A Family History of Stroke Is Associated with Increased Intima-Media Thickness in Young Ischemic Stroke - The Norwegian Stroke in the Young Study (NOR-SYS)

Halvor Øygarden, Annette Fromm, Kristin Modalsli Sand, Christopher Elnan Kvistad, Geir Egil Eide, Lars Thomassen, Halvor Naess, Ulrike Waje-Andreassen, Halvor Øygarden, Annette Fromm, Kristin Modalsli Sand, Christopher Elnan Kvistad, Geir Egil Eide, Lars Thomassen, Halvor Naess, Ulrike Waje-Andreassen

Abstract

Background and purpose: Positive family history (FH+) of cardiovascular disease (CVD) is a risk factor for own CVD. We aimed to analyze the effect of different types of FH (stroke, coronary heart disease (CHD), peripheral artery disease (PAD) on carotid intima-media thickness (cIMT) in young and middle-aged ischemic stroke patients.

Methods: First-degree FH of CVD was assessed in ischemic stroke patients ≤ 60y using a standardized interview. Carotid ultrasound was performed and far wall cIMT in three carotid artery segments was registered, representing the common carotid (CCA-IMT), carotid bifurcation (BIF-IMT) and the internal carotid artery (ICA-IMT). Measurements were compared between FH+ and FH negative groups and stepwise backward regression analyses were performed to identify factors associated with increased cIMT.

Results: During the study period 382 patients were enrolled, of which 262 (68%) were males and 233 (61%) reported FH of CVD. Regression analyses adjusting for risk factors revealed age as the most important predictor of cIMT in all segments. The association between FH+ and cIMT was modified by age (p = 0.014) and was significant only regarding ICA-IMT. FH+ was associated with increased ICA-IMT in patients aged < 45y (p = 0.001), but not in patients ≥ 45y (p = 0.083). The association with ICA-IMT was present for a FH of stroke (p = 0.034), but not a FH+ of CHD or PAD.

Conclusions: FH of stroke is associated with higher ICA-IMT in young ischemic stroke patients. Subtyping of cardiovascular FH is important to investigate heredity in young ischemic stroke patients.

Trial registration: ClinicalTrials.gov NCT01597453.

Conflict of interest statement

Competing Interests: The authors have declared that no competing interests exist.

Figures

Fig 1. Transformed ICA-IMT by age.
Fig 1. Transformed ICA-IMT by age.
The distribution of the transformed ICA-IMT (1/√ICA-IMT) is plotted by age in 382 young and middle-aged ischemic stroke patients included in the Norwegian Stroke in the Young Study (NOR-SYS) in Bergen, Norway 2010–2015. Lines of best fit for FH+ and FH- patients are superimposed on the plot. There is a strong negative correlation between the 1/√ICA-IMT and age (Pearson’s r = -0.514; p

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