Common genetic markers and prediction of recurrent events after ischemic stroke in young adults

A. Pezzini, M. Grassi, E. Del Zotto, C. Lodigiani, P. Ferrazzi, A. Spalloni, R. Patella, A. Giossi, I. Volonghi, L. Iacoviello, M. Magoni, L. L. Rota, M. Rasura, A. Padovani

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Abstract

Background: Scarce information is available on the usefulness of new prediction markers for identifying young ischemic stroke patients at highest risk of recurrence. Methods: The predictive effect of traditional risk factors as well as of the 20210A variant of prothrombin gene, the 1691A variant of factor V gene, and the TT677 genotype of the methylenetetrahydrofolate reductase (MTHFR) gene on the risk of recurrence was investigated in a hospital-based cohort study of 511 ischemic stroke patients younger than 45 years followed up for a mean of 43.4 months. Outcome measures were fatal/nonfatal myocardial infarction, ischemic stroke, or TIA. Risk prediction was assessed with the use of the concordance c (c index), and the Net Reclassification Improvement (NRI). RESULTS:: The risk of recurrence increased with increasing number of traditional factors (hazard ratio [HR] 2.29, 95% confidence interval [CI] 1.57-3.35 for subjects with 1 factor: HR 5.25, 95% CI 2.45-11.2 for subjects with 2), as well as with that of predisposing genotypes (HR 1.96, 95% CI 1.33-2.89 for subjects carrying 1 at-risk genotype; HR 3.83, 95% CI 1.76-8.34 for those carrying 2). The c statistics increased significantly when the genotypes were included into a model with traditional risk factors (0.696 vs 0.635, test z = 2.41). The NRI was also significant (NRI = 0.172, test z = 2.17). Conclusions: Addition of common genetic variants to traditional risk factors may be an effective method for discriminating young stroke patients at different risk of future ischemic events.

Original languageEnglish
Pages (from-to)717-723
Number of pages7
JournalNeurology
Volume73
Issue number9
DOIs
Publication statusPublished - Sep 1 2009

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ASJC Scopus subject areas

  • Clinical Neurology

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Pezzini, A., Grassi, M., Del Zotto, E., Lodigiani, C., Ferrazzi, P., Spalloni, A., Patella, R., Giossi, A., Volonghi, I., Iacoviello, L., Magoni, M., Rota, L. L., Rasura, M., & Padovani, A. (2009). Common genetic markers and prediction of recurrent events after ischemic stroke in young adults. Neurology, 73(9), 717-723. https://doi.org/10.1212/WNL.0b013e3181b59aaf