Background and Purpose
Functional polymorphisms (Ser49Gly and Arg389Gly) in ADRB1 have been associated with cardiovascular and β-blocker response outcomes. Herein we examined associations of these polymorphisms with Major Adverse Cardiovascular Events (MACE), with and without stratification by β-blocker treatment in patients with a history of stroke.
Methods
926 participants of the Secondary Prevention of Small Subcortical Strokes (SPS3) trial’s genetic substudy with hypertension were included. MACE included stroke, myocardial infarction, and all-cause death. Kaplan-Meier and multivariable Cox regression analyses were used. Because the primary component of MACE was ischemic stroke, we tested the association of Ser49Gly with ischemic stroke among 41,475 individuals of European and African ancestry in the NINDS Stroke Genetics Network (SiGN).
Results
MACE was higher in carriers of the Gly49 allele than those with the Ser49Ser genotype (10.5% vs. 5.4%, log-rank p=0.005). Gly49 carrier status was associated with MACE (HR 1.62; 95% CI 1.00–2.68) and ischemic stroke (HR 1.81; 95% CI 1.01–3.23) in SPS3 and with small artery ischemic stroke (OR 1.14; 95% CI 1.03–1.26) in SiGN. In SPS3, β-blocker-treated Gly49 carriers had increased MACE versus non-β-blocker-treated individuals and non-carriers (HR 2.03; 95% CI 1.20–3.45). No associations were observed with the Arg389Gly polymorphism.
Conclusion
Among individuals with previous small artery ischemic stroke, the ADRB1 Gly49 polymorphism was associated with MACE, particularly small artery ischemic stroke, a risk that may be increased among β-blocker-treated individuals. Further research is needed to define β-blocker benefit among ischemic stroke patients by ADRB1 genotype.
Clinical Trial Registration-URL
http://www.clinicaltrials.gov. Unique identifier: NCT00059306.