Objective To investigate whether telomere length shortening in blood leukocytes contributes to the risk of post-stroke prognosis in a large prospective cohort of patients with first onset stroke in Chinese population.
Methods Patients with first onset stroke within 21 days of an acute event were recruited from December 2000 to December 2001 from seven clinical centers. Peripheral venous blood sample was collected at recruitment. The present study included 1662 stroke patients(725 cerebral atherothrombosis, 481 lacunar infarction, and 456 intracerebral hemorrhage). Relative telomere length in blood leukocytes was measured by a quantitative real-time polymerase chain reaction(PCR)-based technique. Cox proportional hazards models were used to examine the association between telomere length and post-stroke all-cause death or cardio-cerebrovascular death.
Results Stroke patients were prospectively followed up for median 4.5 years, and 312 deaths(of which 181 deaths caused by fatal stroke or coronary heart disease) were documented. After adjustment for age, gender, body mass index, smoking, alcohol intake, dyslipidemia, fasting glucose, diabetes, family history of stroke, and hypertension, results showed that atherothrombotic stroke patients with shorter telomeres had 69% increased risk(adjusted relative risk[adj.RR]1.69, 95% confidence interval[CI] 1.07~2.67; P=0.02) for post-stroke all-cause death, and 2.57-fold risk for cardio-cerebrovascular death(adj.RR 2.57, 95%CI 1.24~5.31; P=0.01) in comparison of the lowest to highest tertile. In the follow-up patients with lacunar infarction or hemorrhagic stroke, shorter telomere length was not related to the risk of all-cause death(adj.RR 1.14, 95%CI 0.59~2.18, P=0.35; adj.RR 0.92, 95%CI 0.57~1.50, P=0.59, respectively), and cardio-cerebrovascular death(adj.RR 1.95, 95%CI 0.76~4.97, P=0.24; adj.RR 1.06, 95%CI 0.59~1.89, P=0.56, respectively).
Conclusion Shorter telomere length in blood leukocytes may serve as a potential marker for the risk of cardio-cerebrovascular death for patients with first onset cerebral atherothrombotic stroke.
