The role of haematological traits in risk of ischaemic stroke and its subtypes
Oxford University Press
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Harshfield, E., Sims, M., Traylor, M., Ouwehand, W., & Markus, H. (2019). The role of haematological traits in risk of ischaemic stroke and its subtypes. Brain https://doi.org/10.1093/brain/awz362
Thrombosis and platelet activation play a central role in stroke pathogenesis, and antiplatelet and anticoagulant therapies are central to stroke prevention. However, whether haematological traits contribute equally to all ischaemic stroke subtypes is uncertain. Furthermore, identification of associations with new traits may offer novel treatment opportunities. The aim of this research was to ascertain causal relationships between a wide range of haematological traits and ischaemic stroke and its subtypes. We obtained summary statistics from 27 published genome-wide association studies of haematological traits involving over 375,000 individuals, and genetic associations with stroke from the MEGASTROKE Consortium (N=67,000 stroke cases). Using two-sample Mendelian randomization we analysed the association of genetically elevated levels of 36 blood cell traits (platelets, mature/immature red cells, and myeloid/lymphoid/compound white cells) and 49 haemostasis traits (including clotting cascade factors and markers of platelet function) with risk of developing ischaemic (AIS), cardioembolic (CES), large-artery (LAS), and small vessel stroke (SVS). Several factors on the intrinsic clotting pathway were significantly associated (P<3.85 x 10-4) with CES and LAS, but not with SVS (e.g. reduced factor VIII [FVIII] activity with AIS/CES/LAS; raised FVIII antigen with AIS/CES; and increased factor XI [FXI] activity with AIS/CES). On the common pathway, increased gamma (γ’) fibrinogen was significantly associated with AIS/CES. Furthermore, elevated plateletcrit was significantly associated with AIS/CES, eosinophil percentage of white cells with LAS, and thrombin-activatable fibrinolysis inhibitor activation peptide antigen with AIS. We also conducted a follow-up analysis in UK Biobank which showed that amongst individuals with atrial fibrillation, those with genetically lower levels of FXI are at reduced risk of AIS compared to those with normal levels of FXI. These results implicate components of the intrinsic and common pathways of the clotting cascade, as well as several other haematological traits, in the pathogenesis of CES and possibly LAS, but not SVS. The lack of associations with SVS suggests thrombosis may be less important for this stroke subtype. Plateletcrit and FXI are potentially tractable new targets for secondary prevention of ischaemic stroke, while FVIII and γ’ fibrinogen require further population-based studies to ascertain their possible aetiological roles.
Mendelian randomization, Haematology, Clotting cascade, Stroke, Genetics
This study was supported by a British Heart Foundation Programme grant (RG/16/4/32218) and the European Union’s Horizon 2020 research and innovation programme under grant agreement No 667375 (CoSTREAM). It also received infrastructural support from the Cambridge University Hospitals NIHR Biomedical Research Centre. This research was conducted using the UK Biobank resource (application 36509). The MEGASTROKE project received funding from sources specified at http://megastroke.org/acknowledgements.html (a list of members and affiliations appears in Appendix 2). MCS is supported by an MRC Clinical Research Training Fellowship (MR/R002363/1). HSM and WHO are supported by NIHR Senior Investigator awards. WHO also receives research support from the European Commission, MRC, and NHS Blood and Transplant.
European Commission Horizon 2020 (H2020) Societal Challenges (667375)
British Heart Foundation (RG/16/4/32218)
QUEEN MARY UNIVERSITY OF LONDON (FB MRC) (MC_PC_14089)
External DOI: https://doi.org/10.1093/brain/awz362
This record's URL: https://www.repository.cam.ac.uk/handle/1810/297352
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