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on August 11, 2005

Stroke. 2005
Published online before print August 11, 2005, doi: 10.1161/01.STR.0000177978.97428.53
A more recent version of this article appeared on September 1, 2005
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Submitted on February 20, 2005
Revised on April 13, 2005
Accepted on May 3, 2005

Promoter Polymorphisms in the Nitric Oxide Synthase 3 Gene Are Associated With Ischemic Stroke Susceptibility in Young Black Women

Timothy D. Howard PhD; Wayne H. Giles MD, MPH; Jianfeng Xu MD, DrPH; Marcella A. Wozniak MD, PhD; Ann M. Malarcher PhD, MSPH; Leslie A. Lange PhD; Richard F. Macko MD; Monica J. Basehore; Deborah A. Meyers PhD; John W. Cole MD; and Steven J. Kittner MD, MPH*

From the Center for Human Genomics (T.D.H., J.X., M.J.B., D.A.M.), Wake Forest University School of Medicine, Winston-Salem, NC; Division of Adult and Community Health (W.H.G., A.M.M.), Centers for Disease Control and Prevention, Atlanta, Ga; Department of Neurology (M.A.W., R.F.M., J.W.C., S.J.K.) and the Department of Epidemiology and Preventive Medicine (S.J.K.), University of Maryland at Baltimore, Md; the Geriatrics Research, Education, and Clinical Center (R.F.M., J.W.C., S.J.K.), Baltimore Department of Veterans Affairs Medical Center, Md; and Department of Genetics (L.A.L.), University of North Carolina, Chapel Hill.

* To whom correspondence should be addressed. E-mail: skittner{at}umaryland.edu.

Background and Purpose--Endothelial nitric oxide exerts a variety of protective effects on endothelial cells and blood vessels, and therefore the nitric oxide synthase 3 gene (NOS3) is a logical candidate gene for stroke susceptibility.

Methods--We used the population-based Stroke Prevention in Young Women case-control study to assess the association of five NOS3 polymorphisms in 110 cases (46% black) with ischemic stroke and 206 controls (38% black), 15 to 44 years of age. Polymorphisms included 3 single nucleotide polymorphisms (SNPs) in the promoter region (-1468 T>A, -922 G>A, -786 T>C), 1 SNP in exon 7 (G894T), and 1 insertion/deletion polymorphism within intron 4.

Results--Significant associations with both the -922 G>A and -786 T>C SNPs with ischemic stroke were observed in the black, but not the white, population. This association was attributable to an increased prevalence of the -922 A allele (OR=3.0, 95% CI=1.3 to 6.8; P=0.005) and the -786 T allele (OR=2.9, 95% CI=1.3 to 6.4; P=0.005) in cases versus controls. These 2 SNPs were in strong linkage disequilibrium (D'=1.0), making it impossible to determine, within the confines of this genetic study, whether 1 or both of these polymorphisms are functionally related to NOS3 expression. Two sets of haplotypes were also identified, 1 of which may confer an increased susceptibility to stroke in blacks, whereas the other appears to be protective.

Conclusion--Promoter variants in NOS3 may be associated with ischemic stroke susceptibility among young black women.


Key words: genetics • nitric oxide • women and minorities • young, stroke in


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