Comparing Risk Factor Profiles between Intracerebral Hemorrhage and Ischemic Stroke in Chinese and White Populations: Systematic Review and Meta-Analysis

Background

Chinese populations have a higher proportion of intracerebral hemorrhage (ICH) in total strokes. However, the reasons are not fully understood.

Methods

To assess the differences in frequency of major risk factors between ICH and ischemic stroke (IS) in Chinese versus white populations of European descent, we systematically sought studies conducted since 1990 that compared frequency of risk factors between ICH and IS in Chinese or white populations. For each risk factor, in Chinese and Whites separately, we calculated study-specific and random effects pooled prevalence and odds ratios (ORs) for ICH versus IS.

Results

Six studies among 36190 Chinese, and seven among 52100 white stroke patients studied hypertension, diabetes, atrial fibrillation (AF), ischemic heart disease (IHD), hypercholesterolemia, smoking and alcohol. Pooled prevalence of AF was significantly lower in Chinese. Pooled ORs for ICH versus IS were mostly similar in Chinese and Whites. However, in Chinese–but not Whites–mean age was lower (62 versus 69 years), while hypertension and alcohol were significantly more frequent in ICH than IS (ORs 1.38, 95% CI 1.18–1.62, and 1.46, 1.12–1.91). Hypercholesterolemia and smoking were significantly less frequent in ICH in Whites, but not Chinese, while IHD, AF and diabetes were less frequent in ICH in both.

Conclusions

Different risk factor distributions in ICH and IS raise interesting possibilities about variation in mechanisms underlying the different distributions of pathological types of stroke between Chinese and Whites. Further analyses in large, prospective studies, including adjustment for potential confounders, are needed to consolidate and extend these findings.     

Activation of membrane-bound high-affinity calcium ion-sensitive adenosine triphosphatase of human erythrocytes by bivalent metal ions.

The Ca2+-sensitive ATPase (adenosine triphosphatase) of human erythrocyte membranes is activated, not only by Ca2+ ions, but also by a series of other bivalent metal ions including Sr2+, Ba2+, Mn2+, Ni2+, Co2+, Cd2+, Cu2+, Zn2+ and Pb2+. The degree of activation is dependent on the radius of the ion rather than on its nature, in contrast with the dissociation constant of the enzyme--metal ion complex.     

Structure of human high density lipoprotein reassembled in vitro. Radioimmunoassay studies.

Immunologic approaches to studying lipoprotein structure have been limited because the methods have not been quantitative enough. Recently we reported (Schonfeld, G., and Pfleger, B. (1974) J. Clin. Invest. 54, 236-246) a radioimmunoassay for human apoprotein A-1 (ApoA-I). Only 8% of the ApoA-I of high density lipoprotein (HDL) reacted in the radioimmunoassay system consisting of rabbit anti-human ApoA-I, 125I-ApoA-I, and unlabeled ApoA-I. We suggested that the ApoA-I in HDL were poorly reactive in the radioimmunoassay because they were "masked" by lipid- or protein-protein interactions. To test this, "lipoproteins" were reconstituted from lipids and apoproteins and assayed for their reactivity in the radioimmunoassay. Apo-HDL, ApoA-I alone, or ApoA-I + ApoA-II were sonified with lecithin or with lipids extracted from HDL. Sonicates were fractionated by ultracentrifugation or by Sepharose 4B chromatography. HDLs were also made by incubating dispersed lecithin or lecithin + cholesterol with Apo-HDL, ApoA-I, or ApoA-II. The lipoproteins were analyzed for lipids and protein chemically. Apoprotein compositions were determined by polyacrylamide disc gel electrophoresis. ApoA-I content by radioimmunoassay then was compared with the ApoA-I content obtained by disc gel electrophoresis. Most reconstituted "lipoproteins" had less than the expected ApoA-I contents. Discrepancies between ApoA-I contents were greatest for lipoproteins prepared from Apo-HDL and HDL-lipids (20 to 30% of expected contents). Discrepancies were smaller for particles prepared with lecithin, with ApoA-I alone or with ApoA-I + ApoA-II (40 to 85% of expected). HDLs made by incubation were less reactive than those prepared by sonication. Thus, the reactivity of ApoA-I in the radioimmunoassay could be diminished by causing it to interact with lipids or their apoproteins, or both, suggesting that antigenic sites became masked. From this one can extrapolate that the poor reactivity of the ApoA-I in HDL isolated from plasma also may have been due to the masking of some of its antigenic determinants. The identification of the determinants involved awaits the development of radioimmunoassays for specific regions of ApoA-I.     

Cloning of carotenoid biosynthesis genes fromRhodopseudomonas sphaeroides

Two cosmids, pJP1433 and pJP1488, have been constructed which carry between them 60 kilobases of the central section of the photosynthesis region ofRhodopseudomonas sphaeroides. Within this region is a segment of some 15 kilobases which encompasses the known carotenoid biosynthesis genesCrtA,CrtB,CrtC,CrtD,CrtE, andCrtF.     

Utilization of exogenous free fatty acids for the production of very low density lipoprotein triglyceride by livers of carbohydrate-fed rats

High carbohydrate diets enhance the hepatic output of very low density lipoprotein triglycerides. The fatty acids of these triglycerides could come from exogenous sources (i.e., diet or adipose tissue) or from de novo fatty acid synthesis in the liver. The role of exogenous free fatty acids was evaluated in rats fed Purina Chow or diets containing 10% fructose for up to 14 wk. In carbohydrate-fed rats, serum triglycerides were twice normal, and VLDL accounted for about 60% of the increases. Pre-beta-lipoprotein was increased and alpha- and beta-lipoprotein were decreased. Phospholipid and cholesterol levels were unchanged. Livers were perfused with glucose and free fatty acids. Perfusate free fatty acids rose from 180 to 1800 micro eq/liter as the infused acids increased from 0 to 992 micro eq/3 hr; simultaneously, net free fatty acid uptake rose from < 1 to 18 micro eq/g/hr and triglyceride output by the liver doubled. However, rates of secretion of triglyceride became constant, and triglyceride accumulated in liver at uptakes of free fatty acids > 13 micro eq/g/hr. More lauric and myristic acid appeared in the perfusate than was infused, suggesting the hepatic discharge of free fatty acids. Livers of fructose-fed rats secreted twice as much oleate-(14)C-labeled triglyceride as controls at all levels of free fatty acid uptake. The ratios of the specific activities of perfusate triglyceride to free oleate-(14)C were unaffected by diet and were about 0.6 and 1.0 at low and high triglyceride secretion rates, respectively. Thus, carbohydrate feeding did not result in altered uptakes of free fatty acids or preferential secretion of triglycerides containing endogenously synthesized fatty acid. Instead, the increased secretion of triglyceride was accomplished by enhanced formation of VLDL triglyceride from exogenous free fatty acids.     

Effects of Ethanol, Temperature, and Endogenous Regulatory Factors on the Characteristics of Striatal Opiate Receptors

Ethanol can alter the affinity of mouse striatal opiate receptors for their ligands, and the present studies were aimed at determining the importance of the receptor microenvironment for this effect of ethanol. Changing the temperature of the binding assay, and thus altering the properties of neuronal membrane lipids, resulted in changes in the observed affinity of striatal binding sites for dihydromorphine (DHM), but not for D-Ala2, D-Leu5-enkephalin (ENK). The changes in temperature also differentially altered the response of the two binding sites to ethanol. Two other factors that regulate opiate receptor affinity, Na+ and GTP, also affected the response to ethanol. High concentrations of ethanol were more effective at decreasing receptor affinity for both DHM and ENK when the binding assays were performed in the presence of GTP or Na+. In addition, at 37 degrees C and in the presence of GTP or Na+, DHM binding, but not ENK binding, was significantly inhibited by a low, physiologically attainable concentration of ethanol. Our results suggest that the response of opiate receptors to ethanol is influenced by the microenvironment of the receptors, including the physical state of the membrane lipids and/or by the nature of the interactions of receptors with "coupling proteins" within the membrane. The differential responses of mu and delta receptors to temperature and to ethanol suggest that these receptors reside in specific membrane environments. Under physiological conditions, several different factors may contribute to a selective action of ethanol on particular subtypes of opiate receptors.     

Expression ofRhodopseudomonas sphaeroides carotenoid photopigment genes in phylogenetically related nonphotosynthetic bacteria

The carotenoid photopigment genes of the purple nonsulfur photosynthetic bacteriumRhodospeudomonas sphaeroides have been cloned into the kanamycin resistance transposon Tn5 to create a carotenoid transposon-Tn5-Crt⁺. Transposition of Tn5-Crt⁺ onto the broad host range plasmid pR751 produced a broad host range carotenoid plasmid-pJP115. Transfer of pJP115 to the phylogenetically related nonphotosynthetic bacteriaParacoccus denitrificans, Agrobacterium tumefaciens, Agrobacterium radiobacter, andAzotomonas insolita resulted in carotenoid biosynthesis by these strains. Expression of carotenoid photopigment genes in nonphotosynthetic bacteria lends credence to the evolutionary relationships between photosynthetic and non-photosynthetic bacteria.