PhD student Centre de recherche de l’Institut universitaire de cardiologie et de pneumologie de Québec (IUCPQ) – Université LavaL, Canada
Background: Individuals with an unfavorable socioeconomic status have a higher risk of developing cardiovascular diseases such as ischemic stroke (IS). However, the contribution of social determinants of health and genetic background on IS risk remains unknown. We investigated the contribution of social determinants of health and a polygenic risk score (PRS) on IS incidence.
METHODS AND RESULTS: We developed a polysocial risk score (PsRS) using latent class analysis based on socioeconomic factors, psychosocial factors and living environment using participants of the UK Biobank (UKB) free of IS (N=331,144). An IS polygenic risk score (PRS) released by the UKB was used for genetic analysis. Participants were divided into tertiles according to their their PsRS and IS-PRS. The impact of the PsRS on incident IS was assessed using Cox proportional hazards for all participants, women and men adjusted for age, sex, ethnicity and a cardiovascular health score (CVHS) based on lifestyle and metabolic health. The joint impact of the PsRS and an IS-PRS on the incidence of IS was also assessed using Cox proportional hazards for all participants, women and men adjusted for age, sex and ethnicity. Compared to participants with a low PsRS, those with a high PsRS had a higher risk of IS (hazard ratio [HR]=1.62 [95% CI, 1.51-1.74], p< 0.001) when adjusted for age, sex and ethnicity. When adding the CVHS in the adjustment, participants with a high PsRS still had a higher risk of IS compared to participants with a low PsRS (HR=1.32 [95% CI, 1.23-1.42], p< 0.001). Compared to participants with a low PsRS in the bottom tertile of IS-PRS, those with a high PsRS in the top tertile of IS-PRS were those at higher IS risk (HR = 2.76 [95% CI: 2.42–3.15], p< 0.001). Consistent results were observed in both females and males.
Conclusion: A PsRS based on the living environment as well as socioeconomic and psychosocial factors was associated with incident IS in participants of the UKB and may influence the impact of genetic susceptibility to IS. Multifactor approaches targeting both social determinants of health and IS risk factors could reduce the burden of cardiovascular disease in the general population.
