Integrating polygenic and clinical risks to improve stroke risk stratification in prospective Chinese cohorts

Genetic Risk Scores in Stroke Research and Care

Stroke remains a leading cause of death and disability worldwide. While well-established risk factors play a major role, genetic predisposition is a crucial determinant of stroke susceptibility, with heritability estimates up to 39% for ischemic stroke and 29% for intracerebral hemorrhage. Advances in next-generation sequencing and genome-wide association studies have identified numerous genetic loci associated with stroke risk, paving the way for the development of genetic risk scores. These scores aggregate information from multiple genetic variants to estimate an individual's stroke risk, offering a promising tool for personalized risk stratification that complements traditional clinical models. While GRSs have demonstrated strong predictive potential for primary stroke events in population-based settings, their integration into clinical practice remains limited. Emerging evidence suggests that GRSs could add value in clinical decision-making, for instance, for stratifying ischemic stroke risk in patients with atrial fibrillation, assessing intracerebral hemorrhage risk in anticoagulant users, and predicting vascular risk factor control in stroke survivors. The incorporation of GRSs with multiomics data and machine learning may further refine risk assessment, driving personalized prevention strategies for both primary and secondary stroke preventions. A major challenge is the limited applicability of GRS across diverse populations, as most genome-wide association studies have been conducted in individuals of European ancestry. Addressing this limitation is critical for ensuring equitable and effective implementation of GRSs in clinical settings. As methodologies continue to evolve, integrating GRS into stroke research could significantly enhance risk assessment and support precision medicine approaches tailored to individual patients.

Impact of resting heart rate and predicted cardiovascular risk on mortality in nearly 110,000 Chinese adults

BACKGROUND

The association of mortality with resting heart rate (RHR) and predicted risk of incident cardiovascular disease (CVD) has not been comprehensively elucidated.

OBJECTIVE

The purpose of this study was to evaluate the individual and combined impacts of RHR and predicted CVD risk on mortality among Chinese adults.

METHODS

A total of 108,257 Chinese adults underwent follow-up during 1992 to 2015. The Cox proportional hazards model was used to assess the hazard ratio (HR) and 95% confidence interval (CI) of mortality associated with RHR and the predicted risk of incident CVD.

RESULTS

During an average of 8.53 years of follow-up, we identified 6267 nonaccidental deaths, including 2324 CVD deaths. High-RHR participants had higher HRs of nonaccidental (HR 1.58; 95% CI 1.47-1.70), CVD (HR 1.71; 95% CI 1.53-1.92), and non-CVD mortality (HR 1.50; 95% CI 1.37-1.64) than low-RHR participants. Compared to individuals with low CVD risk, those with high CVD risk demonstrated HRs of 1.67 (95% CI 1.51-1.83) and 3.90 (95% CI 3.29-4.61) for nonaccidental and CVD mortality, respectively. Mortality risk gradually increased with elevation of CVD risk and RHR, showing the greatest HRs of nonaccidental (HR 2.57; 95% CI 2.24-2.94) and CVD mortality (HR 7.16; 95% CI 5.52-9.29) among participants with both high CVD risk and high RHR.

CONCLUSION

Our findings demonstrated that RHR and CVD risk are independently associated with mortality, and integrating them potentially could refine risk stratification of mortality. The study highlighted their important role in personalized strategies for primordial and primary prevention.

Carotid artery atherosclerosis: mechanisms of instability and clinical implications

Cardiovascular disease remains a prominent cause of disability and premature death worldwide. Within this spectrum, carotid artery atherosclerosis is a complex and multifaceted condition, and a prominent precursor of acute ischaemic stroke and other cardiovascular events. The intricate interplay among inflammation, oxidative stress, endothelial dysfunction, lipid metabolism, and immune responses participates in the development of lesions, leading to luminal stenosis and potential plaque instability. Even non-stenotic plaques can precipitate a sudden cerebrovascular event, regardless of the degree of luminal encroachment. In this context, carotid imaging modalities have proved their efficacy in providing in vivo characterization of plaque features, contributing substantially to patient risk stratification and clinical management. This review emphasizes the importance of identifying high-risk individuals by use of current imaging modalities, biomarkers, and risk stratification tools. Such approaches inform early intervention and the implementation of personalized therapeutic strategies, ultimately enhancing patient outcomes in the realm of cardiovascular disease management.

Genetics in Ischemic Stroke: Current Perspectives and Future Directions

Ischemic stroke is a heterogeneous condition influenced by a combination of genetic and environmental factors. Recent advancements have explored genetics in relation to various aspects of ischemic stroke, including the alteration of individual stroke occurrence risk, modulation of treatment response, and effectiveness of post-stroke functional recovery. This article aims to review the recent findings from genetic studies related to various clinical and molecular aspects of ischemic stroke. The potential clinical applications of these genetic insights in stratifying stroke risk, guiding personalized therapy, and identifying new therapeutic targets are discussed herein.