title: Evaluation of the modifying effects of unfavourable genotypes on classical clinical risk factors for ischaemic stroke.
abstract: OBJECTIVE
  Ischaemic stroke is a frequent heterogeneous multifactorial disease that is affected by a number of genetic mutations and environmental factors. We hypothesised the clinical importance of the interactions between common, unfavourable genetic mutations and clinical risk factors in the development of ischaemic stroke.
  
  
  METHODS
  The Factor V Leiden G1691A (Leiden V), the prothrombin G20210A, the methylenetetrahydrofolate reductase C677T (MTHFR C677T) mutations, the angiotensin converting enzyme I/D (ACE I/D), and apolipoprotein allele e4 (APO e4) genotypes were examined by the polymerase chain reaction (PCR) technique in 867 ischaemic stroke patients and 743 healthy controls. Logistic regression models were used to estimate the roles of the co-occurrences of the clinical risk factors and common genetic mutations in ischaemic stroke.
  
  
  RESULTS
  The Leiden V mutation in combination with hypertension or diabetes mellitus increased the risk of ischaemic stroke. We found synergistic effects between the ACE D/D and MTHFR 677TT genotypes and drinking or smoking. The presence of the APO e4 greatly facilitated the unfavourable effects of hypertension, diabetes mellitus, smoking, or drinking on the incidence of ischaemic stroke.
  
  
  CONCLUSIONS
  In certain combinations, pairing of common unfavourable genetic factors, which alone confer only minor or non-significant risk, with clinical risk factors can greatly increase the susceptibility to ischaemic stroke.
authors.affiliation: Department of Neurology and Neurophysiology, Pándy Kálmán County Hospital, Gyula, Hungary. szolnoki99@hotmail.com
authors.forename: Z
authors.initials: Z
authors.lastname: Szolnoki
authors.forename: F
authors.initials: F
authors.lastname: Somogyvári
authors.forename: A
authors.initials: A
authors.lastname: Kondacs
authors.forename: M
authors.initials: M
authors.lastname: Szabó
authors.forename: L
authors.initials: L
authors.lastname: Fodor
authors.forename: J
authors.initials: J
authors.lastname: Bene
authors.forename: B
authors.initials: B
authors.lastname: Melegh
mesh_terms: D000368:Aged; D000428:Alcohol Drinking / Q000009:adverse effects*; D002545:Brain Ischemia / Q000235:genetics*; D048909:Diabetes Complications; D005260:Female; D020022:Genetic Predisposition to Disease; D005838:Genotype; D006801:Humans; D006973:Hypertension / Q000150:complications*; D008297:Male; D008875:Middle Aged; D009154:Mutation / Q000235:genetics; D011446:Prospective Studies; D012307:Risk Factors; D012907:Smoking / Q000009:adverse effects*; D020521:Stroke / Q000235:genetics*