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Genetic polymorphisms and the risk of stroke after cardiac surgery
Hilary P Grocott1, William D White, Richard W Morris
1Department of Anesthesiology, Duke University Medical Center, Durham, NC 27710, USA. h.grocott@duke.edu
Insights
Genetic variants in C-reactive protein (CRP) and interleukin-6 (IL-6) are linked to increased stroke risk after cardiac surgery. This finding highlights inflammation
Area of Science:
- Cardiovascular Surgery
- Genetics
- Neurology
Background:
- Stroke is a major complication following cardiac surgery.
- Genetic factors influencing post-cardiac surgery stroke risk are not fully understood.
- Inflammation plays a role in cardiovascular disease and stroke.
Purpose of the Study:
- To investigate the association between specific genetic polymorphisms and stroke risk in patients undergoing cardiac surgery.
- To test the hypothesis that genetic variants increase the likelihood of stroke after cardiopulmonary bypass surgery.
Main Methods:
- Studied 1635 patients undergoing cardiopulmonary bypass surgery.
- Analyzed DNA for 26 single-nucleotide polymorphisms (SNPs).
- Used multivariable logistic regression and permutation analysis to assess genetic and clinical associations with stroke.
Main Results:
- A combination of minor alleles in C-reactive protein (CRP; 3'UTR 1846C/T) and interleukin-6 (IL-6; -174G/C) polymorphisms was significantly associated with stroke (OR, 3.3; P=0.0023).
- This association remained significant after adjusting for age in multivariable analysis (P=0.0020).
- The combined genetic variant occurred in 35.7% of patients and was linked to a 1.7% stroke incidence.
Conclusions:
- Common genetic variants in CRP and IL-6 are significantly associated with post-cardiac surgery stroke risk.
- These findings suggest a crucial role for inflammation in the development of stroke after cardiac procedures.
- Identifying at-risk individuals through genetic markers could inform preventative strategies.
Background And Purpose:
Stroke represents a significant cause of morbidity and mortality after cardiac surgery. Although the risk of stroke varies according to both patient and procedural factors, the impact of genetic variants on stroke risk is not well understood. Therefore, we tested the hypothesis that specific genetic polymorphisms are associated with an increased risk of stroke after cardiac surgery.
Methods:
Patients undergoing cardiac surgery utilizing cardiopulmonary bypass surgery were studied. DNA was isolated from preoperative blood and analyzed for 26 different single-nucleotide polymorphisms. Multivariable logistic regression modeling was used to determine the association of clinical and genetic characteristics with stroke. Permutation analysis was used to adjust for multiple comparisons inherent in genetic association studies.
Results:
A total of 1635 patients experiencing 28 strokes (1.7%) were included in the final genetic model. The combination of the 2 minor alleles of C-reactive protein (CRP; 3'UTR 1846C/T) and interleukin-6 (IL-6; -174G/C) polymorphisms, occurring in 583 (35.7%) patients, was significantly associated with stroke (odds ratio, 3.3; 95% CI, 1.4 to 8.1; P=0.0023). In a multivariable logistic model adjusting for age, the CRP and IL-6 single-nucleotide polymorphism combination remained significantly associated with stroke (P=0.0020).
Conclusions:
We demonstrate that common genetic variants of CRP (3'UTR 1846C/T) and IL-6 (-174G/C) are significantly associated with the risk of stroke after cardiac surgery, suggesting a pivotal role of inflammation in post-cardiac surgery stroke.
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