Stroke and coronary heart disease
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Stroke and Coronary Heart Disease: A Comprehensive Overview
Genetic and Epigenetic Factors in Stroke and Coronary Heart Disease
DNA Methylation and miRNAs
Recent research highlights the significant role of genetic and epigenetic factors in the development of coronary artery disease (CAD) and ischemic stroke. DNA methylation and microRNA (miRNA) expression are key regulatory determinants that influence disease predisposition, pathophysiology, and therapeutic outcomes. Studies have identified differences in global DNA methylation, genome-wide DNA methylation, and altered DNA methylation at specific loci in CAD and stroke patients. Notably, miR-223 hypomethylation and altered expression are associated with cerebral infarction and stroke, indicating a shared epigenetic mechanism between these conditions.
Shared Genetic Susceptibility
Genome-wide analyses have demonstrated substantial overlap in the genetic risk factors for ischemic stroke and CAD. Common genetic variants associated with CAD also show significant associations with ischemic stroke, particularly the large artery stroke subtype. Specific loci such as SH2B3, ABO, HDAC9, and 9p21 have been identified as shared genetic determinants, underscoring the intertwined genetic basis of these cardiovascular diseases.
Lifestyle and Behavioral Risk Factors
Long Working Hours
Long working hours have been identified as a significant risk factor for both coronary heart disease and stroke. A meta-analysis involving over 600,000 individuals found that working 55 hours or more per week is associated with a 13% increased risk of coronary heart disease and a 33% increased risk of stroke compared to standard working hours. This association remains robust even after adjusting for various confounding factors, highlighting the need for workplace interventions to manage vascular risk factors.
Blood Pressure
Blood pressure is a critical determinant of both stroke and coronary heart disease. Prolonged differences in diastolic blood pressure (DBP) are associated with significant reductions in the risk of both conditions. For instance, a 10 mm Hg reduction in usual DBP is linked to a 56% lower risk of stroke and a 37% lower risk of coronary heart disease. These findings emphasize the importance of maintaining optimal blood pressure levels to mitigate the risk of vascular diseases.
Metabolic and Physiological Mediators
Body-Mass Index (BMI)
Body-mass index (BMI) is a well-established risk factor for both coronary heart disease and stroke. Elevated BMI increases the risk of these conditions through its effects on blood pressure, cholesterol, and glucose levels. Approximately 46% of the excess risk of coronary heart disease and 76% of the excess risk of stroke associated with high BMI are mediated by these metabolic factors. Blood pressure is the most significant mediator, accounting for a substantial portion of the risk.
Hypertension, Smoking, and Diabetes
Hypertension, smoking, and diabetes are common risk factors for both coronary heart disease and stroke, although their impact may vary. For example, smoking has a stronger association with coronary heart disease than with stroke, while hypertension shows a consistent association with both conditions. These differences highlight the need for tailored public health interventions to address specific risk factors for each disease.
Conclusion
Stroke and coronary heart disease share numerous genetic, epigenetic, lifestyle, and metabolic risk factors. Understanding these commonalities and differences is crucial for developing effective prevention and treatment strategies. Maintaining optimal blood pressure, managing work-related stress, and addressing metabolic risk factors such as BMI are essential steps in reducing the burden of these cardiovascular diseases. Continued research into the shared genetic and epigenetic mechanisms will further enhance our ability to combat these prevalent health issues.
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