Sleep-disordered breathing-related symptoms and risk of stroke: cohort study and Mendelian randomization analysis

Journal of Neurology ◽

10.1007/s00415-021-10824-y ◽

2021 ◽

Author(s):

Olga E. Titova ◽

Shuai Yuan ◽

John A. Baron ◽

Eva Lindberg ◽

Karl Michaëlsson ◽

...

Keyword(s):

Cohort Study ◽

Ischemic Stroke ◽

Subarachnoid Hemorrhage ◽

Sleep Apnea ◽

Confidence Interval ◽

Intracerebral Hemorrhage ◽

Sleep Disordered Breathing ◽

Mendelian Randomization ◽

Genome Wide ◽

Increased Risk

Abstract Background Sleep-disordered breathing (SDB) may contribute to development of stroke. However, findings are inconclusive. We investigated whether SDB-related symptoms are associated with incidence of stroke and its types in a general community sample of adult men and women as well as to perform Mendelian randomization (MR) analysis. Methods We used data from a cohort of 41,742 Swedish adults (56–94 years of age) who completed questionnaires regarding snoring, cessation of breathing, lifestyle and health characteristics. Participants were followed up for incident stroke and death over 8 years through linkage to the Swedish Registers. Hazard ratios, adjusted for potential confounders, were estimated by Cox proportional hazards regression. MR analyses were performed using single-nucleotide polymorphisms associated with sleep apnea at the genome-wide significance level and summary-level data for stroke and its subtypes from consortia and a meta-analysis of Genome-Wide Association Studies. Results In the cohort study, symptoms of disturbing snoring and/or cessation of breathing were associated with increased risk of total stroke (hazard ratio 1.12, 95% confidence interval 1.02–1.24) and intracerebral hemorrhage (hazard ratio 1.59, 95% confidence interval 1.23–2.05) but not with ischemic stroke or subarachnoid hemorrhage. MR analyses showed no association of genetic liability to sleep apnea with the risk of overall stroke or any specific types of stroke or ischemic stroke subtypes. Conclusions SDB-related symptoms were associated with increased risk of total stroke, specifically intracerebral hemorrhage, in the observational analyses but not in the MR analyses. There was limited evidence of an association of SDB with ischemic stroke and subarachnoid hemorrhage.

Download Full-text

Association between Apolipoprotein E Polymorphism and Clinical Outcome after Ischemic Stroke, Intracerebral Hemorrhage, and Subarachnoid Hemorrhage

Cerebrovascular Diseases ◽

10.1159/000520053 ◽

2021 ◽

pp. 1-10

Author(s):

Wen Pan ◽

Min Zhang ◽

Zhenping Guo ◽

Wenfeng Xiao ◽

Chao You ◽

...

Keyword(s):

Ischemic Stroke ◽

Subarachnoid Hemorrhage ◽

Clinical Outcome ◽

Intracerebral Hemorrhage ◽

Apolipoprotein E ◽

Functional Outcomes ◽

Fixed Effects ◽

Meta Analysis ◽

Fixed Effects Models ◽

Increased Risk

Backgrounds: Previous studies reported inconsistent results regarding associations between apolipoprotein E (APOE) polymorphism and clinical outcomes after ischemic stroke (IS), intracerebral hemorrhage (ICH), or subarachnoid hemorrhage (SAH). Thus, the study was designed to make a systematic review and meta-analysis regarding the association between APOE polymorphism and clinical outcome after IS, ICH, and SAH. Methods: To identify studies eligible for this meta-analysis, we searched for articles published before August 2021 in the databases (PubMed, Web of Science, and Google Scholar). We used STATA 12.0 software to compute hazard ratios (HRs) and their 95% confidence intervals (CIs) regarding APOE polymorphism and clinical outcome after IS, ICH, and SAH. Results: Meta-analysis showed no significant association between APOE polymorphism and functional outcome after IS with fixed effects models (ε4 carrier vs. non-ε4 carrier: HR, 1.00; 95% CI: 0.83–1.21, I2 = 29.4%, p = 0.183; ε2 carrier vs. non-ε2 carrier: HR, 0.92; 95% CI: 0.72–1.16, I2 = 15.6%, p = 0.307). Meta-analysis showed that ICH patients carrying ε4 allele have increased risk of poor outcome in Caucasian population with fixed effects models (ε4 carrier vs. non-ε4 carrier: HR, 1.75; 95% CI: 1.19–2.57, I2 = 0.0%, p = 0.543). Meta-analysis showed no significant association between APOE polymorphism and functional outcomes after SAH with random effects models (ε4 carrier vs. non-ε4 carrier: HR, 1.51; 95% CI: 0.80–2.84, I2 = 57.1%, p = 0.022). Conclusions: In conclusion, the present study demonstrated APOE ε4 carriers show worse functional outcomes after ICH, but not after IS or SAH. More large-scale studies were critical to explore the association between APOE polymorphism and clinical outcome after IS, ICH, and SAH.

Download Full-text

Sleep Duration and Stroke

Stroke ◽

10.1161/strokeaha.120.029902 ◽

2020 ◽

Vol 51 (11) ◽

pp. 3279-3285

Author(s):

Olga E. Titova ◽

Karl Michaëlsson ◽

Susanna C. Larsson

Keyword(s):

Ischemic Stroke ◽

Intracerebral Hemorrhage ◽

Prospective Study ◽

Sleep Duration ◽

Mendelian Randomization ◽

Short Sleep ◽

Mendelian Randomization Analysis ◽

Increased Risk ◽

Long Sleep ◽

Randomization Analysis

Background and Purpose: Studies of sleep duration in relation to specific types of stroke are scarce. Moreover, the results are inconclusive and causality remains unclear. Our objective was to investigate whether sleep duration is associated with risk of stroke and its types using observational and Mendelian randomization designs. Methods: The prospective study included 79 881 women and men (45–79 years of age) who were followed up for incident stroke or death over a mean follow-up of 14.6 years (1 164 646 person-years) through linkage to Swedish Registers. For the Mendelian randomization study, single-nucleotide polymorphisms associated with sleep duration were identified from a genome-wide association study. Summarized data for genetic associations with stroke were obtained from publicly available data of the MEGASTROKE and the International Stroke Genetics Consortia. Results: Compared with normal sleep duration, long sleep (≥9 hours per day) was associated with increased risk of total and ischemic stroke (hazard ratios [95% CI], 1.12 [1.03–1.22] and 1.14 [1.03–1.24], respectively), whereas short sleep (<7 h/d) was linked to higher risk of intracerebral hemorrhage (hazard ratio [95% CI], 1.21 [1.03–1.41]). The 2-sample Mendelian randomization analysis supported no causal association of short or long sleep duration with ischemic stroke as a whole. Conclusions: In a prospective study, long sleep duration was associated with increased risk of total and ischemic stroke, whereas short sleep was linked to increased risk of intracerebral hemorrhage. However, the Mendelian randomization analysis did not show a significant detrimental effect of short or long sleep duration on the risk of total stroke or stroke types.

Download Full-text

Abstract WMP60: Association Between Liver Cirrhosis and Stroke in a Nationally Representative Cohort

Stroke ◽

10.1161/str.48.suppl_1.wmp60 ◽

2017 ◽

Vol 48 (suppl_1) ◽

Author(s):

Neal S Parikh ◽

Babak B Navi ◽

Yecheskel Schneider ◽

Hooman Kamel

Keyword(s):

Risk Factors ◽

Liver Cirrhosis ◽

Ischemic Stroke ◽

Subarachnoid Hemorrhage ◽

Intracerebral Hemorrhage ◽

Cox Proportional Hazards ◽

Medicare Beneficiaries ◽

Stroke Incidence ◽

Increased Risk ◽

Thrombotic Complications

Introduction: Liver cirrhosis is characterized by a coagulopathy associated with both hemorrhagic and thrombotic complications. However, the risk of stroke - hemorrhagic and ischemic - in patients with cirrhosis has not been rigorously assessed. Methods: We performed a retrospective cohort study of Medicare beneficiaries ≥66 years of age using a 5% sample of inpatient and outpatient claims from 2008-2014. Our predictor was liver cirrhosis, defined by presence of at least two ICD-9-CM inpatient or outpatient claims for liver cirrhosis or its complications, a validated algorithm previously used to study cirrhosis in Medicare beneficiaries. The primary outcome was stroke, and the secondary outcomes were ischemic stroke, intracerebral hemorrhage, and subarachnoid hemorrhage. Outcomes were defined by validated ICD-9-CM algorithms. Patients were censored at the time of an outcome, death, or on December 31, 2014. We used survival analysis to compare stroke incidence in patients with and without liver cirrhosis. Cox proportional hazards analysis was used to evaluate the association between cirrhosis and stroke while adjusting for demographics and established stroke risk factors. Results: Among the 1,564,277 beneficiaries in our sample, we identified 10,512 (0.7%) patients with liver cirrhosis. The mean age of patients with cirrhosis was 74.1 (±6.5) years. Over a median follow-up of 5 years, 76,195 patients were hospitalized with a stroke. The incidence of stroke was 1.9% (95% confidence interval [CI], 1.7-2.1%) per year in patients with cirrhosis and 1.1% (95% CI, 1.1-1.1%) per year in patients without cirrhosis. After adjusting for demographics and vascular risk factors, patients with cirrhosis experienced a higher risk of stroke (hazard ratio [HR], 1.4; 95% CI, 1.2-1.5); however, associations appeared more robust for intracerebral hemorrhage (HR, 2.2; 95% CI, 1.7-2.8) and subarachnoid hemorrhage (HR, 2.0; 95% CI, 1.2-3.1) than for ischemic stroke (HR, 1.3; 95% CI, 1.1-1.4). Conclusions: We found that liver cirrhosis was associated with an increased risk of stroke, particularly hemorrhagic stroke. Our results build on recent work investigating the hemorrhagic and thrombotic complications of liver cirrhosis outside of the portal circulation.

Download Full-text

Homocysteine, B vitamins, and cardiovascular disease: a Mendelian randomization study

BMC Medicine ◽

10.1186/s12916-021-01977-8 ◽

2021 ◽

Vol 19 (1) ◽

Author(s):

Shuai Yuan ◽

Amy M. Mason ◽

Paul Carter ◽

Stephen Burgess ◽

Susanna C. Larsson

Keyword(s):

Cardiovascular Disease ◽

Ischemic Stroke ◽

Subarachnoid Hemorrhage ◽

Vitamin B12 ◽

Vitamin B6 ◽

Mendelian Randomization ◽

Nucleotide Polymorphisms ◽

Multiple Testing Correction ◽

Increased Risk ◽

B Vitamin

Abstract Background Whether a modestly elevated homocysteine level is causally associated with an increased risk of cardiovascular disease remains unestablished. We conducted a Mendelian randomization study to assess the associations of circulating total homocysteine (tHcy) and B vitamin levels with cardiovascular diseases in the general population. Methods Independent single nucleotide polymorphisms associated with tHcy (n = 14), folate (n = 2), vitamin B6 (n = 1), and vitamin B12 (n = 14) at the genome-wide significance level were selected as instrumental variables. Summary-level data for 12 cardiovascular endpoints were obtained from genetic consortia, the UK Biobank study, and the FinnGen consortium. Results Higher genetically predicted circulating tHcy levels were associated with an increased risk of stroke. For each one standard deviation (SD) increase in genetically predicted tHcy levels, the odds ratio (OR) was 1.11 (95% confidence interval (CI), 1.03, 1.21; p = 0.008) for any stroke, 1.26 (95% CI, 1.05, 1.51; p = 0.013) for subarachnoid hemorrhage, and 1.11 (95% CI, 1.03, 1.21; p = 0.011) for ischemic stroke. Higher genetically predicted folate levels were associated with decreased risk of coronary artery disease (ORSD, 0.88; 95% CI, 0.78, 1.00, p = 0.049) and any stroke (ORSD, 0.86; 95% CI, 0.76, 0.97, p = 0.012). Genetically predicted increased vitamin B6 levels were associated with a reduced risk of ischemic stroke (ORSD, 0.88; 95% CI, 0.81, 0.97, p = 0.009). None of these associations persisted after multiple testing correction. There was no association between genetically predicted vitamin B12 and cardiovascular disease. Conclusions This study reveals suggestive evidence that B vitamin therapy and lowering of tHcy may reduce the risk of stroke, particularly subarachnoid hemorrhage and ischemic stroke.

Download Full-text

Genetically Predicted Cardiac Troponin I Concentrations and Risk of Stroke and Atrial Fibrillation

10.21203/rs.3.rs-699688/v1 ◽

2021 ◽

Author(s):

Dandan Liu ◽

Yue Deng ◽

Jiao Wang ◽

Yanan Chen ◽

Jian Yu ◽

...

Keyword(s):

Atrial Fibrillation ◽

Ischemic Stroke ◽

Intracerebral Hemorrhage ◽

Cardiac Troponin ◽

Troponin I ◽

Mendelian Randomization ◽

Cardiac Troponin I ◽

Cardioembolic Stroke ◽

Large Artery ◽

Increased Risk

Abstract Background: Observational studies have shown that elevated circulating cardiac troponin I (cTnI) concentrations were associated with higher risk of stroke and atrial fibrillation, but the causality remains unclear. Therefore, we conducted a two-sample mendelian randomization study to evaluate the causal effects of cTnI concentrations on the risk of stroke subtypes and atrial fibrillation.Methods: The instrumental variables for circulating cTnI concentrations were selected from a genome-wide association study meta-analysis of 48,115 European individuals. Applying a 2-sample mendelian randomization approach, we examined the associations of circulating cTnI concentrations with stroke (40,585 cases and 406,111 controls), ischemic stroke (34,217 cases and 406,111 controls), ischemic stroke subtypes (cardioembolic, large artery, small vessel stroke), intracerebral hemorrhage (1,545 cases and 1,481 controls) and atrial fibrillation (60,620 cases and 970,216 controls). Results: Genetically predicted elevated circulating cTnI concentrations were associated with increased risk of cardioembolic stroke (odds ratio [OR], 1.80; 95% confidence interval [CI], 1.20-2.68; P = 0.004). However, no significant association was observed for cTnI concentrations with large artery stroke, small vessel stroke, total stroke, ischemic stroke and intracerebral hemorrhage. Additionally, we also found that elevated cTnI concentrations were associated with higher risk of atrial fibrillation (OR, 1.30; 95% CI, 1.10-1.53; P = 0.003).Conclusions: This study provides evidence that genetically predicted circulating cTnI concentrations are causally associated with increased risk of cardioembolic stroke and atrial fibrillation.

Download Full-text

Abstract P439: Mortality After an Arterial Ischemic Event Among Intracerebral Hemorrhage Survivors

Stroke ◽

10.1161/str.52.suppl_1.p439 ◽

2021 ◽

Vol 52 (Suppl_1) ◽

Author(s):

Melvin Parasram ◽

Neal S Parikh ◽

Alexander E Merkler ◽

Guido J Falcone ◽

Kevin N Sheth ◽

...

Keyword(s):

Ischemic Stroke ◽

Confidence Interval ◽

Intracerebral Hemorrhage ◽

Medicare Beneficiaries ◽

Ischemic Event ◽

Risk Of Death ◽

Diagnosis Codes ◽

Increased Risk ◽

Secondary Analyses ◽

Ischemic Events

Background and Purpose: Emerging data suggest an increased risk of arterial ischemic events after intracerebral hemorrhage (ICH), but their impact on ICH outcomes is unclear. This study aimed to evaluate the risk of death among ICH survivors with and without an incident arterial ischemic event. Methods: We performed a retrospective cohort study using claims data from Medicare beneficiaries with a non-traumatic ICH from January 2008 to October 2015. Our exposure was an arterial ischemic event, defined as a composite of acute ischemic stroke or myocardial infarction (MI), identified using validated ICD-9-CM diagnosis codes. The outcome was death. After excluding ischemic events and deaths in the first 30 days after ICH discharge to prevent carryover of diagnosis codes from the initial hospitalization, we used marginal structural models to analyze the risk of death among ICH patients with and without an arterial ischemic event, after adjusting for demographics and vascular comorbidities as time-varying covariates. In secondary analyses, we studied the mortality risk separately after an ischemic stroke and MI. Results: Among 8,222 Medicare beneficiaries with an ICH, 2,371 (28.8%) had an arterial ischemic event. During a median follow up time of 2.0 years (interquartile range, 0.8-3.8), the cumulative mortality rate was 7.0% (95% confidence interval [CI], 6.5-7.5%) in patients with an arterial ischemic event and 4.0% (95% CI, 3.8-4.2%) in patients without an arterial ischemic event. In the marginal structural model, the occurrence of an arterial ischemic event was associated with an increased risk of death (hazard ratio [HR], 1.6; 95% confidence interval [CI], 1.5- 1.7). In secondary analyses, the mortality risk was elevated after both an ischemic stroke (HR, 1.5; 95% CI, 1.4-1.6), and a MI (HR, 2.6; 95% CI, 2.1-3.2). Conclusions: In a large population-based cohort, we found that elderly patients who survived an ICH had an increased risk of death after a subsequent ischemic stroke or MI. Careful exploration of secondary cardiovascular and stroke prevention strategies may be warranted in these patients.

Download Full-text

Risk of Mortality After an Arterial Ischemic Event Among Intracerebral Hemorrhage Survivors

The Neurohospitalist ◽

10.1177/19418744211026709 ◽

2021 ◽

pp. 194187442110267

Author(s):

Melvin Parasram ◽

Neal S. Parikh ◽

Alexander E. Merkler ◽

Guido J. Falcone ◽

Kevin N. Sheth ◽

...

Keyword(s):

Ischemic Stroke ◽

Confidence Interval ◽

Intracerebral Hemorrhage ◽

Structural Model ◽

Medicare Beneficiaries ◽

Ischemic Event ◽

Risk Of Death ◽

Increased Risk ◽

The Impact ◽

Time Varying Covariates

Background and Purpose: The impact of arterial ischemic events after intracerebral hemorrhage (ICH) on outcomes is unclear. This study aimed to evaluate the risk of death among ICH survivors with and without an incident arterial ischemic event. Methods: We performed a retrospective cohort study using claims data from Medicare beneficiaries with a non-traumatic ICH from January 2008 to October 2015. Our exposure was an arterial ischemic event, a composite of acute ischemic stroke or myocardial infarction (MI), identified using validated ICD-9-CM diagnosis codes. The outcome was mortality. We used marginal structural models to analyze the risk of death among ICH patients with and without an arterial ischemic event, after adjusting for confounders as time-varying covariates. Results: Among 8,804 Medicare beneficiaries with ICH, 2,371 (26.9%) had an arterial ischemic event. During a median follow-up time of 1.9 years (interquartile range, 0.7-3.9), ICH patients with an arterial ischemic event had a mortality rate of 21.7 (95% confidence interval [CI], 20.4-23.0) per 100 person-years compared to a rate of 15.0 (95% CI, 14.4-15.6) per 100 person-years in those without. In the marginal structural model, an arterial ischemic event was associated with an increased risk of death (hazard ratio [HR], 1.8; 95% confidence interval [CI], 1.6-1.9). In secondary analyses, the mortality risk was elevated after an ischemic stroke (HR, 1.7; 95% CI, 1.5-1.8), and MI (HR, 3.0; 95% CI, 2.4-3.8). Conclusions: We found that elderly patients who survived an ICH had an increased risk of death after a subsequent ischemic stroke or MI.

Download Full-text

Differences in risk factors for 3 types of stroke

Neurology ◽

10.1212/wnl.0000000000004856 ◽

2018 ◽

Vol 90 (4) ◽

pp. e298-e306 ◽

Cited By ~ 18

Author(s):

Alison J. Price ◽

F. Lucy Wright ◽

Jane Green ◽

Angela Balkwill ◽

Sau Wan Kan ◽

...

Keyword(s):

Risk Factors ◽

Ischemic Stroke ◽

Subarachnoid Hemorrhage ◽

Intracerebral Hemorrhage ◽

Cox Regression ◽

Related Factors ◽

Stroke Incidence ◽

Relative Risks ◽

Increased Risk ◽

Meta Analyses

ObjectiveTo compare associations of behavioral and related factors for incident subarachnoid hemorrhage and intracerebral hemorrhage and ischemic stroke.MethodsA total of 712,433 Million Women Study participants without prior stroke, heart disease, or cancer reported behavioral and related factors at baseline (1999–2007) and were followed up by record linkage to national hospital admission and death databases. Cox regression yielded adjusted relative risks (RRs) by type of stroke. Heterogeneity was assessed with χ2 tests. When appropriate, meta-analyses were done of published prospective studies.ResultsAfter 12.9 (SD 2.6) years of follow-up, 8,128 women had an incident ischemic stroke, 2,032 had intracerebral hemorrhage, and 1,536 had subarachnoid hemorrhage. In women with diabetes mellitus, the risk of ischemic stroke was substantially increased (RR 2.01, 95% confidence interval [CI] 1.84–2.20), risk of intracerebral hemorrhage was increased slightly (RR 1.31, 95% CI 1.04–1.65), but risk of subarachnoid hemorrhage was reduced (RR 0.43, 95% CI 0.26–0.69) (heterogeneity by stroke type, p < 0.0001). Stroke incidence was greater in women who rated their health as poor/fair compared to those who rated their health as excellent/good (RR 1.36, 95% CI 1.30–1.42). Among 565,850 women who rated their heath as excellent/good, current smokers were at an increased risk of all 3 stroke types, (although greater for subarachnoid hemorrhage [≥15 cigarettes/d vs never smoker, RR 4.75, 95% CI 4.12–5.47] than for intracerebral hemorrhage [RR 2.30, 95% CI 1.94–2.72] or ischemic stroke [RR 2.50, 95% CI 2.29–2.72]; heterogeneity p < 0.0001). Obesity was associated with an increased risk of ischemic stroke and a decreased risk of hemorrhagic stroke (heterogeneity p < 0.0001). Meta-analyses confirmed the associations and the heterogeneity across the 3 types of stroke.ConclusionClassic risk factors for stroke have considerably different effects on the 3 main pathologic types of stroke.

Download Full-text

Blood pressure levels and the risk of intracerebral hemorrhage after ischemic stroke

Neurology ◽

10.1212/wnl.0000000000003489 ◽

2016 ◽

Vol 88 (2) ◽

pp. 177-181 ◽

Cited By ~ 3

Author(s):

Nina A. Hilkens ◽

Jacoba P. Greving ◽

Ale Algra ◽

Catharina J.M. Klijn

Keyword(s):

Blood Pressure ◽

Ischemic Stroke ◽

Confidence Interval ◽

Intracerebral Hemorrhage ◽

Incidence Rate ◽

Hazard Ratio ◽

Stroke Subtype ◽

Cox Regression Analysis ◽

Increased Risk ◽

Ischemic Stroke Subtype

Objective:To investigate the association between blood pressure (BP) levels and risk of intracerebral hemorrhage (ICH) after ischemic stroke.Methods:We performed a post hoc analysis of data from the Prevention Regimen for Effectively Avoiding Second Strokes (PRoFESS) trial, a randomized clinical trial including 20,332 patients with recent noncardioembolic ischemic stroke. BP measurements were divided into predefined categories. We calculated incidence rates per BP category and performed multivariable Cox regression analysis with systolic blood pressure (SBP) and diastolic blood pressure (DBP) categories as time-dependent covariables.Results:One hundred thirty-three ICHs occurred during 50,778 person-years of follow-up, resulting in an incidence rate of 2.6 per 1,000 person-years. The incidence rate of ICH increased with increasing SBP and DBP categories. Risk of ICH was significantly higher in patients with SBP ≥160 mm Hg (hazard ratio 2.27, 95% confidence interval 1.34–3.86) compared with those with SBP of 130–<140 mm Hg and in patients with DBP ≥100 mm Hg (hazard ratio 3.08, 95% confidence interval 1.78–5.34) compared with those with DBP of 80–<90 mm Hg. The association between SBP or DBP and ICH did not differ by ischemic stroke subtype (p = 0.55 and 0.93).Conclusions:Among patients with recent noncardioembolic ischemic stroke, the risk of ICH is high. High SBP and DBP are associated with an increased risk of ICH. The association between BP and ICH is not dependent on ischemic stroke subtype.

Download Full-text

Triglyceride-glucose index and the risk of stroke and its subtypes in the general population: an 11-year follow-up

Cardiovascular Diabetology ◽

10.1186/s12933-021-01238-1 ◽

2021 ◽

Vol 20 (1) ◽

Author(s):

Anxin Wang ◽

Guangyao Wang ◽

Qian Liu ◽

Yingting Zuo ◽

Shuohua Chen ◽

...

Keyword(s):

Ischemic Stroke ◽

Subarachnoid Hemorrhage ◽

General Population ◽

Intracerebral Hemorrhage ◽

Cox Regression ◽

Surrogate Marker ◽

Tyg Index ◽

Increased Risk

Abstract Background Triglyceride-glucose (TyG) index was recently suggested to be a reliable surrogate marker of insulin resistance. We aim to investigate the associations between baseline and long-term TyG index with subsequent stroke and its subtypes in a community-based cohort. Methods A total of 97,653 participants free of history of stroke in the Kailuan Study were included. TyG index was calculated as ln (fasting triglyceride [mg/dL] × fasting glucose [mg/dL]/2). Baseline TyG index was measured during 2006–2007. Updated cumulative average TyG index used all available TyG index from baseline to the outcome events of interest or the end of follow up. The outcome was the first occurrence of stroke, including ischemic stroke, intracerebral hemorrhage and subarachnoid hemorrhage. The associations of TyG index with outcomes were explored with Cox regression. Results During a median of 11.02 years of follow-up, 5122 participants developed stroke of whom 4277 were ischemic stroke, 880 intracerebral hemorrhage, and 144 subarachnoid hemorrhage. After adjusting for confounding variables, compared with participants in the lowest quartile of baseline TyG index, those in the third and fourth quartile were associated with an increased risk of stroke (adjusted hazard ratio [HR] 1.22, 95% confidence interval [CI] 1.12–1.33, and adjusted HR 1.32, 95% CI 1.21–1.44, respectively, P for trend < 0.001). We also found a linear association between baseline TyG index with stroke. Similar results were found for ischemic stroke. However, no significant associations were observed between baseline TyG index and risk of intracranial hemorrhage. Parallel results were observed for the associations of updated cumulative average TyG index with outcomes. Conclusions Elevated levels of both baseline and long-term updated cumulative average TyG index can independently predict stroke and ischemic stroke but not intracerebral hemorrhage in the general population during an 11-year follow-up.

Download Full-text