Multi-ancestry meta-analysis identifies 5 novel loci for ischemic stroke and reveals heterogeneity of effects between sexes and ancestries

Stroke is the second leading cause of death and disability worldwide. Stroke prevalence varies by sex and ancestry, possibly due to genetic heterogeneity between subgroups. We performed a genome-wide meta-analysis of 16 biobanks across multiple ancestries to study the genetics of ischemic stroke (60,176 cases, 1,310,725 controls) as part of the Global Biobank Meta-analysis Initiative (GBMI) and further combined the results with previously published MegaStroke. Five novel loci for ischemic stroke ( LAMC1 , CALCRL , PLSCR1 , CDKN1A , and SWAP70 ) were identified after replication in four additional datasets. One previously reported locus showed significant ancestry heterogeneity ( ABO ), and one showed significant sex heterogeneity ( ALDH2 ). The ALDH2 association was male specific (males p = 1.67e−24, females p = 0.126) and was additionally observed only in the East Asian ancestry (male) samples. These findings emphasize the need for more diverse datasets with large sample sizes to further understand the genetic predisposition of stroke in different ancestry and sex groups. • Five novel loci associated with ischemic stroke were discovered • Previously reported ABO locus shows significant ancestry heterogeneity • Known association in ALDH2 locus is sex and ancestry specific By combining data from diverse Global Biobank Meta-analysis Initiative (GBMI) and the MegaStroke consortium, Surakka et al. identified five novel loci associated with ischemic stroke and showed that some genetic associations differ between sexes and ancestries. These results highlight the importance of sex- and ancestry-informed investigations in complex disease genetics.