Key result
Higher ApoB links to ~24% greater coronary risk and preferentially associates with coronary events over stroke.
Why the study?
Coronary events and ischemic stroke share many risk factors, but important differences exist, requiring assessment of risk factor associations and heterogeneity in risk profiles between the two outcomes.
Cohort (n=26,519)
No
Coronary events and ischemic stroke share broadly similar risk factors, but specific factors like smoking, ApoB, and male sex are more strongly associated with coronary events, while age is more strongly associated with ischemic stroke.
Answers are grounded in this paper and cite their sources.
May guide event-specific prevention counseling; hypothesis-generating and requires prospective validation.
BACKGROUND: Although coronary events (CE) and ischemic stroke share many risk factors, there are also some important differences. The aim of this paper was to assess the association of risk factors in relation to incident CE and ischemic stroke and to evaluate the heterogeneity in patterns of risk factors between the two outcomes. METHOD: Traditional risk factors and inflammatory markers associated with coronary events and ischemic stroke were measured in the Malmö Diet and Cancer Cohort (MDCS, n = 26 519), where a total of 2270 incident ischemic stroke and 3087 incident CE occurred during a mean follow up time 19 ± 6 years, and in relation to inflammatory markers in the cardiovascular sub-cohort (MDC-CV, n = 4795). Cox regression analysis was used to obtain hazard ratios. A modified Lunn-McNeil competing risk analysis was conducted to assess the significance of any differences in risk profiles of these outcomes. RESULTS: Most cardiovascular risk factors were associated both with incident CE and ischemic stroke. However, current smoking, ApoB, low ApoA1, male sex and education level of ≤ 9 years of schooling were preferentially associated with CE compared to ischemic stroke. Conversely, age showed a stronger association with ischemic stroke than with CE. CONCLUSION: CE and ischemic stroke have broadly similar risk factors profiles. However, there are some important differential associations, as well as substantial differences in the magnitude of the association. These could reflect the distinct biology of atherogenesis in different vascular beds. The difference in the determinants highlights the importance of looking at CE and ischemic stroke, two manifestations of cardiovascular disease, separately.
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Muhammad et al. (2021) conducted a cohort in Incident coronary events and ischemic stroke (n=26,519). Cardiovascular risk factors (e.g., ApoB, smoking, age) was evaluated on Incident coronary events (per 1 SD increase in ApoB) (HR 1.24, 95% CI 1.19-1.28, p=<0.001). Current smoking, ApoB, male sex, and lower education level were preferentially associated with incident coronary events compared to ischemic stroke, whereas age was more strongly associated with stroke.
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