As illustrated in Fig. 2, the IVW analysis with multiplicative random effects model demonstrated that genetically determined ICAM-4 levels were positively associated with the risks of ischemic stroke (OR per SD [standard deviation] increase: 1.04; 95% CI: 1.01–1.07; P = 0.006) and CES (OR per SD increase: 1.08; 95% CI: 1.02–1.14; P = 0.004). This evidence concerns the gene ICAM4 and ischemic stroke.