Genetic risk, incident stroke, and the benefits of adhering to a healthy lifestyle: cohort study of 306 473 UK Biobank participants
BMJ 2018; 363 doi: https://doi.org/10.1136/bmj.k4168 (Published 24 October 2018) Cite this as: BMJ 2018;363:k4168
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We read an article recently published online in The BMJ by Rutten-Jacobs et al. with great interest and appreciate the authors' efforts to show that genetic and lifestyle factors were independently associated with incident stroke [1]. However, we are concerned that they did not take socioeconomic status (SES) into account.
SES could be a strong confounder of the association between lifestyle factors and stroke [2, 3]. SES could confound the association between genetic factors and stroke as well. A previous study suggests SES impacts well-being at multiple levels, including both family and neighborhood [4]. We presume SES could be passed on from parents to children.
References:
1. Rutten-Jacobs LC, Larsson SC, Malik R, Rannikmae K, consortium M, International Stroke Genetics C, et al. Genetic risk, incident stroke, and the benefits of adhering to a healthy lifestyle: cohort study of 306 473 UK Biobank participants. BMJ. 2018;363:k4168.
2. Winkleby MA, Jatulis DE, Frank E, Fortmann SP. Socioeconomic status and health: how education, income, and occupation contribute to risk factors for cardiovascular disease. American journal of public health. 1992;82(6):816-20.
3. Lantz PM, House JS, Lepkowski JM, Williams DR, Mero RP, Chen J. Socioeconomic factors, health behaviors, and mortality: results from a nationally representative prospective study of US adults. Jama. 1998;279(21):1703-8.
4. Bradley RH, Corwyn RF. Socioeconomic Status and Child Development. Annual Review of Psychology. 2002;53(1):371-99.
Competing interests: No competing interests
Health and sickness are familial, and both often relate back to genetic predisposition. But what is genetics? Basically, genetics and epigenetics study how DNA affects our hereditary sensitivity to diet, toxins, and addictions. So when we find familial patterns of health or sickness, we should assume that DNA is at work, and search for patterns of dietary, toxic, and addictive factors. This will promote health and heal sickness.
Competing interests: No competing interests
Accounting for insulin treatment can improve the accuracy of stroke risk estimates.
A study by Rutten-Jacobs et al. [1] proposes a new approach to the problem and perhaps for the first time convincingly compares the genetic and modifiable aspects of the etiology of strokes.
However, such broad generalizations may not take into account the important features of certain categories of adults. For example, the authors presented data on the number of people with diabetes 12,927 (4.2%) and an increase in their stroke incidence (10.1% vs. 4.2 in “no stroke” category), tabl.1.
It should be noted that stroke frequency grows as the glucose lowering treatment of type 2 diabetes (T2D) is increased, reaching its maximum in insulin-treated T2D [2].
Accounting for insulin treatment can significantly improve the accuracy of stroke risk estimates. Perhaps the same can be said about treatment with statins.
1. BMJ 2018;363:k4168
2. M. Khalangot, G. Hu, M. Tronko, V. Kravchenko, V. Guryanov, Gender risk of nonfatal stroke in type 2 diabetic patients differs depending on the type of treatment, J. Women Health 18 (1) (2009) 97–103.
Competing interests: No competing interests