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.
BACKGROUND: Scarce information is available on the usefulness of new prediction markers for identifying young ischemic strokepatients 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 strokepatients 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 strokepatients at different risk of future ischemic events.
Authors: Noortje A M M Maaijwee; Loes C A Rutten-Jacobs; Pauline Schaapsmeerders; Ewoud J van Dijk; Frank-Erik de Leeuw Journal: Nat Rev Neurol Date: 2014-04-29 Impact factor: 42.937
Authors: Julie Y M Johnson; Brian H Rowe; Ryan W Allen; Paul A Peters; Paul J Villeneuve Journal: BMC Public Health Date: 2013-04-19 Impact factor: 3.295
Authors: Douglas D Thompson; Gordon D Murray; Martin Dennis; Cathie L M Sudlow; William N Whiteley Journal: BMC Med Date: 2014-04-04 Impact factor: 8.775
Authors: Mijntje M I Schellekens; Mayte E van Alebeek; Renate M Arntz; Nathalie E Synhaeve; Noortje A M M Maaijwee; Hennie C Schoonderwaldt; Maureen J van der Vlugt; Ewoud J van Dijk; Loes C A Rutten-Jacobs; Frank-Erik de Leeuw Journal: J Thromb Thrombolysis Date: 2018-05 Impact factor: 2.300