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  1. Putative apolipoprotein A-I, natural killer cell enhancement factor and lysozyme g are involved in the early immune response of brown-marbled grouper, Epinephelus fuscoguttatus, Forskal, to Vibrio alginolyticus
    Low CF, Shamsudin MN, Chee HY, Aliyu-Paiko M, Idrus ES
    J Fish Dis, 2014 Aug;37(8):693-701.
    PMID: 24304156 DOI: 10.1111/jfd.12153
    The gram-negative bacterium, Vibrio alginolyticus, has frequently been identified as the pathogen responsible for the infectious disease called vibriosis. This disease is one of the major challenges facing brown-marbled grouper aquaculture, causing fish farmers globally to suffer substantial economic losses. The objective of this study was to investigate the proteins involved in the immune response of brown-marbled grouper fingerlings during their initial encounter with pathogenic organisms. To achieve this objective, a challenge experiment was performed, in which healthy brown-marbled grouper fingerlings were divided into two groups. Fish in the treated group were subjected to intraperitoneal injection with an infectious dose of V. alginolyticus suspended in phosphate-buffered saline (PBS), and those in the control group were injected with an equal volume of PBS. Blood samples were collected from a replicate number of fish from both groups at 4 h post-challenge and analysed for immune response-related serum proteins via two-dimensional gel electrophoresis. The results showed that 14 protein spots were altered between the treated and control groups; these protein spots were further analysed to determine the identity of each protein via MALDI-TOF/TOF. Among the altered proteins, three were clearly overexpressed in the treated group compared with the control; these were identified as putative apolipoprotein A-I, natural killer cell enhancement factor and lysozyme g. Based on these results, these three highly expressed proteins participate in immune response-related reactions during the initial exposure (4 h) of brown-marbled grouper fingerling to V. alginolyticus infection.
    Matched MeSH terms: Apolipoprotein A-I/genetics; Apolipoprotein A-I/metabolism*
  2. Fulltext Tamarindus indica extract alters release of alpha enolase, apolipoprotein A-I, transthyretin and Rab GDP dissociation inhibitor beta from HepG2 cells
    Chong UR, Abdul-Rahman PS, Abdul-Aziz A, Hashim OH, Junit SM
    PLoS One, 2012;7(6):e39476.
    PMID: 22724021 DOI: 10.1371/journal.pone.0039476
    The plasma cholesterol and triacylglycerol lowering effects of Tamarindus indica extract have been previously described. We have also shown that the methanol extract of T. indica fruit pulp altered the expression of lipid-associated genes including ABCG5 and APOAI in HepG2 cells. In the present study, effects of the same extract on the release of proteins from the cells were investigated using the proteomics approach.
    Matched MeSH terms: Apolipoprotein A-I/biosynthesis*; Apolipoprotein A-I/genetics
  3. Identification of potential glycoprotein biomarkers in oral squamous cell carcinoma using sweet strategies
    Wong YL, Anand R, Yuen KM, Mustafa WMW, Abraham MT, Tay KK, et al.
    Glycoconj J, 2021 02;38(1):1-11.
    PMID: 33547992 DOI: 10.1007/s10719-021-09973-z
    The prevalence of oral squamous cell carcinoma (OSCC) is high in South and Southeast Asia regions. Most OSCC patients are detected at advanced stages low 5-year survival rates. Aberrant expression of glycosylated proteins was found to be associated with malignant transformation and cancer progression. Hence, identification of cancer-associated glycoproteins could be used as potential biomarkers that are beneficial for diagnosis or clinical management of patients. This study aims to identify the differentially expressed glycoproteins using lectin-based glycoproteomics approaches. Serum samples of 40 patients with OSCC, 10 patients with oral potentially malignant disorder (OPMD), and 10 healthy individuals as control group were subjected to two-dimensional gel electrophoresis (2-DE) coupled with lectin Concanavalin A and Jacalin that specifically bind to N- and O-glycosylated proteins, respectively. Five differentially expressed N- and O-glycoproteins with various potential glycosylation sites were identified, namely N-glycosylated α1-antitrypsin (AAT), α2-HS-glycoprotein (AHSG), apolipoprotein A-I (APOA1), and haptoglobin (HP); as well as O-glycosylated AHSG and clusterin (CLU). Among them, AAT and APOA1 were further validated using enzyme-linked immunosorbent assay (ELISA) (n = 120). It was found that AAT and APOA1 are significantly upregulated in OSCC and these glycoproteins are independent risk factors of OSCC. The clinical utility of AAT and APOA1 as potential biomarkers of OSCC is needed for further evaluation.
    Matched MeSH terms: Apolipoprotein A-I/blood; Apolipoprotein A-I/metabolism
  4. Lactobacillus fermentum FTDC 8312 combats hypercholesterolemia via alteration of gut microbiota
    Lye HS, Kato T, Low WY, Taylor TD, Prakash T, Lew LC, et al.
    J Biotechnol, 2017 Sep 19.
    PMID: 28935567 DOI: 10.1016/j.jbiotec.2017.09.007
    In this study, hypercholesterolemic mice fed with Lactobacillus fermentum FTDC 8312 after a seven-week feeding trial showed a reduction in serum total cholesterol (TC) levels, accompanied by a decrease in serum low-density lipoprotein cholesterol (LDL-C) levels, an increase in serum high-density lipoprotein cholesterol (HDL-C) levels, and a decreased ratio of apoB100:apoA1 when compared to those fed with control or a type strain, L. fermentum JCM 1173. These have contributed to a decrease in atherogenic indices (TC/HDL-C) of mice on the FTDC 8312 diet. Serum triglyceride (TG) levels of mice fed with FTDC 8312 and JCM 1173 were comparable to those of the controls. A decreased ratio of cholesterol and phospholipids (C/P) was also observed for mice fed with FTDC 8312, leading to a decreased number of spur red blood cells (RBC) formation in mice. Additionally, there was an increase in fecal TC, TG, and total bile acid levels in mice on FTDC 8312 diet compared to those with JCM 1173 and controls. The administration of FTDC 8312 also altered the gut microbiota population such as an increase in the members of genera Akkermansia and Oscillospira, affecting lipid metabolism and fecal bile excretion in the mice. Overall, we demonstrated that FTDC 8312 exerted a cholesterol lowering effect that may be attributed to gut microbiota modulation.
    Matched MeSH terms: Apolipoprotein A-I
  5. Fulltext IFN-γ Induction of Apolipoprotein A-I Expression is Mediated by NF-κB Signalling in HepG2 Cells
    Lui Siang Tong, Hong Kin Wong, Choy Hoong Chew
    Trop Life Sci Res, 2019;30(2):1-13.
    MyJurnal
    Keradangan hati berkait rapat dengan perubahan dalam ekspresi lipoprotein dan apolipoprotein. Interferon-γ (IFN-γ), wakil tunggal jenis kedua IFN, memainkan peranan yang penting dalam memodulasi dan mempergiatkan tindak balas keradangan. Justeru itu, kajian ini direka untuk mengenal pasti kesan IFN-γ terhadap apolipoprotein A-I (APOA-I) dan penglibatan nuclear factor–kappa B (NF-κB) dalam laluan isyarat tersebut. Tindak balas rantai polymerase transkripsi berbalik kuantitatif (qRT-PCR) dan analisis blot western telah dilaksanakan untuk menguantifikasi ekspresi APOA-I dalam sel-sel HepG2 selepas dirawat dengan IFN-γ. Kajian ini menunjukkan bahawa 50 ng/mL IFN-γ merangsangkan ekspresi mRNA dan protein APOA-I. Walau bagaimanapun, pra-rawatan sel dengan inhibitor laluan isyarat NF-κB mengurangkan tahap ekspresi APOA-I. Kajian ini juga mendemonstrasikan penglibatan langsung isyarat NF-κB dalam ekspresi APOA-I akibat rangsangan IFN-γ, di mana IFN-γ meningkatkan tahap fosforilasi NF-κB p65 Ser468 dan Ser536 kepada 2.59-ganda and 1.63-ganda. Namun demikian, pra-rawatan sel dengan perencat laluan isyarat NF-κB melumpuhkan peningkatkan tersebut dan kemudian mengurangkan ekspresi APOA-I dalam sel HepG2. Sebagai rumusan, kajian ini berjaya mengenalpasti peranan isyarat NF-κB dan pengaktifan p65 Ser468 dan Ser536 sebagai pengantara IFN-γ ke atas induksi APOA-I di dalam sel-sel HepG2.
    Matched MeSH terms: Apolipoprotein A-I
  6. Targeting the vivid facets of apolipoproteins as a cardiovascular risk factor in rheumatoid arthritis
    Sharma A, Sharma C, Sharma L, Wal P, Mishra P, Sachdeva N, et al.
    Can J Physiol Pharmacol, 2024 May 01;102(5):305-317.
    PMID: 38334084 DOI: 10.1139/cjpp-2023-0259
    Mostly, cardiovascular diseases are blamed for casualties in rheumatoid arthritis (RA) patients. Customarily, dyslipidemia is probably the most prevalent underlying cause of untimely demise in people suffering from RA as it hastens the expansion of atherosclerosis. The engagement of inflammatory cytokines like tumor necrosis factor-α (TNF-α), interleukin-1 (IL-1), interleukin-6 (IL-6), etc., is crucial in the progression and proliferation of both RA and abnormal lipid parameters. Thus, lipid abnormalities should be monitored frequently in patients with both primary and advanced RA stages. An advanced lipid profile examination, i.e., direct role of apolipoproteins associated with various lipid molecules is a more dependable approach for better understanding of the disease and selecting suitable therapeutic targets. Therefore, studying their apolipoproteins is more relevant than assessing RA patients' altered lipid profile levels. Among the various apolipoprotein classes, Apo A1 and Apo B are primarily being focused. In addition, it also addresses how calculating Apo B:Apo A1 ratio can aid in analyzing the disease's risk. The marketed therapies available to control lipid abnormalities are associated with many other risk factors. Hence, directly targeting Apo A1 and Apo B would provide a better and safer option.
    Matched MeSH terms: Apolipoprotein A-I
  7. Supplementation with tocotrienol-rich fraction alters the plasma levels of Apolipoprotein A-I precursor, Apolipoprotein E precursor, and C-reactive protein precursor from young and old individuals
    Heng EC, Karsani SA, Abdul Rahman M, Abdul Hamid NA, Hamid Z, Wan Ngah WZ
    Eur J Nutr, 2013 Oct;52(7):1811-20.
    PMID: 23287846 DOI: 10.1007/s00394-012-0485-3
    PURPOSE: Tocotrienol possess beneficial effects not exhibited by tocopherol. In vitro studies using animal models have suggested that these effects are caused via modulation of gene and protein expression. However, human supplementation studies using tocotrienol-rich isomers are limited. This study aims to identify plasma proteins that changed in expression following tocotrienol-rich fraction (TRF) supplementation within two different age groups.

    METHODS: Subjects were divided into two age groups-32 ± 2 (young) and 52 ± 2 (old) years old. Four subjects from each group were assigned with TRF (78% tocotrienol and 22% tocopherol, 150 mg/day) or placebo capsules for 6 months. Fasting plasma were obtained at 0, 3, and 6 months. Plasma tocopherol and tocotrienol levels were determined. Plasma proteome was resolved by 2DE, and differentially expressed proteins identified by MS. The expressions of three proteins were validated by Western blotting.

    RESULTS: Six months of TRF supplementation significantly increased plasma levels of tocopherols and tocotrienols. Proteins identified as being differentially expressed were related to cholesterol homeostasis, acute-phase response, protease inhibitor, and immune response. The expressions of Apolipoprotein A-I precursor, Apolipoprotein E precursor, and C-reactive protein precursor were validated. The old groups showed more proteins changing in expression.

    CONCLUSIONS: TRF appears to not only affect plasma levels of tocopherols and tocotrienols, but also the levels of plasma proteins. The identity of these proteins may provide insights into how TRF exerts its beneficial effects. They may also be potentially developed into biomarkers for the study of the effects and effectiveness of TRF supplementation.

    Matched MeSH terms: Apolipoprotein A-I/blood*
  8. Ethnic variation of cord plasma apolipoprotein levels in relation to coronary risk level: a study in three ethnic groups of Singapore
    Low PS, Saha N, Tay JS, Hong S
    Acta Paediatr, 1996 Dec;85(12):1476-82.
    PMID: 9001661
    In multiracial Singapore, the prevalence of coronary artery disease is highest in ethnic Indian and lowest in ethnic Chinese populations. Since susceptibility to coronary artery disease is closely associated with plasma lipid traits, we studied the cord blood lipid and apolipoprotein profiles of the three ethnic groups in Singapore to determine if ethnic differences in lipid profile are present at birth. The high-risk lipid traits of high LDL-cholesterol, triglycerides and apo B, low HDL-cholesterol and apo A-I were found to be highest in ethnic Indian and lowest in ethnic Chinese populations. This difference was concordant with the relative coronary mortality rates for their respective adult populations in Singapore.
    Matched MeSH terms: Apolipoprotein A-I/blood
  9. Fulltext The hypocholesterolemic effect of germinated brown rice involves the upregulation of the apolipoprotein A1 and low-density lipoprotein receptor genes
    Imam MU, Ismail M, Omar AR, Ithnin H
    J Diabetes Res, 2013;2013:134694.
    PMID: 23671850 DOI: 10.1155/2013/134694
    Germinated brown rice (GBR) is rich in bioactive compounds, which confer GBR with many functional properties. Evidence of its hypocholesterolemic effects is emerging, but the exact mechanisms of action and bioactive compounds involved have not been fully documented. Using type 2 diabetic rats, we studied the effects of white rice, GBR, and brown rice (BR) on lipid profile and on the regulation of selected genes involved in cholesterol metabolism. Our results showed that the upregulation of apolipoprotein A1 and low-density lipoprotein receptor genes was involved in the hypocholesterolemic effects of GBR. Additionally, in vitro studies using HEPG2 cells showed that acylated steryl glycoside, gamma amino butyric acid, and oryzanol and phenolic extracts of GBR contribute to the nutrigenomic regulation of these genes. Transcriptional and nontranscriptional mechanisms are likely involved in the overall hypocholesterolemic effects of GBR suggesting that it may have an impact on the prevention and/or management of hypercholesterolemia due to a wide variety of metabolic perturbations. However, there is need to conduct long-term clinical trials to determine the clinical relevance of the hypocholesterolemic effects of GBR determined through animal studies.
    Matched MeSH terms: Apolipoprotein A-I
  10. Anticholesterol activity of anacardium occidentale linn. Does it involve in reverse cholesterol transport?
    Mohd Kamal Nik Hasan, Ihsan Safwan Kamarazaman, Nur Zalikha Mohd Taza, Rasadah Mat Ali, Mohd Shahidan Mohd Arshad, Zamree Md Shah, et al.
    Sains Malaysiana, 2015;44:1501-1510.
    Anacardium occidentale belongs to the Anacardiaceae family. It had been scientifically proven to have antihypercholesterolemia effect in high cholesterol diet induced animal laboratory study. However there is no study regarding the mechanisms involves in cholesterol reducing effect by A. occidentale leaves extract. In this study, cytotoxic assessment and anti-cholesterol activity of A. occidentale leaves aqueous extract (AOE) were investigated. Cytotoxic study was performed by exposing hepatoma cell (Hep G2) towards AOE with concentration ranging from 0.002 to 20 mg/mL for 24 h. Anacardium occidentale extract was found to be not toxic to the cell. Then, the highest and not toxic AOE concentrations (20, 10, 5 and 2.5 mg/mL) were selected for anti-cholesterol study. The ability of AOE to reduce cholesterol in cell culture experiment was carried out by pretreating Hep G2 with selected concentrations of AOE in 6-well plate before the cell was exposed to low density lipoprotein (LDL). The concentration of farnesyl-diphosphate farnesyltransferase (FDFT1), apolipoprotein A1 (Apo A1), lecithin-cholesterol acyltransferase (LCAT), low density lipoprotein receptor (LDL R), scavenger receptor B1 (SR-B1), ATP binding cassette transporter A1 (ABCA-1) and hepatic lipase (HL) were determined from the 6-well plate media. The results showed that AOE did not significantly increase the concentration of LDLR. However, AOE significantly increased the concentration of FDFT1, APO A1, LCAT, SRB-1, ABCA-1 and HL. The HMGR activity experiment showed that all selected AOE concentrations cannot significantly reduce the HMGR enzyme activity. These findings suggested that AOE may involve in reverse cholesterol transport process to reduce cholesterol metabolism in Hep G2 cell.
    Matched MeSH terms: Apolipoprotein A-I
  11. Fulltext Identification of Haptoglobin as a Potential Biomarker in Young Adults with Acute Myocardial Infarction by Proteomic Analysis
    Mohamed Bakrim N, Mohd Shah ANS, Talib NA, Ab Rahman J, Abdullah A
    Malays J Med Sci, 2020 Mar;27(2):64-76.
    PMID: 32788843 MyJurnal DOI: 10.21315/mjms2020.27.2.8
    Background: Acute myocardial infarction (AMI) molecular research in young adults is still limited. The aim of this study is to identify AMI proteomic biomarker(s) in young adults.

    Methods: This study comprised of two phases namely discovery and verification. In the discovery phase, proteins in the pooled plasma samples from young male adults between 18 and 45 years (10 AMI patients and 10 controls) were separated using two-dimensional electrophoresis. The protein spots that were expressed differently in the AMI patients were identified via matrix-assisted laser desorption/ionisation time-of-flight mass spectrometry. The plasma concentrations of these proteins were quantified using enzyme-linked immunosorbent assay during the verification phase (40 AMI patients and 80 controls).

    Results: Haptoglobin (Hp), apolipoprotein AI (Apo AI) and apolipoprotein AIV (Apo AIV) were up-regulated in the discovery phase. In the verification phase, the plasma concentration of Hp was significantly higher in AMI patients than the controls (P < 0.001). Logistic regression showed an association between Hp and AMI in young adults (odds ratio [OR] = 1.016, 95% CI: 1.002-1.030, P = 0.025) independent of other AMI risk factors. Hp was significantly correlated with high sensitivity C-reactive protein (hs-CRP) (r = 0.424, P < 0.001).

    Conclusion: In young adults with AMI, plasma Hp concentrations were elevated and it is independently associated with AMI. A positive correlation with hs-CRP suggests Hp could be a potential biomarker of AMI in young adults.

    Matched MeSH terms: Apolipoprotein A-I
  12. ABCA1 gene polymorphisms and their associations with coronary artery disease and plasma lipids in males from three ethnic populations in Singapore
    Tan JH, Low PS, Tan YS, Tong MC, Saha N, Yang H, et al.
    Hum Genet, 2003 Jul;113(2):106-17.
    PMID: 12709788
    Mutations in the ATP-binding cassette transporter ABCA1 underlie Tangier disease and familial hypoalphaliproteinemia (FHA), disorders that are characterised by reduced high-density lipoprotein-cholesterol (HDL-C) concentration and cholesterol efflux, and increased coronary artery disease (CAD). We explored if polymorphisms in the ABCA1 gene are associated with CAD and variations in plasma lipid levels, especially HDL-C, and whether the associations may depend on ethnicity. Male cases and controls from the Singapore Chinese, Malay and Indian populations were genotyped for five ABCA1 single nucleotide polymorphisms. Various single-locus frequency distribution differences between cases and controls were detected in different ethnic groups: the promoter -14C>T in Indians, exon 18 M883I in Malays, and 3'-untranslated (UTR) region 8994A>G in Chinese. For the Malay population, certain haplotypes carrying the I825- A (exon 17) and M883- G alleles were more frequent among cases than controls, whereas the converse was true for the alternative configuration of V825- G and I883- A, and this association was reinforced in multi-locus disequilibrium analysis that utilized genotypic data. In the healthy controls, associations were found for -14C>T genotypes with HDL-C in Chinese; 237indelG (5'UTR) with apolipoprotein A1 (apoA1) in Malays and total cholesterol (TC) in Indians; M883I with lipoprotein(a) [Lp(a)] in Malays and apolipoprotein B (apoB) in Chinese; and 8994A>G with Lp(a) in Malays, and TC, low-density lipoprotein-cholesterol (LDL-C) as well as apoB in Indians. While genotype-phenotype associations were not reproduced across populations and loci, V825I and M883I were clearly associated with CAD status in Malays with no effects on HDL-C or apoA1.
    Matched MeSH terms: Apolipoprotein A-I/blood
  13. Serum HDL cholesterol and apolipoprotein AI, AII and B levels in Singapore newborns
    Saha N, Wong HB
    Biol. Neonate, 1987;52(2):93-6.
    PMID: 3115319
    The mortality from coronary artery disease (CAD) in Indians is more than three times that in the Chinese and Malays of Singapore. Serum total and HDL cholesterol as well as apolipoprotein (Apo) AI, AII and B levels were determined in a group of 349 newborns (cord blood) from both sexes in these three ethnic groups in order to examine if a trend is reflected at birth. Both serum LDL cholesterol and Apo B levels were low in the newborn, while HDL cholesterol and Apo AII levels were almost the same as in adults. Serum Apo AI levels were also low in newborns. No consistent difference as to ethnic group or sex was observed in any of the parameters investigated, except that the females had significantly higher levels of serum Apo AI in all the ethnic groups. Serum total and HDL cholesterol levels in Singapore newborns were comparable to those reported in Caucasians and Asians. The trends of incidence of CAD were not reflected in the lipid profiles studied at birth.
    Matched MeSH terms: Apolipoprotein A-I; Apolipoprotein A-II
  14. Influence of dietary fat on plasma lipid profiles of Malaysian adolescents
    Marzuki A, Arshad F, Razak TA, Jaarin K
    Am J Clin Nutr, 1991 04;53(4 Suppl):1010S-1014S.
    PMID: 1901440 DOI: 10.1093/ajcn/53.4.1010S
    We studied the effects of saturated (palm olein) and polyunsaturated (soybean oil) cooking oils on the lipid profiles of Malaysian male adolescents eating normal Malaysian diets for 5 wk. Diets cooked with palm olein did not significantly alter plasma total-cholesterol, LDL cholesterol, and HDL cholesterol concentrations or the ratio of total cholesterol to HDL cholesterol compared with diets cooked with soybean oil. However, the diet cooked with palm olein significantly increased apolipoprotein A-I (11%) and apolipoprotein B (9%) concentrations. Unexpectedly, soybean-oil-cooked diets caused a significant increase (47%) in plasma triglycerides compared with palm-olein-cooked diets. We conclude that palm olein, when used as cooking oil, has no detrimental effects on plasma lipid profiles in Malaysian adolescents.
    Matched MeSH terms: Apolipoprotein A-I
  15. Fulltext Association between dietary patterns and cardiometabolic risks in Malaysian Punjabi adults
    Yik Fah Chee, Satvinder Kaur, Roseline Wai Kuan Yap
    Malaysian Journal of Medicine and Health Sciences, 2020;16(106):106-115.
    MyJurnal
    Introduction: Globally, the prevalence of cardiovascular diseases (CVD) is high in Punjabi population. This could due to the increased cardiometabolic risks associated with diets high in dietary fats and refined grains. However, studies on the relationship between dietary pattern and cardiometabolic risks involving Malaysian Punjabis popu- lation are scarce. Hence, this study aims to determine the associations between dietary patterns and cardiometa- bolic risks in Malaysian Punjabi adults. Methods: Socio-demographic, lifestyle and dietary intake information was collected using self-administered questionnaire. Anthropometric measurements: weight and height for body mass index (BMI) calculation, waist circumference (WC); systolic (SBP) and diastolic blood pressure (DBP); and biomark- ers: blood glucose, glycated haemoglobin A1c (HbA1c), triglycerides, total cholesterol (TC), low-density-lipopro- tein cholesterol (LDL-C), high-density-lipoprotein cholesterol (HDL-C), apolipoprotein A1 and B100 were obtained. Major dietary patterns were derived using principal component analysis. Association between dietary patterns and cardiometabolic risk factors were performed using ANCOVA and Kruskal-Wallis tests. Results: A total of 164 (35.4% males and 64.6% females) Punjabis were included in this study. Four dietary patterns were extracted, namely ‘fruits and vegetables diet’ (FVD), ‘whole grains, condiments and beverages diet’ (WCBD), ‘protein diet’ (PD) and ‘rice, noodles, cereals and meat diet’ (RNCMD). Significant associations were obtained for FVD with BMI (p=0.012), WC (p=0.011), SBP (p=0.020) and DBP (p=0.009); WCBD with TC (p=0.010), LDL-C (p=0.015) and apolipoprotein B100 (p=0.038). Conclusion: Dietary pattern comprised of fruits, vegetables and beverages containing antioxidant-rich spices, ginger, and black tea may lower cardiometabolic risks in Malaysian Punjabis, particularly in obesity, high blood pressure and hyperlipidaemia.
    Matched MeSH terms: Apolipoprotein A-I
  16. Global and regional effects of potentially modifiable risk factors associated with acute stroke in 32 countries (INTERSTROKE): a case-control study
    O'Donnell MJ, Chin SL, Rangarajan S, Xavier D, Liu L, Zhang H, et al.
    Lancet, 2016 Aug 20;388(10046):761-75.
    PMID: 27431356 DOI: 10.1016/S0140-6736(16)30506-2
    BACKGROUND:Stroke is a leading cause of death and disability, especially in low-income and middle-income countries. We sought to quantify the importance of potentially modifiable risk factors for stroke in different regions of the world, and in key populations and primary pathological subtypes of stroke.
    METHODS:We completed a standardised international case-control study in 32 countries in Asia, America, Europe, Australia, the Middle East, and Africa. Cases were patients with acute first stroke (within 5 days of symptom onset and 72 h of hospital admission). Controls were hospital-based or community-based individuals with no history of stroke, and were matched with cases, recruited in a 1:1 ratio, for age and sex. All participants completed a clinical assessment and were requested to provide blood and urine samples. Odds ratios (OR) and their population attributable risks (PARs) were calculated, with 99% confidence intervals.
    FINDINGS: Between Jan 11, 2007, and Aug 8, 2015, 26 919 participants were recruited from 32 countries (13 447 cases [10 388 with ischaemic stroke and 3059 intracerebral haemorrhage] and 13 472 controls). Previous history of hypertension or blood pressure of 140/90 mm Hg or higher (OR 2·98, 99% CI 2·72-3·28; PAR 47·9%, 99% CI 45·1-50·6), regular physical activity (0·60, 0·52-0·70; 35·8%, 27·7-44·7), apolipoprotein (Apo)B/ApoA1 ratio (1·84, 1·65-2·06 for highest vs lowest tertile; 26·8%, 22·2-31·9 for top two tertiles vs lowest tertile), diet (0·60, 0·53-0·67 for highest vs lowest tertile of modified Alternative Healthy Eating Index [mAHEI]; 23·2%, 18·2-28·9 for lowest two tertiles vs highest tertile of mAHEI), waist-to-hip ratio (1·44, 1·27-1·64 for highest vs lowest tertile; 18·6%, 13·3-25·3 for top two tertiles vs lowest), psychosocial factors (2·20, 1·78-2·72; 17·4%, 13·1-22·6), current smoking (1·67, 1·49-1·87; 12·4%, 10·2-14·9), cardiac causes (3·17, 2·68-3·75; 9·1%, 8·0-10·2), alcohol consumption (2·09, 1·64-2·67 for high or heavy episodic intake vs never or former drinker; 5·8%, 3·4-9·7 for current alcohol drinker vs never or former drinker), and diabetes mellitus (1·16, 1·05-1·30; 3·9%, 1·9-7·6) were associated with all stroke. Collectively, these risk factors accounted for 90·7% of the PAR for all stroke worldwide (91·5% for ischaemic stroke, 87·1% for intracerebral haemorrhage), and were consistent across regions (ranging from 82·7% in Africa to 97·4% in southeast Asia), sex (90·6% in men and in women), and age groups (92·2% in patients aged ≤55 years, 90·0% in patients aged >55 years). We observed regional variations in the importance of individual risk factors, which were related to variations in the magnitude of ORs (rather than direction, which we observed for diet) and differences in prevalence of risk factors among regions. Hypertension was more associated with intracerebral haemorrhage than with ischaemic stroke, whereas current smoking, diabetes, apolipoproteins, and cardiac causes were more associated with ischaemic stroke (p<0·0001).
    INTERPRETATION: Ten potentially modifiable risk factors are collectively associated with about 90% of the PAR of stroke in each major region of the world, among ethnic groups, in men and women, and in all ages. However, we found important regional variations in the relative importance of most individual risk factors for stroke, which could contribute to worldwide variations in frequency and case-mix of stroke. Our findings support developing both global and region-specific programmes to prevent stroke.
    FUNDING: Canadian Institutes of Health Research, Heart and Stroke Foundation of Canada, Canadian Stroke Network, Health Research Board Ireland, Swedish Research Council, Swedish Heart and Lung Foundation, The Health & Medical Care Committee of the Regional Executive Board, Region Västra Götaland (Sweden), AstraZeneca, Boehringer Ingelheim (Canada), Pfizer (Canada), MSD, Chest, Heart and Stroke Scotland, and The Stroke Association, with support from The UK Stroke Research Network.
    Matched MeSH terms: Apolipoprotein A-I/blood
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