Page 54

Karger_ESC London_2013

22. European Stroke Conference 8 Etiology of stroke and risk factors A 15:40 - 15:50 Autoimmune disease as a risk factor for stroke: population-based case-control study L.E. Binney1, Z. Mehta2, P.M. Rothwell3 Stroke Prevention Unit, Department of Clinical Neurosciences, University of Oxford, Ox-ford, UNITED KINGDOM1,Stroke Prevention Unit, Department of Clinical Neurosciences, University of Oxford, Oxford, UNITED KINGDOM2, Stroke Prevention Unit, Department of Clinical Neurosciences, University of Oxford, Oxford, UNITED KINGDOM3 BACKGROUND: High rates of ischaemic stroke in women are not fully explained by tradi-tional risk factors. Cohort studies in women with some non-cerebral autoimmune diseases have reported high risks of ischaemic vascular events. We studied the frequency of autoimmune dis-ease in women with TIA or ischaemic stroke versus controls and versus women with myocardi-al infarction (MI). METHODS: We compared rates of premorbid non-cerebral autoimmune diseases (thyroid dis-ease, rheumatoid arthritis, pernicious anaemia and type 1 diabetes) in consecutive women with TIA, ischaemic stroke and MI in a population-based study (Oxford Vascular Study) and in age-matched community controls. In cases, we determined associations with risk of recurrent vas-cular events. RESULTS: We recruited 613 women with TIA or ischaemic stroke, 280 with MI and 278 con-trols. Autoimmune disease was more frequent in women with TIA or ischaemic stroke than in female controls (age-adjusted OR: 2.1, 95%CI 1.2-3.7, p=0.008). However, autoimmune dis-ease was no more frequent in women with TIA and stroke than with MI (adjusted OR: 1.1, 0.7- 1.6). Autoimmune disease was not associated with any increase in five-year risk of recurrent stroke following a first TIA or stroke (age-adjusted HR= 1.1, 0.6-1.9). CONCLUSIONS: Although a history of autoimmune disease was more frequent in women with TIA or ischaemic stroke than in controls, there was no excess in comparison with women with MI, suggesting that susceptibility to systemic autoimmune disease is not a specific risk factor for cerebral ischaemic events. 7 Etiology of stroke and risk factors A 15:30 - 15:40 High-Density Lipoprotein Cholesterol Subfractions and Carotid IMT:The Northern Man-hattan Stroke Study (NOMAS) E. Tiozzo1, H. Gardener2, C. Dong3, D. Weiss4, D.D. Morte5, M.S. Elkind6, P. Gervasi-Frank-lin7, C.B. Wright8, R.L. Sacco9, T. Rundek10 University of Miami, Miami, USA1,University of Miami, Miami, USA2, University of Miami, Miami, USA3, University of Miami, Miami, USA4, University of Miami, Miami, USA5, Colum-bia University, New York, USA6, Columbia University, New York, USA7, University of Miami, Miami, USA8, University of Miami, Miami, USA9, University of Miami, Miami, USA10 Background Recent trials have challenged the “HDL hypothesis”, implicating the need to focus on HDL subfractions and function rather than total HDL concentration as better markers of vascular risk. The objective of this cross-sectional study was to investigate the relation between HDL2 and HDL3 fractions and carotid intima-media thickness (IMT), a marker of subclinical athero-sclerosis. Methods In NOMAS, a prospective population-based study of the incidence and risk factors of stroke, we evaluated 1041 participants (mean age 68±9 years; 38% men; 62% Hispanic, 19% black, 17% white) with available data on HDL subfractions and carotid IMT assessed by a high-reso-lution 2D carotid ultrasound. Carotid IMT was a composite measure of the mean IMT in all ca-rotid artery segments. The cross-sectional association between HDL-subfractions and IMT was analyzed by linear regression. Results The mean±SD of total HDL was 46.15±14.25 mg/dl (median = 44.00), HDL2 14.59±8.29 mg/ dl (median = 13.00), HDL3 31.06±8.32 mg/dl (median = 32.00). The mean IMT was 0.90±0.08 mm. After controlling for demographics, LDL, triglycerides, and cholesterol-lowering med-ication, total HDL, HDL2 and HDL3 were all strongly associated with IMT (per SD, HDL: beta=-0.008, p= 0.01; HDL2: beta=-0.006, p=0.03; HDL3: beta=-0.007 p=0.01). A significant interaction (p<0.05) was observed between diabetes and HDL2 in relation to IMT. A signif-icant association was found between HDL2 and IMT among those with diabetes (p=0.01; -0.018mm). Conclusion Besides total HDL, we observed strong independent inverse associations between both HDL subfractions and carotid IMT. HDL2 however was significantly associated with IMT only among those with diabetes. These observations show novel evidence for a potential role of HDL subfractions in the etiology of atherosclerosis, providing the opportunity to develop inter-ventions to target specific HDL subfractions in various patient populations. 54 © 2013 S. Karger AG, Basel Scientific Programme


Karger_ESC London_2013
To see the actual publication please follow the link above