O10 Ischemic stroke subtypes in SLE-associations with a STAT4 risk genotype

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Objective Ischemic stroke is 2–3 times more common among SLE patients than in the general population, but it unknown if certain subtypes of stroke are more common in SLE patients, nor if stroke subtypes are associated with the susceptibility gene, STAT4, which we previously reported to be associated with stroke among patients with SLE. We investigated the distribution of ischemic stroke subtypes, classified according to the Trial of Org 10172 in Acute Stroke Treatment (TOAST) system,1 among patients with SLE. Genetic susceptibility in the signal transducer and activator of transcription factor 4 (STAT4) gene, defined by the single nucleotide polymorphism (SNP) rs10181656(G) was explored. Methods We identified 69/665 SLE patients with stroke in this multicenter study. Medical charts were retrieved and brain, cardiac and vascular imaging at the time of stroke were examined. Classification was performed according to TOAST: large-artery atherosclerosis (LAA), cardioembolism (CE), small-artery occlusion (SAO), stroke of other determined etiology (OC) and stroke of undetermined etiology (UE). Occurrence of the antiphospholipid syndrome (APS) was documented. Evaluators were blinded to genotypes. General population controls and SLE patients free from previous cerebrovascular disease were comparators. Results 56/69 patients with ischemic stroke had charts with sufficient information for TOAST classification. Median age was 52 (Range 17–84) years, 91% were female. All strokes classified as OC were attributed to APS, and this group was younger at first stroke, 42 years (p= p=0.003). TOAST classification is presented in table 1. Stroke of OE/APS and CE origin were associated with the STAT4 risk genotype as presented in table 1, figure 1. Conclusion Most ischemic strokes among SLE patients were of APS or CE origin. These two subtypes were associated with genetic susceptibility in the STAT4 gene. Patients with APS associated strokes were remarkably young. STAT4 genotype could, in addition to antiphospholipid antibodies and echocardiography, add information about stroke risk and help identify patients who will benefit from prophylactic anticoagulation treatment. Reference Adams HP, et al. Classification of subtype of acute ischemic stroke. Definitions for use in a multicenter clinical trial. TOAST. Trial of Org 10172 in Acute Stroke Treatment. Stroke. 1993;24(1):35–41.

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