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  4. Iron status and risk of stroke
 
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Iron status and risk of stroke
File(s)
str_stroke-2018-022701_supp1.pdf (997.78 KB)
Supporting information
STROKEAHA.118.022701.pdf (359.18 KB)
Published version
Author(s)
Gill, Dipender
Monori, Grace
Tzoulaki, Ioanna
Dehghan, Abbas
Type
Journal Article
Abstract
Background and Purpose- Both iron deficiency and excess have been associated with stroke risk in observational studies. However, such associations may be attributable to confounding from environmental factors. This study uses the Mendelian randomization technique to overcome these limitations by investigating the association between genetic variants related to iron status and stroke risk. Methods- A study of 48 972 subjects performed by the Genetics of Iron Status consortium identified genetic variants with concordant relations to 4 biomarkers of iron status (serum iron, transferrin saturation, ferritin, and transferrin) that supported their use as instruments for overall iron status. Genetic estimates from the MEGASTROKE consortium were used to investigate the association between the same genetic variants and stroke risk. The 2-sample ratio method Mendelian randomization approach was used for the main analysis, with the MR-Egger and weighted median techniques used in sensitivity analyses. Results- The main results, reported as odds ratio (OR) of stroke per SD unit increase in genetically determined iron status biomarker, showed a detrimental effect of increased iron status on stroke risk (serum iron OR, 1.07; 95% CI, 1.01-1.14; [log-transformed] ferritin OR, 1.18; 95% CI, 1.02-1.36; and transferrin saturation OR, 1.06; 95% CI, 1.01-1.11). A higher transferrin, indicative of lower iron status, was also associated with decreased stroke risk (OR, 0.92; 95% CI, 0.86-0.99). Examining ischemic stroke subtypes, we found the detrimental effect of iron status to be driven by cardioembolic stroke. These results were supported in statistical sensitivity analyses more robust to the inclusion of pleiotropic variants. Conclusions- This study provides Mendelian randomization evidence that higher iron status is associated with increased stroke risk and, in particular, cardioembolic stroke. Further work is required to investigate the underlying mechanism and whether this can be targeted in preventative strategies.
Date Issued
2018-12
Date Acceptance
2018-09-24
Citation
Stroke, 2018, 49 (12), pp.2815-2821
URI
http://hdl.handle.net/10044/1/65956
DOI
https://www.dx.doi.org/10.1161/STROKEAHA.118.022701
ISSN
0039-2499
Publisher
American Heart Association
Start Page
2815
End Page
2821
Journal / Book Title
Stroke
Volume
49
Issue
12
Copyright Statement
© 2018 The Authors. Stroke is published on behalf of the American Heart Association, Inc., by Wolters Kluwer Health, Inc. This is an open access article under the terms of the Creative Commons Attribution License (https://creativecommons.org/licenses/by/4.0/), which permits use, distribution, and reproduction in any medium, provided that the original work is properly cited.
Identifier
https://www.ncbi.nlm.nih.gov/pubmed/30571402
Subjects
diet
ferritin
iron
stroke
transferrin
Publication Status
Published
Coverage Spatial
United States
Date Publish Online
2018-10-25
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