Neal S Parikh1, Insu Koh2, Lisa B VanWagner3, Mitchell S V Elkind4, Neil A Zakai5, Mary Cushman5. 1. Clinical and Translational Neuroscience Unit, Feil Family Brain and Mind Research Institute and Department of Neurology, Weill Cornell Medicine, New York, NY USA. Electronic address: nsp2001@med.cornell.edu. 2. Department of Pathology and Laboratory Medicine, Larner College of Medicine at the University of Vermont, Burlington, VT USA. 3. Departments of Medicine, Division of Gastroenterology and Hepatology, and Preventive Medicine, Northwestern Medicine, Chicago, IL USA. 4. Department of Neurology, Columbia University, New York, NY USA; Department of Epidemiology, Mailman School of Public Health, Columbia University, New York, NY USA. 5. Department of Pathology and Laboratory Medicine, Larner College of Medicine at the University of Vermont, Burlington, VT USA; Department of Medicine, Larner College of Medicine at the University of Vermont, Burlington, VT USA.
Abstract
BACKGROUND: Nonalcoholic fatty liver disease is inconsistently associated with ischemic stroke, with one study suggesting an association in women and not men. The relative importance of liver fibrosis, as opposed to fatty liver, for cardiovascular risk is increasingly appreciated. We hypothesized that advanced liver fibrosis is associated with incident ischemic stroke risk, and especially in women. METHODS: We performed a case-cohort study in the REasons for Geographic and Racial Differences in Stroke cohort. Black and white individuals aged 45 and older were recruited between 2003 and 2007 and followed for ischemic stroke. The Fibrosis-4 (FIB-4) score and Nonalcoholic Fatty Liver Disease Fibrosis Score (NFS) were calculated using baseline data for stroke cases and a cohort random sample; advanced liver fibrosis was classified using validated cutoffs. Cox proportional hazards models were used to estimate hazard ratios (HR) of stroke after adjusting for potential confounders. Sex differences were assessed. RESULTS: There were 572 incident ischemic strokes (285 in women) over 5.4 (SD, 2.2) years. Advanced liver fibrosis was not significantly associated with ischemic stroke overall using the FIB-4 (HR 1.44; 95% CI 0.49-4.28) or NFS (HR 1.76; 95% CI 0.67-4.61). However, liver fibrosis was associated with stroke in women (HR 3.51; 95% CI 1.00-12.34) but not men (HR 0.70, 95% CI 0.16-3.16) (P = 0.098 for interaction) when using FIB-4. A similar but non-significant sex difference was seen for NFS. CONCLUSION: Advanced liver fibrosis may be associated with a higher risk of ischemic stroke in women but not men.
BACKGROUND: Nonalcoholic fatty liver disease is inconsistently associated with ischemic stroke, with one study suggesting an association in women and not men. The relative importance of liver fibrosis, as opposed to fatty liver, for cardiovascular risk is increasingly appreciated. We hypothesized that advanced liver fibrosis is associated with incident ischemic stroke risk, and especially in women. METHODS: We performed a case-cohort study in the REasons for Geographic and Racial Differences in Stroke cohort. Black and white individuals aged 45 and older were recruited between 2003 and 2007 and followed for ischemic stroke. The Fibrosis-4 (FIB-4) score and Nonalcoholic Fatty Liver Disease Fibrosis Score (NFS) were calculated using baseline data for stroke cases and a cohort random sample; advanced liver fibrosis was classified using validated cutoffs. Cox proportional hazards models were used to estimate hazard ratios (HR) of stroke after adjusting for potential confounders. Sex differences were assessed. RESULTS: There were 572 incident ischemic strokes (285 in women) over 5.4 (SD, 2.2) years. Advanced liver fibrosis was not significantly associated with ischemic stroke overall using the FIB-4 (HR 1.44; 95% CI 0.49-4.28) or NFS (HR 1.76; 95% CI 0.67-4.61). However, liver fibrosis was associated with stroke in women (HR 3.51; 95% CI 1.00-12.34) but not men (HR 0.70, 95% CI 0.16-3.16) (P = 0.098 for interaction) when using FIB-4. A similar but non-significant sex difference was seen for NFS. CONCLUSION: Advanced liver fibrosis may be associated with a higher risk of ischemic stroke in women but not men.
Authors: Seung Up Kim; Dongbeom Song; Ji Hoe Heo; Joonsang Yoo; Beom Kyung Kim; Jun Yong Park; Do Young Kim; Sang Hoon Ahn; Kwang Joon Kim; Kwang-Hyub Han; Young Dae Kim Journal: Atherosclerosis Date: 2017-02-12 Impact factor: 5.162
Authors: Llorenç Caballería; Guillem Pera; Ingrid Arteaga; Lluís Rodríguez; Alba Alumà; Rosa Ma Morillas; Napoleón de la Ossa; Alba Díaz; Carmen Expósito; Dolores Miranda; Carmen Sánchez; Rosa Ma Prats; Marta Urquizu; Angels Salgado; Magda Alemany; Alba Martinez; Irfan Majeed; Núria Fabrellas; Isabel Graupera; Ramón Planas; Isabel Ojanguren; Miquel Serra; Pere Torán; Juan Caballería; Pere Ginès Journal: Clin Gastroenterol Hepatol Date: 2018-02-13 Impact factor: 11.382