Coronary artery disease and stroke
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Coronary Artery Disease and Stroke: A Comprehensive Overview
Shared Genetic Susceptibility in Coronary Artery Disease and Stroke
Coronary artery disease (CAD) and ischemic stroke (IS) share several genetic risk factors. A genome-wide analysis revealed significant overlap in genetic loci associated with both conditions. Specifically, 15 loci were identified that passed genome-wide significance for the combined phenotype of IS or CAD, and 17 loci for large artery stroke (LAS) or CAD. This indicates a substantial genetic overlap, suggesting that individuals with a genetic predisposition to one condition may also be at increased risk for the other.
Epigenetic Factors: DNA Methylation and miRNAs
Epigenetic modifications, such as DNA methylation and microRNA (miRNA) expression, play crucial roles in the pathophysiology of both CAD and stroke. Studies have shown that aberrant DNA methylation patterns and altered miRNA expression are associated with these diseases. For instance, mir-223 hypomethylation has been linked to cerebral infarction and stroke. These findings highlight the importance of epigenetic regulation in the development and progression of CAD and stroke.
Carotid Artery Disease and Stroke Risk Post-CABG
Carotid artery disease significantly influences the risk of stroke following coronary artery bypass grafting (CABG). Patients with severe carotid stenosis or occlusion have a higher risk of peri-operative stroke. However, it is noteworthy that 50% of stroke sufferers post-CABG did not have significant carotid disease, indicating other contributing factors. This underscores the complexity of stroke pathophysiology in the context of coronary interventions.
Arterial Stiffness as a Predictor of Coronary Heart Disease and Stroke
Arterial stiffness, measured by aortic pulse wave velocity, is an independent predictor of both coronary heart disease and stroke. Increased arterial stiffness correlates with a higher risk of these cardiovascular events, even after adjusting for traditional risk factors. This suggests that arterial stiffness could be a valuable marker for identifying individuals at risk for both conditions.
Coronary Risk in Stroke and TIA Patients
Patients who have experienced a transient ischemic attack (TIA) or ischemic stroke often have a high prevalence of asymptomatic coronary artery disease. Studies indicate that 48%-70% of stroke survivors without a known history of CAD have coronary plaques, and significant stenosis is found in 31% of these patients. This highlights the need for comprehensive cardiovascular risk assessment in stroke survivors to improve long-term outcomes.
Factors Associated with CAD and Stroke in Congenital Heart Disease Patients
In adults with congenital heart disease (ACHD), traditional atherosclerotic risk factors such as hypertension, hypercholesterolemia, and smoking are associated with CAD. In contrast, ischemic stroke in these patients is more often related to cardioembolic factors such as previous shunt operations and mechanical valves. These findings suggest different underlying mechanisms for CAD and stroke in ACHD patients, necessitating tailored prevention strategies.
Epidemiology and Risk Factors in Asia
In Asia, the epidemiology of stroke and CAD varies, with stroke being more prevalent in East Asian countries compared to CAD. Major risk factors include hypertension, diabetes, hypercholesterolemia, and smoking, similar to Western countries. However, the increasing prevalence of metabolic risk factors and high smoking rates among Asian men pose significant challenges for prevention efforts.
Conclusion
Coronary artery disease and stroke are closely linked through shared genetic, epigenetic, and environmental risk factors. Understanding these connections is crucial for developing effective prevention and treatment strategies. Comprehensive cardiovascular risk assessments, including genetic and epigenetic profiling, arterial stiffness measurements, and monitoring for asymptomatic CAD in stroke survivors, are essential for improving patient outcomes.
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