IRCCS Cà Granda, Milan, Italy (S.L.); Department of Neurology, Washington U
| | - Agnieszka Slowik
- From the Department of Radiology, AA Martinos Center for Biomedical Imaging (H.A., E.M.A., T.B.), Stroke Service, Department of Neurology (H.A., J.R.), and Center for Human Genetic Research (J.R.), Massachusetts General Hospital, Harvard Medical School, Boston; Department of Neurology and Rehabilitation Medicine, Skåne University Hospital, Lund, Sweden (G.A., H.D., A.L., O.M., B.N.); Department of Neurology, Mayo Clinic Rochester, MN (R.D.B.); Department of Neurology (S.N.C., B.B.W.), Center for Public Health Genomics (S.S.R.), and Department of Public Health Sciences (B.B.W.), University of Virginia, Charlottesville; Department of Neurology (J.W.C., S.J.K.) and Division of Endocrinology, Diabetes, and Nutrition, Department of Medicine (P.F.M.), University of Maryland School of Medicine, Baltimore; Institute for Stroke and Dementia Research (ISD), Klinikum der Universität München, Ludwig-Maximilians-University, München, Germany (M.D., M.L.); Department of Clinical Science, Lund University, Malmö, Sweden (G.E., B.N.); Department of Neurology, Neurovascular Research Group, IMIM-Hospital del Mar, Universitat Autonoma de Barcelona/DCEXS-Universitat Pompeu Fabra, Spain (E.G.-S., J.J.-C., J.R.); Neuroscience Institute, Saint Francis Medical Center, Trenton, NJ (R.P.G., L.R.P.); National Institute of Neurological Disorders and Stroke, National Institutes of Health, Bethesda, MD (K.G.); Institute of Biomedicine (C.J., A.P.) and Institute of Neuroscience and Physiology (K.J.), Sahlgrenska Academy at University of Gothenburg, Sweden; Department of Neurology, University of Miami Miller School of Medicine, FL (M.K., T.R., R.L.S.); Department of Neurology, University of Cincinnati College of Medicine, OH (B.K., D.O.K.); Department of Neurology, Stern Stroke Center, Albert Einstein College of Medicine, Bronx, NY (D.L.L.); Department of Neuroscience and Sensory Organs, Policlinico Hospital Foundation IRCCS Cà Granda, Milan, Italy (S.L.); Department of Neurology, Washington U
| | - Cathie Sudlow
- From the Department of Radiology, AA Martinos Center for Biomedical Imaging (H.A., E.M.A., T.B.), Stroke Service, Department of Neurology (H.A., J.R.), and Center for Human Genetic Research (J.R.), Massachusetts General Hospital, Harvard Medical School, Boston; Department of Neurology and Rehabilitation Medicine, Skåne University Hospital, Lund, Sweden (G.A., H.D., A.L., O.M., B.N.); Department of Neurology, Mayo Clinic Rochester, MN (R.D.B.); Department of Neurology (S.N.C., B.B.W.), Center for Public Health Genomics (S.S.R.), and Department of Public Health Sciences (B.B.W.), University of Virginia, Charlottesville; Department of Neurology (J.W.C., S.J.K.) and Division of Endocrinology, Diabetes, and Nutrition, Department of Medicine (P.F.M.), University of Maryland School of Medicine, Baltimore; Institute for Stroke and Dementia Research (ISD), Klinikum der Universität München, Ludwig-Maximilians-University, München, Germany (M.D., M.L.); Department of Clinical Science, Lund University, Malmö, Sweden (G.E., B.N.); Department of Neurology, Neurovascular Research Group, IMIM-Hospital del Mar, Universitat Autonoma de Barcelona/DCEXS-Universitat Pompeu Fabra, Spain (E.G.-S., J.J.-C., J.R.); Neuroscience Institute, Saint Francis Medical Center, Trenton, NJ (R.P.G., L.R.P.); National Institute of Neurological Disorders and Stroke, National Institutes of Health, Bethesda, MD (K.G.); Institute of Biomedicine (C.J., A.P.) and Institute of Neuroscience and Physiology (K.J.), Sahlgrenska Academy at University of Gothenburg, Sweden; Department of Neurology, University of Miami Miller School of Medicine, FL (M.K., T.R., R.L.S.); Department of Neurology, University of Cincinnati College of Medicine, OH (B.K., D.O.K.); Department of Neurology, Stern Stroke Center, Albert Einstein College of Medicine, Bronx, NY (D.L.L.); Department of Neuroscience and Sensory Organs, Policlinico Hospital Foundation IRCCS Cà Granda, Milan, Italy (S.L.); Department of Neurology, Washington U
| | - Vincent Thijs
- From the Department of Radiology, AA Martinos Center for Biomedical Imaging (H.A., E.M.A., T.B.), Stroke Service, Department of Neurology (H.A., J.R.), and Center for Human Genetic Research (J.R.), Massachusetts General Hospital, Harvard Medical School, Boston; Department of Neurology and Rehabilitation Medicine, Skåne University Hospital, Lund, Sweden (G.A., H.D., A.L., O.M., B.N.); Department of Neurology, Mayo Clinic Rochester, MN (R.D.B.); Department of Neurology (S.N.C., B.B.W.), Center for Public Health Genomics (S.S.R.), and Department of Public Health Sciences (B.B.W.), University of Virginia, Charlottesville; Department of Neurology (J.W.C., S.J.K.) and Division of Endocrinology, Diabetes, and Nutrition, Department of Medicine (P.F.M.), University of Maryland School of Medicine, Baltimore; Institute for Stroke and Dementia Research (ISD), Klinikum der Universität München, Ludwig-Maximilians-University, München, Germany (M.D., M.L.); Department of Clinical Science, Lund University, Malmö, Sweden (G.E., B.N.); Department of Neurology, Neurovascular Research Group, IMIM-Hospital del Mar, Universitat Autonoma de Barcelona/DCEXS-Universitat Pompeu Fabra, Spain (E.G.-S., J.J.-C., J.R.); Neuroscience Institute, Saint Francis Medical Center, Trenton, NJ (R.P.G., L.R.P.); National Institute of Neurological Disorders and Stroke, National Institutes of Health, Bethesda, MD (K.G.); Institute of Biomedicine (C.J., A.P.) and Institute of Neuroscience and Physiology (K.J.), Sahlgrenska Academy at University of Gothenburg, Sweden; Department of Neurology, University of Miami Miller School of Medicine, FL (M.K., T.R., R.L.S.); Department of Neurology, University of Cincinnati College of Medicine, OH (B.K., D.O.K.); Department of Neurology, Stern Stroke Center, Albert Einstein College of Medicine, Bronx, NY (D.L.L.); Department of Neuroscience and Sensory Organs, Policlinico Hospital Foundation IRCCS Cà Granda, Milan, Italy (S.L.); Department of Neurology, Washington U
| | - Rebecca Woodfield
- From the Department of Radiology, AA Martinos Center for Biomedical Imaging (H.A., E.M.A., T.B.), Stroke Service, Department of Neurology (H.A., J.R.), and Center for Human Genetic Research (J.R.), Massachusetts General Hospital, Harvard Medical School, Boston; Department of Neurology and Rehabilitation Medicine, Skåne University Hospital, Lund, Sweden (G.A., H.D., A.L., O.M., B.N.); Department of Neurology, Mayo Clinic Rochester, MN (R.D.B.); Department of Neurology (S.N.C., B.B.W.), Center for Public Health Genomics (S.S.R.), and Department of Public Health Sciences (B.B.W.), University of Virginia, Charlottesville; Department of Neurology (J.W.C., S.J.K.) and Division of Endocrinology, Diabetes, and Nutrition, Department of Medicine (P.F.M.), University of Maryland School of Medicine, Baltimore; Institute for Stroke and Dementia Research (ISD), Klinikum der Universität München, Ludwig-Maximilians-University, München, Germany (M.D., M.L.); Department of Clinical Science, Lund University, Malmö, Sweden (G.E., B.N.); Department of Neurology, Neurovascular Research Group, IMIM-Hospital del Mar, Universitat Autonoma de Barcelona/DCEXS-Universitat Pompeu Fabra, Spain (E.G.-S., J.J.-C., J.R.); Neuroscience Institute, Saint Francis Medical Center, Trenton, NJ (R.P.G., L.R.P.); National Institute of Neurological Disorders and Stroke, National Institutes of Health, Bethesda, MD (K.G.); Institute of Biomedicine (C.J., A.P.) and Institute of Neuroscience and Physiology (K.J.), Sahlgrenska Academy at University of Gothenburg, Sweden; Department of Neurology, University of Miami Miller School of Medicine, FL (M.K., T.R., R.L.S.); Department of Neurology, University of Cincinnati College of Medicine, OH (B.K., D.O.K.); Department of Neurology, Stern Stroke Center, Albert Einstein College of Medicine, Bronx, NY (D.L.L.); Department of Neuroscience and Sensory Organs, Policlinico Hospital Foundation IRCCS Cà Granda, Milan, Italy (S.L.); Department of Neurology, Washington U
| | - Bradford B Worrall
- From the Department of Radiology, AA Martinos Center for Biomedical Imaging (H.A., E.M.A., T.B.), Stroke Service, Department of Neurology (H.A., J.R.), and Center for Human Genetic Research (J.R.), Massachusetts General Hospital, Harvard Medical School, Boston; Department of Neurology and Rehabilitation Medicine, Skåne University Hospital, Lund, Sweden (G.A., H.D., A.L., O.M., B.N.); Department of Neurology, Mayo Clinic Rochester, MN (R.D.B.); Department of Neurology (S.N.C., B.B.W.), Center for Public Health Genomics (S.S.R.), and Department of Public Health Sciences (B.B.W.), University of Virginia, Charlottesville; Department of Neurology (J.W.C., S.J.K.) and Division of Endocrinology, Diabetes, and Nutrition, Department of Medicine (P.F.M.), University of Maryland School of Medicine, Baltimore; Institute for Stroke and Dementia Research (ISD), Klinikum der Universität München, Ludwig-Maximilians-University, München, Germany (M.D., M.L.); Department of Clinical Science, Lund University, Malmö, Sweden (G.E., B.N.); Department of Neurology, Neurovascular Research Group, IMIM-Hospital del Mar, Universitat Autonoma de Barcelona/DCEXS-Universitat Pompeu Fabra, Spain (E.G.-S., J.J.-C., J.R.); Neuroscience Institute, Saint Francis Medical Center, Trenton, NJ (R.P.G., L.R.P.); National Institute of Neurological Disorders and Stroke, National Institutes of Health, Bethesda, MD (K.G.); Institute of Biomedicine (C.J., A.P.) and Institute of Neuroscience and Physiology (K.J.), Sahlgrenska Academy at University of Gothenburg, Sweden; Department of Neurology, University of Miami Miller School of Medicine, FL (M.K., T.R., R.L.S.); Department of Neurology, University of Cincinnati College of Medicine, OH (B.K., D.O.K.); Department of Neurology, Stern Stroke Center, Albert Einstein College of Medicine, Bronx, NY (D.L.L.); Department of Neuroscience and Sensory Organs, Policlinico Hospital Foundation IRCCS Cà Granda, Milan, Italy (S.L.); Department of Neurology, Washington U
| | - James F Meschia
- From the Department of Radiology, AA Martinos Center for Biomedical Imaging (H.A., E.M.A., T.B.), Stroke Service, Department of Neurology (H.A., J.R.), and Center for Human Genetic Research (J.R.), Massachusetts General Hospital, Harvard Medical School, Boston; Department of Neurology and Rehabilitation Medicine, Skåne University Hospital, Lund, Sweden (G.A., H.D., A.L., O.M., B.N.); Department of Neurology, Mayo Clinic Rochester, MN (R.D.B.); Department of Neurology (S.N.C., B.B.W.), Center for Public Health Genomics (S.S.R.), and Department of Public Health Sciences (B.B.W.), University of Virginia, Charlottesville; Department of Neurology (J.W.C., S.J.K.) and Division of Endocrinology, Diabetes, and Nutrition, Department of Medicine (P.F.M.), University of Maryland School of Medicine, Baltimore; Institute for Stroke and Dementia Research (ISD), Klinikum der Universität München, Ludwig-Maximilians-University, München, Germany (M.D., M.L.); Department of Clinical Science, Lund University, Malmö, Sweden (G.E., B.N.); Department of Neurology, Neurovascular Research Group, IMIM-Hospital del Mar, Universitat Autonoma de Barcelona/DCEXS-Universitat Pompeu Fabra, Spain (E.G.-S., J.J.-C., J.R.); Neuroscience Institute, Saint Francis Medical Center, Trenton, NJ (R.P.G., L.R.P.); National Institute of Neurological Disorders and Stroke, National Institutes of Health, Bethesda, MD (K.G.); Institute of Biomedicine (C.J., A.P.) and Institute of Neuroscience and Physiology (K.J.), Sahlgrenska Academy at University of Gothenburg, Sweden; Department of Neurology, University of Miami Miller School of Medicine, FL (M.K., T.R., R.L.S.); Department of Neurology, University of Cincinnati College of Medicine, OH (B.K., D.O.K.); Department of Neurology, Stern Stroke Center, Albert Einstein College of Medicine, Bronx, NY (D.L.L.); Department of Neuroscience and Sensory Organs, Policlinico Hospital Foundation IRCCS Cà Granda, Milan, Italy (S.L.); Department of Neurology, Washington U
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Rannikmäe K, Kalaria RN, Greenberg SM, Chui HC, Schmitt FA, Samarasekera N, Al-Shahi Salman R, Sudlow CLM. APOE associations with severe CAA-associated vasculopathic changes: collaborative meta-analysis. J Neurol Neurosurg Psychiatry 2014; 85:300-5. [PMID: 24163429 PMCID: PMC4018226 DOI: 10.1136/jnnp-2013-306485] [Citation(s) in RCA: 77] [Impact Index Per Article: 7.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
OBJECTIVES Cerebral amyloid angiopathy (CAA) is associated with lobar intracerebral haemorrhage (ICH). While only the ε4 allele of the apolipoprotein E (APOE) gene is associated with the presence of CAA, both APOE-ε4 and ε2 are associated with lobar ICH. The generally accepted explanation is that APOE-ε4 promotes vascular amyloid deposition, while APOE-ε2 promotes progression to severe CAA with associated vasculopathic changes that cause vessel rupture and ICH. We assessed the evidence for these allele-specific effects. METHODS We systematically identified published studies with data on APOE genotype and histopathological assessment of postmortem brains for CAA severity. We obtained unpublished data from these for meta-analyses of the effects of ε4-containing (ε4+) and ε2-containing (ε2+) genotypes on progression to severe CAA. RESULTS Of six eligible studies (543 eligible participants), data were available from 5 (497 participants, 353 with CAA). Meta-analyses showed a possible association of ε4+ genotypes with severe CAA (ε4+ vs ε4-: severe vs mild/moderate CAA, OR 2.5, 95% CI 1.4 to 4.5, p=0.002; severe vs moderate CAA, OR 1.7, 95% CI 0.9 to 3.1, p=0.11). For ε2+ versus ε2- genotypes, there was no significant association, but the very small number of participants with ε2+ genotypes (22) precluded reliable estimates. CONCLUSIONS We found a possible association of severe CAA with APOE-ε4 but not APOE-ε2. However, our findings do not exclude a biologically meaningful association between APOE-ε2 and severe CAA. Further work is needed to elucidate fully the allele-specific associations of APOE with CAA and their mechanisms.
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Affiliation(s)
- Kristiina Rannikmäe
- Division of Clinical Neurosciences, Centre for Clinical Brain Sciences, University of Edinburgh, , Edinburgh, UK
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Rannikmäe K, Samarasekera N, Martînez-Gonzâlez NA, Al-Shahi Salman R, Sudlow CLM. Genetics of cerebral amyloid angiopathy: systematic review and meta-analysis. J Neurol Neurosurg Psychiatry 2013; 84:901-8. [PMID: 23457231 DOI: 10.1136/jnnp-2012-303898] [Citation(s) in RCA: 56] [Impact Index Per Article: 5.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
BACKGROUND AND PURPOSE Cerebral amyloid angiopathy (CAA) is common in the ageing brain and is associated with dementia and lobar intracerebral haemorrhage. We systematically reviewed genetic associations with CAA to better understand its pathogenesis. METHODS We comprehensively sought and critically appraised published studies of associations between any genetic polymorphism and histopathologically confirmed CAA. We assessed the effects of genotype by calculating study specific and pooled odds ratios (ORs) in meta-analyses, and assessed small study bias. RESULTS 58 studies (6855 participants) investigated apolipoprotein E (APOE) genotype and sporadic CAA. Meta-analysis of 24 (3520 participants) of these showed an association of APOE ε4 with CAA (ε4 present vs absent, pooled OR 2.7, 95% CI 2.3 to 3.1, p<0.00001), which was dose dependent, robust to potential small study biases and occurred irrespective of dementia status. There was no significant association between APOE ε2 and CAA. Among 24 studies (4703 participants) of other genetic polymorphisms, there was preliminary evidence of an association with CAA of polymorphisms in the transforming growth factor β1 gene (two studies, 449 participants), translocase of outer mitochondrial membrane 40 gene (one study, 723 participants) and the complement component receptor 1 gene (one study, 544 participants). There were insufficient data to draw conclusions from 24 studies (∼200 participants) of APOE and hereditary CAA or familial Alzheimer's disease. CONCLUSIONS There is convincing evidence for a dose dependent association between APOE ε4 and sporadic CAA. Further work is needed to better understand the mechanism of this association and to further investigate other genetic associations with CAA.
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Affiliation(s)
- Kristiina Rannikmäe
- Division of Clinical Neurosciences, University of Edinburgh, Western General Hospital, Edinburgh, UK
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