Interaction between proatherosclerotic factors and right-to-left shunt on the risk of cryptogenic stroke

The Italian Project on Stroke in Young Adults

Alessandro Pezzini, Mario Grassi, Corrado Lodigiani, Rosalba Patella, Carlo Gandolfo, Andrea Zini, Rossella Musolino, Rocco Salvatore Calabrò, Paolo Bovi, Alessandro Adami, Maria Luisa DeLodovici, Elisabetta Del Zotto, Lidia Luciana Rota, Maurizia Rasura, Massimo Del Sette, Alessandra Spalloni, Alessia Giossi, Irene Volonghi, Federica Casoni, Paolo Cerrato & 7 others Paolo Costa, Mauro Magoni, Antonella Toriello, Maurizio Paciaroni, Giorgio Dalla Volta, Licia Iacoviello, Alessandro Padovani

Research output: Contribution to journalArticle

12 Citations (Scopus)

Abstract

Objective: To explore the interaction effects between cardiac interatrial right-to-left shunt (RLS) and proatherosclerotic factors on the risk of brain ischaemia. Design: Multicentre Italian caseecontrol study. Setting: University hospitals. Participants: 588 patients with cryptogenic stroke (CS) aged ≤45 years and 585 control subjects consecutively enrolled as part of the Italian Project on Stroke in Young Adults. Methods: Interaction effects between RLS and an individual proatherosclerotic score computed from the number of conventional vascular risk factors for the risk of CS were investigated. Data were examined by logistic regression models and expressed as interaction OR or interaction risk difference (RD). Results: CS risk increased with increasing number of proatherosclerotic factors in subjects without RLS (OR 2.73; 95% CI 1.98 to 3.76; RD +0.246; 95% CI +0.17 to +0.32; for subjects with one or more factors), but was higher in subjects with RLS and no additional proatherosclerotic factors (OR 5.14; 95% CI 3.49 to 7.58; RD +0.388; 95% CI +0.31 to +0.47) compared with subjects without RLS and no risk factors. Negative interaction and antagonistic effects between RLS and proatherosclerotic factors were observed (interaction OR 0.52; 95% CI 0.31 to 0.91; interaction RD -0.17; 95% CI -0.29 to -0.05). Conclusions: The influence of RLS on the risk of CS decreases with increasing number of atherosclerotic factors, and is highest when such factors are absent. Individual proatherosclerotic profiles may help to identify patients with CS whose patent foramen ovale is probably pathogenic.

Original languageEnglish
Pages (from-to)485-489
Number of pages5
JournalHeart
Volume98
Issue number6
DOIs
Publication statusPublished - Mar 2012

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Young Adult
Stroke
Logistic Models
Patent Foramen Ovale
Brain Ischemia

ASJC Scopus subject areas

  • Cardiology and Cardiovascular Medicine

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Interaction between proatherosclerotic factors and right-to-left shunt on the risk of cryptogenic stroke : The Italian Project on Stroke in Young Adults. / Pezzini, Alessandro; Grassi, Mario; Lodigiani, Corrado; Patella, Rosalba; Gandolfo, Carlo; Zini, Andrea; Musolino, Rossella; Calabrò, Rocco Salvatore; Bovi, Paolo; Adami, Alessandro; DeLodovici, Maria Luisa; Del Zotto, Elisabetta; Rota, Lidia Luciana; Rasura, Maurizia; Del Sette, Massimo; Spalloni, Alessandra; Giossi, Alessia; Volonghi, Irene; Casoni, Federica; Cerrato, Paolo; Costa, Paolo; Magoni, Mauro; Toriello, Antonella; Paciaroni, Maurizio; Dalla Volta, Giorgio; Iacoviello, Licia; Padovani, Alessandro.

In: Heart, Vol. 98, No. 6, 03.2012, p. 485-489.

Research output: Contribution to journalArticle

Pezzini, A, Grassi, M, Lodigiani, C, Patella, R, Gandolfo, C, Zini, A, Musolino, R, Calabrò, RS, Bovi, P, Adami, A, DeLodovici, ML, Del Zotto, E, Rota, LL, Rasura, M, Del Sette, M, Spalloni, A, Giossi, A, Volonghi, I, Casoni, F, Cerrato, P, Costa, P, Magoni, M, Toriello, A, Paciaroni, M, Dalla Volta, G, Iacoviello, L & Padovani, A 2012, 'Interaction between proatherosclerotic factors and right-to-left shunt on the risk of cryptogenic stroke: The Italian Project on Stroke in Young Adults', Heart, vol. 98, no. 6, pp. 485-489. https://doi.org/10.1136/heartjnl-2011-300970
Pezzini, Alessandro ; Grassi, Mario ; Lodigiani, Corrado ; Patella, Rosalba ; Gandolfo, Carlo ; Zini, Andrea ; Musolino, Rossella ; Calabrò, Rocco Salvatore ; Bovi, Paolo ; Adami, Alessandro ; DeLodovici, Maria Luisa ; Del Zotto, Elisabetta ; Rota, Lidia Luciana ; Rasura, Maurizia ; Del Sette, Massimo ; Spalloni, Alessandra ; Giossi, Alessia ; Volonghi, Irene ; Casoni, Federica ; Cerrato, Paolo ; Costa, Paolo ; Magoni, Mauro ; Toriello, Antonella ; Paciaroni, Maurizio ; Dalla Volta, Giorgio ; Iacoviello, Licia ; Padovani, Alessandro. / Interaction between proatherosclerotic factors and right-to-left shunt on the risk of cryptogenic stroke : The Italian Project on Stroke in Young Adults. In: Heart. 2012 ; Vol. 98, No. 6. pp. 485-489.
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abstract = "Objective: To explore the interaction effects between cardiac interatrial right-to-left shunt (RLS) and proatherosclerotic factors on the risk of brain ischaemia. Design: Multicentre Italian caseecontrol study. Setting: University hospitals. Participants: 588 patients with cryptogenic stroke (CS) aged ≤45 years and 585 control subjects consecutively enrolled as part of the Italian Project on Stroke in Young Adults. Methods: Interaction effects between RLS and an individual proatherosclerotic score computed from the number of conventional vascular risk factors for the risk of CS were investigated. Data were examined by logistic regression models and expressed as interaction OR or interaction risk difference (RD). Results: CS risk increased with increasing number of proatherosclerotic factors in subjects without RLS (OR 2.73; 95{\%} CI 1.98 to 3.76; RD +0.246; 95{\%} CI +0.17 to +0.32; for subjects with one or more factors), but was higher in subjects with RLS and no additional proatherosclerotic factors (OR 5.14; 95{\%} CI 3.49 to 7.58; RD +0.388; 95{\%} CI +0.31 to +0.47) compared with subjects without RLS and no risk factors. Negative interaction and antagonistic effects between RLS and proatherosclerotic factors were observed (interaction OR 0.52; 95{\%} CI 0.31 to 0.91; interaction RD -0.17; 95{\%} CI -0.29 to -0.05). Conclusions: The influence of RLS on the risk of CS decreases with increasing number of atherosclerotic factors, and is highest when such factors are absent. Individual proatherosclerotic profiles may help to identify patients with CS whose patent foramen ovale is probably pathogenic.",
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T1 - Interaction between proatherosclerotic factors and right-to-left shunt on the risk of cryptogenic stroke

T2 - The Italian Project on Stroke in Young Adults

AU - Pezzini, Alessandro

AU - Grassi, Mario

AU - Lodigiani, Corrado

AU - Patella, Rosalba

AU - Gandolfo, Carlo

AU - Zini, Andrea

AU - Musolino, Rossella

AU - Calabrò, Rocco Salvatore

AU - Bovi, Paolo

AU - Adami, Alessandro

AU - DeLodovici, Maria Luisa

AU - Del Zotto, Elisabetta

AU - Rota, Lidia Luciana

AU - Rasura, Maurizia

AU - Del Sette, Massimo

AU - Spalloni, Alessandra

AU - Giossi, Alessia

AU - Volonghi, Irene

AU - Casoni, Federica

AU - Cerrato, Paolo

AU - Costa, Paolo

AU - Magoni, Mauro

AU - Toriello, Antonella

AU - Paciaroni, Maurizio

AU - Dalla Volta, Giorgio

AU - Iacoviello, Licia

AU - Padovani, Alessandro

PY - 2012/3

Y1 - 2012/3

N2 - Objective: To explore the interaction effects between cardiac interatrial right-to-left shunt (RLS) and proatherosclerotic factors on the risk of brain ischaemia. Design: Multicentre Italian caseecontrol study. Setting: University hospitals. Participants: 588 patients with cryptogenic stroke (CS) aged ≤45 years and 585 control subjects consecutively enrolled as part of the Italian Project on Stroke in Young Adults. Methods: Interaction effects between RLS and an individual proatherosclerotic score computed from the number of conventional vascular risk factors for the risk of CS were investigated. Data were examined by logistic regression models and expressed as interaction OR or interaction risk difference (RD). Results: CS risk increased with increasing number of proatherosclerotic factors in subjects without RLS (OR 2.73; 95% CI 1.98 to 3.76; RD +0.246; 95% CI +0.17 to +0.32; for subjects with one or more factors), but was higher in subjects with RLS and no additional proatherosclerotic factors (OR 5.14; 95% CI 3.49 to 7.58; RD +0.388; 95% CI +0.31 to +0.47) compared with subjects without RLS and no risk factors. Negative interaction and antagonistic effects between RLS and proatherosclerotic factors were observed (interaction OR 0.52; 95% CI 0.31 to 0.91; interaction RD -0.17; 95% CI -0.29 to -0.05). Conclusions: The influence of RLS on the risk of CS decreases with increasing number of atherosclerotic factors, and is highest when such factors are absent. Individual proatherosclerotic profiles may help to identify patients with CS whose patent foramen ovale is probably pathogenic.

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