Additive interaction between potentially modifiable risk factors and ethnicity among individuals in the Han, Tujia and Miao populations with first-ever ischaemic stroke

Abstract Background As a country with one-fifth of the global population, China has experienced explosive growth in ischaemic stroke (IS) burden with significant ethnic and geographic disparities. The aim of this study was to examine the differences in potentially modifiable risk factors for ischaemic stroke among the Han population and two ethnic minorities (Tujia and Miao). Methods A case-control study was conducted with 324 cases of first-ever ischaemic stroke from the hospitals of the Xiangxi Tujia and Miao Autonomous Prefecture and 394 controls from communities covering the same area between May 1, 2018, and April 30, 2019. Structured questionnaires were administered, and physical examinations were performed in the same manner for cases and controls. Univariate and multivariate logistic regression analyses with adjusted odds ratios (ORs) and 95% confidence intervals (CIs) were used to examine the association between risk factors and ischaemic stroke. An additive model was used to study the interaction between the modifiable risk factors and ethnicity with R software. Results Higher high-sensitivity C-reactive protein levels (OR 50.54, 95%CI 29.76–85.85), higher monthly family income (4.18, 2.40–7.28), increased frequency of hot pot consumption (2.90, 1.21–6.93), diabetes mellitus (2.62, 1.48–4.62), a higher apolipoprotein (Apo)B/ApoA1 ratio (2.60, 1.39–4.85), hypertension (2.52, 1.45–4.40) and moderate-intensity physical activity (0.50, 0.28–0.89) were associated with ischaemic stroke. There was an additive interaction between the ApoB/ApoA1 ratio and ethnicity in the Tujia and Miao populations with first-ever ischaemic stroke (the relative excess risk due to the interaction was 5.75, 95% CI 0.58 ~ 10.92; the attributable proportion due to the interaction was 0.65, 95% CI 0.38 ~ 0.91; the synergy index was 3.66, 95% CI 1.35 ~ 9.93). Conclusions This is the first case-control study examining modifiable risk factors for ischaemic stroke among the Han population and two ethnic minorities (Tujia and Miao) in China. Some differences were observed in the impact of risk factors among these ethnic groups. Our results may help interpret health-related data, including surveillance and research, when developing strategies for stroke prevention.

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Additive Interaction Between Potentially Modifiable Risk Factors And Ethnicity In The Han, Tujia and Miao Populations With First-Ever Ischemic Stroke

10.21203/rs.3.rs-200468/v1 ◽

2021 ◽

Author(s):

Na Zhang ◽

Xinrui Wu ◽

Mengyuan Tian ◽

Xiaolei Wang ◽

Jian Ding ◽

...

Keyword(s):

Risk Factors ◽

Ischemic Stroke ◽

Ethnic Minorities ◽

Case Control Study ◽

Case Control ◽

Moderate Intensity ◽

Modifiable Risk Factors ◽

Additive Interaction ◽

Han Population ◽

Control Study

Abstract Background: As a country with one-fifth of the global population, China has had explosive growth in ischemic stroke burden with significant ethnic and geographic disparities. The aim of this study was to examine the relative risk of potentially modifiable risk factors for ischemic stroke among the Han population and two ethnic minorities (Tujia and Miao).Methods: A case-control study was conducted: 324 cases of first-ever IS from the hospitals of the Xiangxi Tujia and Miao Autonomous Prefecture and 394 controls were surveyed using structured questionnaires from communities covering the same area. Univariate and multivariate logistic regression analyses with adjusted odds ratios (ORs) and 95% confidence intervals (CIs) were used to examine the association between risk factors and ischemic stroke. The additive model was used to study the interaction between the modifiable risk factor and ethnicity in the R software.Results: Higher high-sensitivity C-reactive protein level(OR 50.54, 95%CI 29.76-85.85), higher monthly family income(4.18, 2.40-7.28), increased frequency of hot pot consumption (2.90, 1.21-6.93), diabetes mellitus (2.62, 1.48-4.62), higher apolipoprotein(Apo)B/ApoA1 ratio(2.60, 1.39-4.85), hypertension(2.52, 1.45-4.40) and moderate-intensity physical activity(0.50, 0.28-0.89) were associated with ischemic stroke. There is an additive interaction between ApoB/ApoA1 ratio and ethnicity in Tujia and Miao populations with first-ever ischemic stroke (the relative excess risk due to interaction was 5.75, 95%CI 0.58~10.92; the attributable proportion due to interaction was 0.65, 95%CI 0.38~0.91; the synergy was 3.66, 95%CI 1.35~9.93). Conclusions: It is the first case-control study examining modifiable risk factors for ischemic stroke among the Han population and two ethnic minorities (Tujia and Miao) in China, some differences were observed in the impact of risk factors among these ethnic groups. Our results may help interpret health-related data, including surveillance and research, when developing strategies for stroke prevention.

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The Auckland Stillbirth study, a case-control study exploring modifiable risk factors for third trimester stillbirth: methods and rationale

Australian and New Zealand Journal of Obstetrics and Gynaecology ◽

10.1111/j.1479-828x.2010.01254.x ◽

2010 ◽

Vol 51 (1) ◽

pp. 3-8 ◽

Cited By ~ 29

Author(s):

Tomasina STACEY ◽

John M.D. THOMPSON ◽

Edwin A. MITCHELL ◽

Alec J. EKEROMA ◽

Jane M. ZUCCOLLO ◽

...

Keyword(s):

Risk Factors ◽

Case Control Study ◽

Case Control ◽

Modifiable Risk Factors ◽

Third Trimester ◽

Control Study

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A Case-Control Study of the Association of the Polymorphisms of MTHFR and APOE with Risk Factors and the Severity of Coronary Artery Disease

Cardiology ◽

10.1159/000499866 ◽

2019 ◽

Vol 142 (3) ◽

pp. 149-157 ◽

Cited By ~ 1

Author(s):

Yan Long ◽

Xiao-Tao Zhao ◽

Chang Liu ◽

Yuan-Yuan Sun ◽

Yin-Ting Ma ◽

...

Keyword(s):

Risk Factors ◽

Logistic Regression ◽

Regression Analysis ◽

Logistic Regression Analysis ◽

Sanger Sequencing ◽

Case Control Study ◽

Case Control ◽

Chinese Han ◽

Han Population ◽

Control Study

Objectives: To explore the association between single-nucleotide polymorphisms (SNPs) in MTHFR and APOE and the risk of CAD and, more importantly, the severity of CAD and the profile of serum lipids, we performed a case-control study in a Chinese Han population. Methods: A total of 1,207 cases of consecutive CAD-suspected inpatients were recruited, and 406 CAD cases and 231 non-CAD controls were enrolled for the final analysis after screening for exclusion criteria. All subjects had undergone coronary angiography, and the severity of CAD was evaluated by 2 cardiologists according to the Gensini scores. The genotypes of MTHFR and APOEwere detected using real-time PCR, and then verified by Sanger sequencing. Environmental risk factors, such as age, sex, smoking, alcohol consumption, hypertension, diabetes, dyslipidemia, and BMI were collected. Statistical analyses (the χ2 test, binary logistic regression analysis, and ordinal polytomous logistic regression analysis) were performed with SPSS v16.0. Results: The genotypes ofall the subjects included in the CAD and non-CAD groups in this study were successfully detected, with an agreement of 100% with Sanger sequencing. The distributions of genotypes CT and TT at MTHFR C667T were higher in CAD cases than in non-CAD controls (OR 1.99, 95% CI 1.34–2.95; OR 1.77, 95% CI 1.18–2.67; p < 0.05), whereas genotype AC at MTHFR A1298Cwas lower in CAD cases (OR 0.71, 95% CI 0.50–1.02; p < 0.05). A significant association was observed in genotypes CT and TT at MTHFR C667T and the risk of CAD (OR 1.44, 95% CI 1.27–3.67; OR 1.56, 95% CI 0.88–2.78; p < 0.05). Both genotypes and alleles of APOE were comparable in the CAD cases and non-CAD controls (p > 0.05). The genotype TT at MTHFR C667T and ε4+ at APOE were more likely to be found in the CAD subgroup with a Gensini score ≥72 (p = 0.040 and p = 0.028, respectively). Meanwhile, in the patients with genotype TT,a higher level of serum Hcy was detected, while genotype ε4+ patients possessed higher levels of serum apolipoprotein E (ApoE) and low-density lipoprotein cholesterol (LDL-C) than other genotypes. Conclusion: This study revealed that the SNP site of MTHFR C667Tis associatedwith the risk of CAD in this Chinese Han population. In addition, the genotypes of TT in MTHFR C667T and ε4+in APOE may increase the severity of CAD, and higher Hcy, LDL-C, and ApoE levels may be involved in this pathogenic process.

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Risk factors for perinatal arterial ischaemic stroke: a large case–control study

Developmental Medicine & Child Neurology ◽

10.1111/dmcn.14347 ◽

2019 ◽

Vol 62 (4) ◽

pp. 513-520 ◽

Cited By ~ 4

Author(s):

Anna‐Lisa Sorg ◽

Rüdiger Kries ◽

Mathias Klemme ◽

Lucia Gerstl ◽

Raphael Weinberger ◽

...

Keyword(s):

Risk Factors ◽

Ischaemic Stroke ◽

Case Control Study ◽

Case Control ◽

Arterial Ischaemic Stroke ◽

Control Study ◽

Large Case

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The Auckland Stillbirth study, a case–control study exploring modifiable risk factors for third trimester stillbirth: methods and rationale

Yearbook of Obstetrics Gynecology and Women s Health ◽

10.1016/j.yobg.2012.06.137 ◽

2012 ◽

Vol 2012 ◽

pp. 105-106

Author(s):

J.S. Dungan

Keyword(s):

Risk Factors ◽

Case Control Study ◽

Case Control ◽

Modifiable Risk Factors ◽

Third Trimester ◽

Control Study

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Authors’ Response to Peer Reviews of “Impact of Modifiable Risk Factors on the Occurrence of Cutaneous Leishmaniasis in Diyala, Iraq: Case-Control Study” (Preprint)

10.2196/preprints.31512 ◽

2021 ◽

Author(s):

Asaad Mahdi Lehlewa ◽

Hanan Abdulghafoor Khaleel ◽

Faris Lami ◽

Saif Aldeen Falah Hasan ◽

Hasanain Asmail Malick ◽

...

Keyword(s):

Risk Factors ◽

Cutaneous Leishmaniasis ◽

Peer Review ◽

Case Control Study ◽

Case Control ◽

Modifiable Risk Factors ◽

Peer Reviews ◽

Control Study

UNSTRUCTURED These are author responses to peer review.

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Association between excessive premature atrial complexes and cryptogenic stroke: results of a case–control study

BMJ Open ◽

10.1136/bmjopen-2019-029164 ◽

2019 ◽

Vol 9 (7) ◽

pp. e029164 ◽

Cited By ~ 3

Author(s):

Jithin K Sajeev ◽

Anoop N Koshy ◽

Helen Dewey ◽

Jonathan M Kalman ◽

Kevin Rajakariar ◽

...

Keyword(s):

Risk Factors ◽

Ischaemic Stroke ◽

Case Control Study ◽

Cryptogenic Stroke ◽

Case Control ◽

Vascular Risk Factors ◽

Control Group ◽

Prior History ◽

Vascular Risk ◽

Control Study

ObjectiveRecent anticoagulation trials in all-comer cryptogenic stroke patients have yielded equivocal results, reinvigorating the focus on identifying reproducible markers of an atrial myopathy. We investigated the role of excessive premature atrial complexes (PACs) in ischaemic stroke, including cryptogenic stroke and its association with vascular risk factors.Methods and resultsA case–control study was conducted utilising a multicentre institutional stroke database to compare 461 patients with an ischaemic stroke or transient ischaemic attack (TIA) with a control group consisting of age matched patients without prior history of ischaemic stroke/TIA. All patients underwent 24-hour Holter monitoring during the study period and atrial fibrillation was excluded. An excessive PAC burden, defined as ≥200 PACs/24 hours, was present in 25.6% and 14.7% (p<0.01), of stroke/TIA and control patients, respectively. On multivariate regression, excessive PACs (OR 1.97; 95% CI 1.29 to 3.02; p<0.01), smoking (OR 1.58; 95% CI 1.06 to 2.36; p<0.05) and hypertension (OR 1.53; 95% CI 1.07 to 2.17; p<0.05) were independently associated with ischaemic stroke/TIA. Excessive PACs remained the strongest independent risk factor for the cryptogenic stroke subtype (OR 1.95; 95% CI 1.16 to 3.28; p<0.05). Vascular risk factors that promote atrial remodelling, increasing age (≥75 years, OR 3.64; 95% CI 2.08 to 6.36; p<0.01) and hypertension (OR 1.54; 95% CI 1.01 to 2.34; p<0.05) were independently associated with excessive PACs.ConclusionsExcessive PACs are independently associated with cryptogenic stroke and may be a reproducible marker of atrial myopathy. Prospective studies assessing their utility in guiding stroke prevention strategies may be warranted.

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