TY - JOUR T1 - Ischemic stroke is associated with the ABO locus: the EuroCLOT study. JF - Ann Neurol Y1 - 2013 A1 - Williams, Frances M K A1 - Carter, Angela M A1 - Hysi, Pirro G A1 - Surdulescu, Gabriela A1 - Hodgkiss, Dylan A1 - Soranzo, Nicole A1 - Traylor, Matthew A1 - Bevan, Steve A1 - Dichgans, Martin A1 - Rothwell, Peter M W A1 - Sudlow, Cathie A1 - Farrall, Martin A1 - Silander, Kaisa A1 - Kaunisto, Mari A1 - Wagner, Peter A1 - Saarela, Olli A1 - Kuulasmaa, Kari A1 - Virtamo, Jarmo A1 - Salomaa, Veikko A1 - Amouyel, Philippe A1 - Arveiler, Dominique A1 - Ferrieres, Jean A1 - Wiklund, Per-Gunnar A1 - Ikram, M Arfan A1 - Hofman, Albert A1 - Boncoraglio, Giorgio B A1 - Parati, Eugenio A A1 - Helgadottir, Anna A1 - Gretarsdottir, Solveig A1 - Thorsteinsdottir, Unnur A1 - Thorleifsson, Gudmar A1 - Stefansson, Kari A1 - Seshadri, Sudha A1 - DeStefano, Anita A1 - Gschwendtner, Andreas A1 - Psaty, Bruce A1 - Longstreth, Will A1 - Mitchell, Braxton D A1 - Cheng, Yu-Ching A1 - Clarke, Robert A1 - Ferrario, Marco A1 - Bis, Joshua C A1 - Levi, Christopher A1 - Attia, John A1 - Holliday, Elizabeth G A1 - Scott, Rodney J A1 - Fornage, Myriam A1 - Sharma, Pankaj A1 - Furie, Karen L A1 - Rosand, Jonathan A1 - Nalls, Mike A1 - Meschia, James A1 - Mosely, Thomas H A1 - Evans, Alun A1 - Palotie, Aarno A1 - Markus, Hugh S A1 - Grant, Peter J A1 - Spector, Tim D KW - ABO Blood-Group System KW - Adolescent KW - Adult KW - Aged KW - Aged, 80 and over KW - Blood Coagulation KW - Brain Ischemia KW - Cohort Studies KW - Europe KW - Female KW - Genetic Loci KW - Genetic Predisposition to Disease KW - Genetic Variation KW - Genome-Wide Association Study KW - Humans KW - Male KW - Middle Aged KW - Polymorphism, Single Nucleotide KW - Stroke KW - Young Adult AB -

OBJECTIVE: End-stage coagulation and the structure/function of fibrin are implicated in the pathogenesis of ischemic stroke. We explored whether genetic variants associated with end-stage coagulation in healthy volunteers account for the genetic predisposition to ischemic stroke and examined their influence on stroke subtype.

METHODS: Common genetic variants identified through genome-wide association studies of coagulation factors and fibrin structure/function in healthy twins (n = 2,100, Stage 1) were examined in ischemic stroke (n = 4,200 cases) using 2 independent samples of European ancestry (Stage 2). A third clinical collection having stroke subtyping (total 8,900 cases, 55,000 controls) was used for replication (Stage 3).

RESULTS: Stage 1 identified 524 single nucleotide polymorphisms (SNPs) from 23 linkage disequilibrium blocks having significant association (p < 5 × 10(-8)) with 1 or more coagulation/fibrin phenotypes. The most striking associations included SNP rs5985 with factor XIII activity (p = 2.6 × 10(-186)), rs10665 with FVII (p = 2.4 × 10(-47)), and rs505922 in the ABO gene with both von Willebrand factor (p = 4.7 × 10(-57)) and factor VIII (p = 1.2 × 10(-36)). In Stage 2, the 23 independent SNPs were examined in stroke cases/noncases using MOnica Risk, Genetics, Archiving and Monograph (MORGAM) and Wellcome Trust Case Control Consortium 2 collections. SNP rs505922 was nominally associated with ischemic stroke (odds ratio = 0.94, 95% confidence interval = 0.88-0.99, p = 0.023). Independent replication in Meta-Stroke confirmed the rs505922 association with stroke, beta (standard error, SE) = 0.066 (0.02), p = 0.001, a finding specific to large-vessel and cardioembolic stroke (p = 0.001 and p = < 0.001, respectively) but not seen with small-vessel stroke (p = 0.811).

INTERPRETATION: ABO gene variants are associated with large-vessel and cardioembolic stroke but not small-vessel disease. This work sheds light on the different pathogenic mechanisms underpinning stroke subtype.

VL - 73 IS - 1 U1 - http://www.ncbi.nlm.nih.gov/pubmed/23381943?dopt=Abstract ER - TY - JOUR T1 - Genetic diversity is a predictor of mortality in humans. JF - BMC Genet Y1 - 2014 A1 - Bihlmeyer, Nathan A A1 - Brody, Jennifer A A1 - Smith, Albert Vernon A1 - Lunetta, Kathryn L A1 - Nalls, Mike A1 - Smith, Jennifer A A1 - Tanaka, Toshiko A1 - Davies, Gail A1 - Yu, Lei A1 - Mirza, Saira Saeed A1 - Teumer, Alexander A1 - Coresh, Josef A1 - Pankow, James S A1 - Franceschini, Nora A1 - Scaria, Anish A1 - Oshima, Junko A1 - Psaty, Bruce M A1 - Gudnason, Vilmundur A1 - Eiriksdottir, Gudny A1 - Harris, Tamara B A1 - Li, Hanyue A1 - Karasik, David A1 - Kiel, Douglas P A1 - Garcia, Melissa A1 - Liu, Yongmei A1 - Faul, Jessica D A1 - Kardia, Sharon Lr A1 - Zhao, Wei A1 - Ferrucci, Luigi A1 - Allerhand, Michael A1 - Liewald, David C A1 - Redmond, Paul A1 - Starr, John M A1 - De Jager, Philip L A1 - Evans, Denis A A1 - Direk, Nese A1 - Ikram, Mohammed Arfan A1 - Uitterlinden, Andre A1 - Homuth, Georg A1 - Lorbeer, Roberto A1 - Grabe, Hans J A1 - Launer, Lenore A1 - Murabito, Joanne M A1 - Singleton, Andrew B A1 - Weir, David R A1 - Bandinelli, Stefania A1 - Deary, Ian J A1 - Bennett, David A A1 - Tiemeier, Henning A1 - Kocher, Thomas A1 - Lumley, Thomas A1 - Arking, Dan E KW - Genome-Wide Association Study KW - Heterozygote KW - Humans KW - Mortality KW - Polymorphism, Single Nucleotide KW - Proportional Hazards Models AB -

BACKGROUND: It has been well-established, both by population genetics theory and direct observation in many organisms, that increased genetic diversity provides a survival advantage. However, given the limitations of both sample size and genome-wide metrics, this hypothesis has not been comprehensively tested in human populations. Moreover, the presence of numerous segregating small effect alleles that influence traits that directly impact health directly raises the question as to whether global measures of genomic variation are themselves associated with human health and disease.

RESULTS: We performed a meta-analysis of 17 cohorts followed prospectively, with a combined sample size of 46,716 individuals, including a total of 15,234 deaths. We find a significant association between increased heterozygosity and survival (P = 0.03). We estimate that within a single population, every standard deviation of heterozygosity an individual has over the mean decreases that person's risk of death by 1.57%.

CONCLUSIONS: This effect was consistent between European and African ancestry cohorts, men and women, and major causes of death (cancer and cardiovascular disease), demonstrating the broad positive impact of genomic diversity on human survival.

VL - 15 U1 - http://www.ncbi.nlm.nih.gov/pubmed/25543667?dopt=Abstract ER - TY - JOUR T1 - Predicting stroke through genetic risk functions: the CHARGE Risk Score Project. JF - Stroke Y1 - 2014 A1 - Ibrahim-Verbaas, Carla A A1 - Fornage, Myriam A1 - Bis, Joshua C A1 - Choi, Seung Hoan A1 - Psaty, Bruce M A1 - Meigs, James B A1 - Rao, Madhu A1 - Nalls, Mike A1 - Fontes, João D A1 - O'Donnell, Christopher J A1 - Kathiresan, Sekar A1 - Ehret, Georg B A1 - Fox, Caroline S A1 - Malik, Rainer A1 - Dichgans, Martin A1 - Schmidt, Helena A1 - Lahti, Jari A1 - Heckbert, Susan R A1 - Lumley, Thomas A1 - Rice, Kenneth A1 - Rotter, Jerome I A1 - Taylor, Kent D A1 - Folsom, Aaron R A1 - Boerwinkle, Eric A1 - Rosamond, Wayne D A1 - Shahar, Eyal A1 - Gottesman, Rebecca F A1 - Koudstaal, Peter J A1 - Amin, Najaf A1 - Wieberdink, Renske G A1 - Dehghan, Abbas A1 - Hofman, Albert A1 - Uitterlinden, André G A1 - DeStefano, Anita L A1 - Debette, Stephanie A1 - Xue, Luting A1 - Beiser, Alexa A1 - Wolf, Philip A A1 - DeCarli, Charles A1 - Ikram, M Arfan A1 - Seshadri, Sudha A1 - Mosley, Thomas H A1 - Longstreth, W T A1 - van Duijn, Cornelia M A1 - Launer, Lenore J KW - Age Factors KW - Aged KW - Aged, 80 and over KW - Area Under Curve KW - Case-Control Studies KW - Cohort Studies KW - European Continental Ancestry Group KW - Female KW - Genetic Predisposition to Disease KW - Genome-Wide Association Study KW - Genotype KW - Humans KW - Male KW - Middle Aged KW - Polymorphism, Single Nucleotide KW - Regression Analysis KW - Risk Factors KW - ROC Curve KW - Sex Factors KW - Stroke AB -

BACKGROUND AND PURPOSE: Beyond the Framingham Stroke Risk Score, prediction of future stroke may improve with a genetic risk score (GRS) based on single-nucleotide polymorphisms associated with stroke and its risk factors.

METHODS: The study includes 4 population-based cohorts with 2047 first incident strokes from 22,720 initially stroke-free European origin participants aged ≥55 years, who were followed for up to 20 years. GRSs were constructed with 324 single-nucleotide polymorphisms implicated in stroke and 9 risk factors. The association of the GRS to first incident stroke was tested using Cox regression; the GRS predictive properties were assessed with area under the curve statistics comparing the GRS with age and sex, Framingham Stroke Risk Score models, and reclassification statistics. These analyses were performed per cohort and in a meta-analysis of pooled data. Replication was sought in a case-control study of ischemic stroke.

RESULTS: In the meta-analysis, adding the GRS to the Framingham Stroke Risk Score, age and sex model resulted in a significant improvement in discrimination (all stroke: Δjoint area under the curve=0.016, P=2.3×10(-6); ischemic stroke: Δjoint area under the curve=0.021, P=3.7×10(-7)), although the overall area under the curve remained low. In all the studies, there was a highly significantly improved net reclassification index (P<10(-4)).

CONCLUSIONS: The single-nucleotide polymorphisms associated with stroke and its risk factors result only in a small improvement in prediction of future stroke compared with the classical epidemiological risk factors for stroke.

VL - 45 IS - 2 U1 - http://www.ncbi.nlm.nih.gov/pubmed/24436238?dopt=Abstract ER - TY - JOUR T1 - Meta-Analysis of Genome-Wide Association Studies Identifies Genetic Risk Factors for Stroke in African Americans. JF - Stroke Y1 - 2015 A1 - Carty, Cara L A1 - Keene, Keith L A1 - Cheng, Yu-Ching A1 - Meschia, James F A1 - Chen, Wei-Min A1 - Nalls, Mike A1 - Bis, Joshua C A1 - Kittner, Steven J A1 - Rich, Stephen S A1 - Tajuddin, Salman A1 - Zonderman, Alan B A1 - Evans, Michele K A1 - Langefeld, Carl D A1 - Gottesman, Rebecca A1 - Mosley, Thomas H A1 - Shahar, Eyal A1 - Woo, Daniel A1 - Yaffe, Kristine A1 - Liu, Yongmei A1 - Sale, Michèle M A1 - Dichgans, Martin A1 - Malik, Rainer A1 - Longstreth, W T A1 - Mitchell, Braxton D A1 - Psaty, Bruce M A1 - Kooperberg, Charles A1 - Reiner, Alexander A1 - Worrall, Bradford B A1 - Fornage, Myriam KW - African Americans KW - Case-Control Studies KW - Cohort Studies KW - Genetic Predisposition to Disease KW - Genome-Wide Association Study KW - Humans KW - Polymorphism, Single Nucleotide KW - Risk Factors KW - Stroke AB -

BACKGROUND AND PURPOSE: The majority of genome-wide association studies (GWAS) of stroke have focused on European-ancestry populations; however, none has been conducted in African Americans, despite the disproportionately high burden of stroke in this population. The Consortium of Minority Population Genome-Wide Association Studies of Stroke (COMPASS) was established to identify stroke susceptibility loci in minority populations.

METHODS: Using METAL, we conducted meta-analyses of GWAS in 14 746 African Americans (1365 ischemic and 1592 total stroke cases) from COMPASS, and tested genetic variants with P<10(-6) for validation in METASTROKE, a consortium of ischemic stroke genetic studies in European-ancestry populations. We also evaluated stroke loci previously identified in European-ancestry populations.

RESULTS: The 15q21.3 locus linked with lipid levels and hypertension was associated with total stroke (rs4471613; P=3.9×10(-8)) in African Americans. Nominal associations (P<10(-6)) for total or ischemic stroke were observed for 18 variants in or near genes implicated in cell cycle/mRNA presplicing (PTPRG, CDC5L), platelet function (HPS4), blood-brain barrier permeability (CLDN17), immune response (ELTD1, WDFY4, and IL1F10-IL1RN), and histone modification (HDAC9). Two of these loci achieved nominal significance in METASTROKE: 5q35.2 (P=0.03), and 1p31.1 (P=0.018). Four of 7 previously reported ischemic stroke loci (PITX2, HDAC9, CDKN2A/CDKN2B, and ZFHX3) were nominally associated (P<0.05) with stroke in COMPASS.

CONCLUSIONS: We identified a novel genetic variant associated with total stroke in African Americans and found that ischemic stroke loci identified in European-ancestry populations may also be relevant for African Americans. Our findings support investigation of diverse populations to identify and characterize genetic risk factors, and the importance of shared genetic risk across populations.

VL - 46 IS - 8 U1 - http://www.ncbi.nlm.nih.gov/pubmed/26089329?dopt=Abstract ER - TY - JOUR T1 - Multiethnic genome-wide association study of cerebral white matter hyperintensities on MRI. JF - Circ Cardiovasc Genet Y1 - 2015 A1 - Verhaaren, Benjamin F J A1 - Debette, Stephanie A1 - Bis, Joshua C A1 - Smith, Jennifer A A1 - Ikram, M Kamran A1 - Adams, Hieab H A1 - Beecham, Ashley H A1 - Rajan, Kumar B A1 - Lopez, Lorna M A1 - Barral, Sandra A1 - van Buchem, Mark A A1 - van der Grond, Jeroen A1 - Smith, Albert V A1 - Hegenscheid, Katrin A1 - Aggarwal, Neelum T A1 - de Andrade, Mariza A1 - Atkinson, Elizabeth J A1 - Beekman, Marian A1 - Beiser, Alexa S A1 - Blanton, Susan H A1 - Boerwinkle, Eric A1 - Brickman, Adam M A1 - Bryan, R Nick A1 - Chauhan, Ganesh A1 - Chen, Christopher P L H A1 - Chouraki, Vincent A1 - de Craen, Anton J M A1 - Crivello, Fabrice A1 - Deary, Ian J A1 - Deelen, Joris A1 - De Jager, Philip L A1 - Dufouil, Carole A1 - Elkind, Mitchell S V A1 - Evans, Denis A A1 - Freudenberger, Paul A1 - Gottesman, Rebecca F A1 - Guðnason, Vilmundur A1 - Habes, Mohamad A1 - Heckbert, Susan R A1 - Heiss, Gerardo A1 - Hilal, Saima A1 - Hofer, Edith A1 - Hofman, Albert A1 - Ibrahim-Verbaas, Carla A A1 - Knopman, David S A1 - Lewis, Cora E A1 - Liao, Jiemin A1 - Liewald, David C M A1 - Luciano, Michelle A1 - van der Lugt, Aad A1 - Martinez, Oliver O A1 - Mayeux, Richard A1 - Mazoyer, Bernard A1 - Nalls, Mike A1 - Nauck, Matthias A1 - Niessen, Wiro J A1 - Oostra, Ben A A1 - Psaty, Bruce M A1 - Rice, Kenneth M A1 - Rotter, Jerome I A1 - von Sarnowski, Bettina A1 - Schmidt, Helena A1 - Schreiner, Pamela J A1 - Schuur, Maaike A1 - Sidney, Stephen S A1 - Sigurdsson, Sigurdur A1 - Slagboom, P Eline A1 - Stott, David J M A1 - van Swieten, John C A1 - Teumer, Alexander A1 - Töglhofer, Anna Maria A1 - Traylor, Matthew A1 - Trompet, Stella A1 - Turner, Stephen T A1 - Tzourio, Christophe A1 - Uh, Hae-Won A1 - Uitterlinden, André G A1 - Vernooij, Meike W A1 - Wang, Jing J A1 - Wong, Tien Y A1 - Wardlaw, Joanna M A1 - Windham, B Gwen A1 - Wittfeld, Katharina A1 - Wolf, Christiane A1 - Wright, Clinton B A1 - Yang, Qiong A1 - Zhao, Wei A1 - Zijdenbos, Alex A1 - Jukema, J Wouter A1 - Sacco, Ralph L A1 - Kardia, Sharon L R A1 - Amouyel, Philippe A1 - Mosley, Thomas H A1 - Longstreth, W T A1 - DeCarli, Charles C A1 - van Duijn, Cornelia M A1 - Schmidt, Reinhold A1 - Launer, Lenore J A1 - Grabe, Hans J A1 - Seshadri, Sudha S A1 - Ikram, M Arfan A1 - Fornage, Myriam KW - Aged KW - Aged, 80 and over KW - Chromosomes, Human KW - Continental Population Groups KW - Female KW - Genetic Loci KW - Genome-Wide Association Study KW - Humans KW - Male KW - Meta-Analysis as Topic KW - Middle Aged KW - Models, Genetic KW - Stroke KW - White Matter AB -

BACKGROUND: The burden of cerebral white matter hyperintensities (WMH) is associated with an increased risk of stroke, dementia, and death. WMH are highly heritable, but their genetic underpinnings are incompletely characterized. To identify novel genetic variants influencing WMH burden, we conducted a meta-analysis of multiethnic genome-wide association studies.

METHODS AND RESULTS: We included 21 079 middle-aged to elderly individuals from 29 population-based cohorts, who were free of dementia and stroke and were of European (n=17 936), African (n=1943), Hispanic (n=795), and Asian (n=405) descent. WMH burden was quantified on MRI either by a validated automated segmentation method or a validated visual grading scale. Genotype data in each study were imputed to the 1000 Genomes reference. Within each ethnic group, we investigated the relationship between each single-nucleotide polymorphism and WMH burden using a linear regression model adjusted for age, sex, intracranial volume, and principal components of ancestry. A meta-analysis was conducted for each ethnicity separately and for the combined sample. In the European descent samples, we confirmed a previously known locus on chr17q25 (P=2.7×10(-19)) and identified novel loci on chr10q24 (P=1.6×10(-9)) and chr2p21 (P=4.4×10(-8)). In the multiethnic meta-analysis, we identified 2 additional loci, on chr1q22 (P=2.0×10(-8)) and chr2p16 (P=1.5×10(-8)). The novel loci contained genes that have been implicated in Alzheimer disease (chr2p21 and chr10q24), intracerebral hemorrhage (chr1q22), neuroinflammatory diseases (chr2p21), and glioma (chr10q24 and chr2p16).

CONCLUSIONS: We identified 4 novel genetic loci that implicate inflammatory and glial proliferative pathways in the development of WMH in addition to previously proposed ischemic mechanisms.

VL - 8 IS - 2 U1 - http://www.ncbi.nlm.nih.gov/pubmed/25663218?dopt=Abstract ER - TY - JOUR T1 - Rare and Coding Region Genetic Variants Associated With Risk of Ischemic Stroke: The NHLBI Exome Sequence Project. JF - JAMA Neurol Y1 - 2015 A1 - Auer, Paul L A1 - Nalls, Mike A1 - Meschia, James F A1 - Worrall, Bradford B A1 - Longstreth, W T A1 - Seshadri, Sudha A1 - Kooperberg, Charles A1 - Burger, Kathleen M A1 - Carlson, Christopher S A1 - Carty, Cara L A1 - Chen, Wei-Min A1 - Cupples, L Adrienne A1 - DeStefano, Anita L A1 - Fornage, Myriam A1 - Hardy, John A1 - Hsu, Li A1 - Jackson, Rebecca D A1 - Jarvik, Gail P A1 - Kim, Daniel S A1 - Lakshminarayan, Kamakshi A1 - Lange, Leslie A A1 - Manichaikul, Ani A1 - Quinlan, Aaron R A1 - Singleton, Andrew B A1 - Thornton, Timothy A A1 - Nickerson, Deborah A A1 - Peters, Ulrike A1 - Rich, Stephen S KW - Aged KW - Brain Ischemia KW - Exome KW - Female KW - Genetic Predisposition to Disease KW - Genetic Variation KW - Genome-Wide Association Study KW - Humans KW - Male KW - Middle Aged KW - Muscle Proteins KW - National Heart, Lung, and Blood Institute (U.S.) KW - Nuclear Proteins KW - Open Reading Frames KW - Palmitoyl-CoA Hydrolase KW - Stroke KW - United States AB -

IMPORTANCE: Stroke is the second leading cause of death and the third leading cause of years of life lost. Genetic factors contribute to stroke prevalence, and candidate gene and genome-wide association studies (GWAS) have identified variants associated with ischemic stroke risk. These variants often have small effects without obvious biological significance. Exome sequencing may discover predicted protein-altering variants with a potentially large effect on ischemic stroke risk.

OBJECTIVE: To investigate the contribution of rare and common genetic variants to ischemic stroke risk by targeting the protein-coding regions of the human genome.

DESIGN, SETTING, AND PARTICIPANTS: The National Heart, Lung, and Blood Institute (NHLBI) Exome Sequencing Project (ESP) analyzed approximately 6000 participants from numerous cohorts of European and African ancestry. For discovery, 365 cases of ischemic stroke (small-vessel and large-vessel subtypes) and 809 European ancestry controls were sequenced; for replication, 47 affected sibpairs concordant for stroke subtype and an African American case-control series were sequenced, with 1672 cases and 4509 European ancestry controls genotyped. The ESP's exome sequencing and genotyping started on January 1, 2010, and continued through June 30, 2012. Analyses were conducted on the full data set between July 12, 2012, and July 13, 2013.

MAIN OUTCOMES AND MEASURES: Discovery of new variants or genes contributing to ischemic stroke risk and subtype (primary analysis) and determination of support for protein-coding variants contributing to risk in previously published candidate genes (secondary analysis).

RESULTS: We identified 2 novel genes associated with an increased risk of ischemic stroke: a protein-coding variant in PDE4DIP (rs1778155; odds ratio, 2.15; P = 2.63 × 10(-8)) with an intracellular signal transduction mechanism and in ACOT4 (rs35724886; odds ratio, 2.04; P = 1.24 × 10(-7)) with a fatty acid metabolism; confirmation of PDE4DIP was observed in affected sibpair families with large-vessel stroke subtype and in African Americans. Replication of protein-coding variants in candidate genes was observed for 2 previously reported GWAS associations: ZFHX3 (cardioembolic stroke) and ABCA1 (large-vessel stroke).

CONCLUSIONS AND RELEVANCE: Exome sequencing discovered 2 novel genes and mechanisms, PDE4DIP and ACOT4, associated with increased risk for ischemic stroke. In addition, ZFHX3 and ABCA1 were discovered to have protein-coding variants associated with ischemic stroke. These results suggest that genetic variation in novel pathways contributes to ischemic stroke risk and serves as a target for prediction, prevention, and therapy.

VL - 72 IS - 7 U1 - http://www.ncbi.nlm.nih.gov/pubmed/25961151?dopt=Abstract ER -