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Neurology. 2019 Apr 16;92(16):e1890-e1898. doi: 10.1212/WNL.0000000000007279. Epub 2019 Mar 13.

A prospective study of serum metabolites and risk of ischemic stroke.

Author information

1
From the Brown Foundation Institute of Molecular Medicine, McGovern Medical School (D.S., X.J., M.F.), and School of Public Health (B.Y., E.B., M.F.), The University of Texas Health Science Center at Houston; Institute for Stroke and Dementia Research (S.T., M.D.), Klinikum der Universität München, Ludwig-Maximilians-Universität LMU, Munich, Germany; Johns Hopkins University School of Medicine (R.F.G.), Baltimore, MD; The University of Mississippi Medical Center (T.H.M.), Jackson; German Center for Neurodegenerative Diseases (DZNE, Munich) (M.D.); and Munich Cluster for Systems Neurology (SyNergy) (S.T., M.D.), Germany.
2
From the Brown Foundation Institute of Molecular Medicine, McGovern Medical School (D.S., X.J., M.F.), and School of Public Health (B.Y., E.B., M.F.), The University of Texas Health Science Center at Houston; Institute for Stroke and Dementia Research (S.T., M.D.), Klinikum der Universität München, Ludwig-Maximilians-Universität LMU, Munich, Germany; Johns Hopkins University School of Medicine (R.F.G.), Baltimore, MD; The University of Mississippi Medical Center (T.H.M.), Jackson; German Center for Neurodegenerative Diseases (DZNE, Munich) (M.D.); and Munich Cluster for Systems Neurology (SyNergy) (S.T., M.D.), Germany. Myriam.Fornage@uth.tmc.edu.

Abstract

OBJECTIVE:

To identify promising blood-based biomarkers and novel etiologic pathways of disease risk, we applied an untargeted serum metabolomics profiling in a community-based prospective study of ischemic stroke (IS).

METHODS:

In 3,904 men and women from the Atherosclerosis Risk In Communities study, Cox proportional hazard models were used to estimate the association of incident IS with the standardized level of 245 fasting serum metabolites individually, adjusting for age, sex, race, field center, batch, diabetes, hypertension, current smoking status, body mass index, and estimated glomerular filtration rate. Validation of results was carried out in an independent sample of 114 IS cases and 112 healthy controls.

RESULTS:

Serum levels of 2 long-chain dicarboxylic acids, tetradecanedioate and hexadecanedioate, were strongly correlated (r = 0.88) and were associated with incident IS after adjusting for covariates (hazard ratio [95% confidence interval (CI)] 1.11 [1.06-1.16] and 1.12 [1.07-1.17], respectively; p < 0.0001). Analyses by IS subtypes suggested that these associations were specific to cardioembolic stroke (CES). Associations of tetradecanedioate and hexadecanedioate with IS were independently confirmed (odds ratio [95% CI] 1.76 [1.21; 2.56] and 1.60 [1.11; 2.32], respectively).

CONCLUSION:

Two serum long-chain dicarboxylic acids, metabolic products of ω-oxidation of fatty acids, were associated with IS and CES independently of known risk factors. Pathways related to intracellular hexadecanedioate synthesis or those involved in its clearance from the circulation may mediate IS risk. These results highlight the potential of metabolomics to discover novel circulating biomarkers for stroke and to unravel novel pathways for IS and its subtypes.

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