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A Polygenic Risk Score Based on a Cardioembolic Stroke Multitrait Analysis Improves a Clinical Prediction Model for This Stroke Subtype

Authors: Jara Cárcel-Márquez; Jara Cárcel-Márquez; Elena Muiño; Cristina Gallego-Fabrega; Cristina Gallego-Fabrega; Natalia Cullell; Natalia Cullell; +39 Authors

A Polygenic Risk Score Based on a Cardioembolic Stroke Multitrait Analysis Improves a Clinical Prediction Model for This Stroke Subtype

Abstract

Background Occult atrial fibrillation (AF) is one of the major causes of embolic stroke of undetermined source (ESUS). Knowing the underlying etiology of an ESUS will reduce stroke recurrence and/or unnecessary use of anticoagulants. Understanding cardioembolic strokes (CES), whose main cause is AF, will provide tools to select patients who would benefit from anticoagulants among those with ESUS or AF. We aimed to discover novel loci associated with CES and create a polygenetic risk score (PRS) for a more efficient CES risk stratification. Methods Multitrait analysis of GWAS (MTAG) was performed with MEGASTROKE-CES cohort ( n = 362,661) and AF cohort ( n = 1,030,836). We considered significant variants and replicated those variants with MTAG p -value < 5 × 10 −8 influencing both traits (GWAS-pairwise) with a p -value < 0.05 in the original GWAS and in an independent cohort ( n = 9,105). The PRS was created with PRSice-2 and evaluated in the independent cohort. Results We found and replicated eleven loci associated with CES. Eight were novel loci. Seven of them had been previously associated with AF, namely, CAV1, ESR2, GORAB, IGF1R, NEURL1, WIPF1 , and ZEB2 . KIAA1755 locus had never been associated with CES/AF, leading its index variant to a missense change (R1045W). The PRS generated has been significantly associated with CES improving discrimination and patient reclassification of a model with age, sex, and hypertension. Conclusion The loci found significantly associated with CES in the MTAG, together with the creation of a PRS that improves the predictive clinical models of CES, might help guide future clinical trials of anticoagulant therapy in patients with ESUS or AF.

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United States, Spain, United States, United Kingdom
Keywords

Cardiac & Cardiovascular Systems, Terapéutica, DISEASES::Cardiovascular Diseases::Vascular Diseases::Embolism and Thrombosis::Embolism, Cardiovascular Medicine, Risk Factors, Anticoagulants (Medicina) - Ús terapèutic, Atrial Fibrillation, Medicine and Health Sciences, GWAS, Fibril·lació auricular - Complicacions, DISEASES::Cardiovascular Diseases::Heart Diseases::Arrhythmias, Cardiac::Atrial Fibrillation, ENFERMEDADES::enfermedades cardiovasculares::enfermedades cardíacas::arritmias cardíacas::fibrilación atrial, Fibrilación atrial, ASSOCIATION, Cerebral Infarction, stroke, Stroke, Accidente cerebrovascular embólico, ISCHEMIC-STROKE, Hypertension, Emergency Medicine, Embòlia, Life Sciences & Biomedicine, Factores de riesgo, Recurrencia, ESUs, 610, Volición, multi-trait analysis, Risk Assessment, Accidente cerebrovascular, Riesgo, UNDETERMINED SOURCE, Polygenic risk score, Hipertensión, COMPUESTOS QUÍMICOS Y DROGAS::acciones y usos químicos::acciones farmacológicas::usos terapéuticos::fármacos hematológicos::anticoagulantes, Diseases of the circulatory (Cardiovascular) system, Humans, CHEMICALS AND DRUGS::Chemical Actions and Uses::Pharmacologic Actions::Therapeutic Uses::Hematologic Agents::Anticoagulants, CAVEOLIN-1, EMBOLIC STROKE, Embolic Stroke, Science & Technology, Multi-trait analysis, Anticoagulants, ENFERMEDADES::enfermedades cardiovasculares::enfermedades vasculares::embolia y trombosis::embolia, Anticoagulantes, RC666-701, ATRIAL-FIBRILLATION, polygenic risk score, Cardiovascular System & Cardiology, Genome-Wide Association Study

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selected citations
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This is an alternative to the "Influence" indicator, which also reflects the overall/total impact of an article in the research community at large, based on the underlying citation network (diachronically).
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popularity
This indicator reflects the "current" impact/attention (the "hype") of an article in the research community at large, based on the underlying citation network.
BIP!Popularity provided by BIP!
influence
This indicator reflects the overall/total impact of an article in the research community at large, based on the underlying citation network (diachronically).
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impulse
This indicator reflects the initial momentum of an article directly after its publication, based on the underlying citation network.
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