Plasma Pro-Enkephalin A and Ischemic Stroke Risk: The Reasons for Geographic and Racial Differences in Stroke Cohort.
Plasma Pro-Enkephalin A and Ischemic Stroke Risk: The Reasons for Geographic and Racial Differences in Stroke Cohort.
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DOI：
10.1016/j.jstrokecerebrovasdis.2021.106237
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发表时间：
2022-03
期刊：
影响因子：
--
通讯作者：
Cushman M
中科院分区：
文献类型：
--
作者：
Short SA;Wilkinson K;Long DL;Judd S;Schulte J;Kissela BM;Howard G;Cushman M
阿片类神经肽前脑啡肽A（PENK-A）可能是心血管风险的循环标志物，先前的研究结果与心力衰竭，肾脏疾病和血管性痴呆有关。尽管有这些发现，但PENK-A与缺血性卒中的相关性尚不清楚，因此我们在一项前瞻性队列研究中检查了这种相关性，并分析了种族和性别的差异。卒中地理和种族差异的原因研究（REGARDS）是一项前瞻性队列研究，纳入30，239名黑人和白色成人。对473名在5.9年内首次发生缺血性卒中的参与者和899名随机选择的参与者进行了血浆PENK-A测定。使用根据人口统计学和卒中风险因素调整的考克斯模型计算基线PENK-A卒中的风险比（HR）。PENK-A随着年龄、女性、白色人种、较低体重指数和抗高血压药物使用的增加而升高。PENK-A每增加一个SD，卒中的校正HR为1.20（95% CI 1.01-1.42），卒中风险因素的混杂最小。样条曲线显示U形关系，尤其是在白色男性中，白色男性中PENK-A第95百分位数与第50百分位数的校正HR为3.88（95% CI 1.94-7.77）。在REGARDS中，较高的基线血浆PENK-A与未来卒中风险独立相关。这种关联在白色男性中最为明显。已确定的卒中危险因素几乎没有混淆，提示在卒中病因学中可能存在因果关系。需要进一步研究以了解内源性阿片类药物在卒中发病机制中的作用。
The opioid neuropeptide pro-enkephalin A (PENK-A) may be a circulating marker of cardiovascular risk, with prior findings relevant to heart failure, kidney disease, and vascular dementia. Despite these findings, the association of PENK-A with ischemic stroke is unknown, so we examined this association in a prospective cohort study and analyzed differences by race and sex. The REasons for Geographic and Racial Differences in Stroke study (REGARDS) is a prospective cohort study of 30,239 Black and White adults. Plasma PENK-A was measured in 473 participants that developed first-time ischemic stroke over 5.9 years and 899 randomly selected participants. Cox models adjusted for demographics and stroke risk factors were used to calculate hazard ratios (HRs) of stroke by baseline PENK-A. PENK-A was higher with increasing age, female sex, White race, lower body mass index, and antihypertensive medication use. Each SD higher increment of PENK-A was associated with an adjusted HR of 1.20 (95% CI 1.01–1.42) for stroke, with minimal confounding by stroke risk factors. Spline plots suggested a U-shaped relationship, particularly in White men, with an adjusted HR 3.88 (95% CI 1.94–7.77) for the 95th versus 50th percentile of PENK-A in White men. Higher baseline plasma PENK-A was independently associated with future stroke risk in REGARDS. This association was most apparent among White men. There was little confounding by established stroke risk factors, suggesting a possible causal role in stroke etiology. Further research is needed to understand the role of endogenous opioids in stroke pathogenesis.
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影响因子：
39.3
作者：
Hijazi Z;Lindbäck J;Alexander JH;Hanna M;Held C;Hylek EM;Lopes RD;Oldgren J;Siegbahn A;Stewart RA;White HD;Granger CB;Wallentin L;ARISTOTLE and STABILITY Investigators
通讯作者：
ARISTOTLE and STABILITY Investigators
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3.7
作者：
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通讯作者：
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影响因子：
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作者：
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通讯作者：
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影响因子：
2
作者：
Calero, Alexa;Villanueva, Hazel;Evinger, Marian
通讯作者：
Evinger, Marian
影响因子：
5
作者：
Balasubramanian, S;Ramakrishnan, S;Roy, S
通讯作者：
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