The association of telomere attrition with first-onset stroke in Southern Chinese: a case-control study and meta-analysis

Jing Li,Mei Zhang,Yu Chen,Weili Zhang,Rutai Hui,Liang Li,Congrui Feng,Shujun Yang

doi:10.1038/s41598-018-20434-w

Abstract

The relationship between telomere length and stroke was inconsistent mostly due to different pathogenesis of subtypes, environment and genetics. We aimed to assess whether leukocyte telomere contributes to stroke in Southern Chinese by investigating a case-control study comprising 543 cases (224 atherothrombotic stroke, 94 hemorrhagic stroke and 225 lacunar infraction) and 616 controls and replicated the investigation in an independent study comprising 773 cases and 875 controls with the same diagnostic criteria. Telomere was inversely correlated with increasing age in controls (correlation coefficient γ = −0.28, P < 0.001) and in cases with atherothrombotic stroke (γ = −0.17, P = 0.012). Individuals within the lowest tertile of telomere showed a higher risk for atherothrombotic stroke [odds ratio 2.33, 95% confidence (CI) 1.42–3.83; P = 0.003], whereas had a lower presence of lacunar infarction (OR 0.49, 95% CI 0.30–0.81; P = 0.007). Similar results were obtained in the second replication study. A further meta-analysis showed a 12% increased pooled risk of ischemic stroke (95% CI 1.04–1.18) in relation to shorter telomere, but this association was stronger in the retrospective studies and in Asians when stratified by study design and ethnicity. Our data provided the first evidence that in Southern Chinese stroke population, leukocyte telomere is independently associated with atherothrombotic stroke and lacunar infarction.

Highlights

Stroke, prone to elderly, is one of major causes of mortality and disability worldwide and in China
The telomere length ratio was divided into the tertile and clinical characteristics by tertile of the telomere length ratio were analyzed in the first stroke study participants (Supplementary Table S1) and 3 subtypes of stroke (Supplementary Table S2), respectively
The results found that the prevalence of conventional vascular risk factors was not significantly different among the highest, middle, and lowest tertile groups, except for blood pressure and fasting glucose

Summary

Introduction

Prone to elderly, is one of major causes of mortality and disability worldwide and in China. Emerging evidence has clearly established that age-dependent telomere shortening of circulating leukocytes is correlated with atherosclerosis and cardiovascular diseases[4,5,6,7], indicating that leukocyte telomere is a valuable biomarker to represent the biological aging of vascular www.nature.com/scientificreports/. Studies have not drawn convincing conclusions with respect to the relationship of telomere length with stroke risk. These studies differed in study design, end-point definitions for stroke, follow-up years, and ethnicity of the population. Another study from European showed no relation between leukocyte telomere and stroke in elderly high-risk hypertensive patients[14]. A positive susceptibility to the risk of ischemic stroke and all-cause mortality related to telomere length has recently been reported in the Chinese population[9,15,16]. Telomere length has been observed a remarkable difference across the geographical areas of Europe[19], pathogenesis underlying the geographical difference of stroke risk in China has not been investigated

Objectives

Methods

Results

Conclusion