C-Reactive Protein as a Prognostic Marker After Lacunar Stroke
Author:
Elkind Mitchell S.V.1, Luna Jorge M.1, McClure Leslie A.1, Zhang Yu1, Coffey Christopher S.1, Roldan Ana1, Del Brutto Oscar H.1, Pretell Edwin Javier1, Pettigrew L. Creed1, Meyer Brett C.1, Tapia Jorge1, White Carole1, Benavente Oscar R.1, Pettigrew Creed, Vaishnav Anand, Sawaya Peter, Fowler Anna, Hughes Nedda, Rice Johnya, Vanderpool Kathy, Meyer Brett, Jackson Christy, Gamble Paul, Kelly Nancy, Warner Janet, Bell Jo, Meissner Irene, Graves John, Herzig Deb, Covalt Jody, Cruz-Flores Salvador, Walden H. Douglas, Holzemer Eve, Coull Bruce, Howard Lien, Malekniazi Mina, VanSkiver Melissa, Bruck Denise, Redman Stacey, Hanna Joseph, Zipp Thomas, Bailey Scott, Cook Dana, Liskay Alice, Simcox Dana, Kappler Joan, Demaerschalk Bart, Hogan Michael, Wochos Daniel, Wieser Judith, Cleary Barbara, Wood Lori, Katramados Angelo, Silver Brian, Yee Jerry, Aiello Krisy, Wilson Kathleen, McCarthy Sharon, Kase Carlos, Gavras Irene, Lau Helena, Ogrodnik Matt, Allen Nancy, Anderson David, Grimm Richard, Brauer Donna, Naritoku Dean, Zweifler Richard, Culpepper Michael, Parnell Mel, Yunker Robin, Boots Kelly, Drinkard Renay, Backlin Rachel, Elkind Mitch, Crew Russell John, Radhakrishan Jai, Corporan Tania E., Diaz Julisa, Aragon Rebeca, Benavente Oscar, Hart Robert, Pergola Pablo, Palacio Santiago, Castro Irma, Farias Arlene, Roldan Ana, Mirsen Tom, McAllister Susan, Bastien Arnaud, Niblack Patricia, Sundararajan Sophia, Rahman Mahboob, Horvath Tom, Korosec David, Murphy Chris, Lutsep Helmi, Girard Don, Seisler Kali, Cingel Megan, Ross Megan, Stone Rachel, Larsen Darren, Doherty Ann, Book Diane, Eapen Sunu, Grimm Clarence, Blaney Barbara, Rozman Stephanie, Gaertner Linda, Bradenburg Erin, Loomis Laura, Monarch-Cotton Jolene, Ravavelli-Meyer Jean, Golembieski Anna, Romano José, Ortiz Gustavo, del Carmen Lichtenberger Maria, Johnson Mark, Liu Yinghui, Goldsteen Robert, Blair April, Wright Gregg, Gathua Naomie, Jacoby Michael, Jones David, DeFrancisco Jeffrey, Hamm Theresa, Burgin Scott W., Hollander Joshua, Polashenski Walter, Wallace Patricia, Weber Cheryl, Greenberg Jason, Lennihan Laura, King Marjorie, Tenteromano Laura, Pereira Lorainne, Ching Marilou, Sawyer Robert, Parkes Kathy, Conover Cheryl, Weinberger Jesse, Wright Lewis, Burch Dorothy, Benesch Curtis, Bisognano John, Leonhardt Ann, Zentner Justine, Hildreth Molly, Karanjia Percy, Murali Narayana, Dart Richard, Mancl Kathleen, Lefkowitz David, Pavel Levy, Buchheimer Nancy, Vaughn Sara, Smith Emily, Satterfield Jean, Van Stavern Renee, Brown Angela, Serna Jannie, Newgent Jill, Naylor Julie, Carpenter Laura, Shuab Ashfaq, Khan Khurshid, Dean Naeen, Herbert Frederika, Kastelic Karen, Atkinson Richard, Lieberman Roger, Carter Teresa, Zrelak Pat, Kenney Nola, Logan William, Carpenter David, Schroer Sally, Berger Leo, Brunet Sylvain, Pontbriand Johanne, Mainville Martine, Racicot Denise, Côté Robert, Green Laurence, Wadup Lisa, Fontaine Anne-Marie, Tapia Jorge, Godoy Ivan Esteban, Valdes Marcela, Matamala Gonzalo, Goecke Helmut, Parra Marcela, Pozo Jessica, del Brutto Oscar, Santibáñez Rocio, Lara Joffre, Zambrano Mauricio, Ruiz Sandoval José Luis, Vásquez Eduardo Salcido, Ruiz Carmen, Arauz Antonio, Cervantes G. Amin, Leyva Adolfo, Camacho Itzel, Pretell Edwin Javier, Valdivia José, Pretell Marissa, Leal Joaquín Serena, Castellanos Mar, Cruz Verónica, Cepeda Mercè, Arboix Adrià, Pelegrí Antoni, Blanco Lorena, Borrego Francisco Rubio, Gudiol Francisco, Gomis Meritxell, Arenillas Juan, Dávalos Antonio, Suñol Ana, Reverté Silvia, Roquer Jaume, Serrano Ana Oliveras, Conde Jordi Jiménez, Rodríguez Ana, Romeral Gemma, Sánchez José Castillo, González Miguel Blanco, Rodríguez Manuel, Jiménez Isabel, Rodríguez Jaime, McClure Leslie, Coffey Christopher, Szychowski Jeff, Howard George, Katholi Charles, Zhang Yu, Peri Kalyani, Allcorn Charles, Mailhot Richard, Irby Lisa, Guyton Fekisha, Sewell Mary Jo, Benavente Oscar, Hart Robert, Pergola Pablo, Roldan Ana, Benavente Marie-France, White Carole, Robu Camilla, Kelly Che, Talbert Robert, Martinez Eduardo, Bazan Carlos, Pergola Gabriela, Pearce Lesly, Costello Raymond, Jacova Claudia, Camelia Luisa, Mendoza Crystal, Pratt Brandy, Holliday Steve, Elkind Mitchell S.V., Luna Jorge, , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , ,
Affiliation:
1. From the Department of Neurology, College of Physicians and Surgeons (M.S.V.E., J.M.L.), Department of Epidemiology, Mailman School of Public Health (M.S.V.E., J.M.L.), and Gertrude H. Sergievsky Center (M.S.V.E.), Columbia University, New York, NY; Department of Biostatistics, University of Alabama at Birmingham, Birmingham, AL (L.A.M., Y.Z.); Department of Biostatistics, University of Iowa, Iowa City, IA (C.S.C.); Department of Neurology, University of Texas at Houston, Houston, TX (A.R.); School...
Abstract
Background and Purpose—
Inflammatory biomarkers predict incident and recurrent cardiac events, but their relationship to stroke prognosis is uncertain. We hypothesized that high-sensitivity C-reactive protein (hsCRP) predicts recurrent ischemic stroke after recent lacunar stroke.
Methods—
Levels of Inflammatory Markers in the Treatment of Stroke (LIMITS) was an international, multicenter, prospective ancillary biomarker study nested within Secondary Prevention of Small Subcortical Strokes (SPS3), a phase III trial in patients with recent lacunar stroke. Patients were assigned in factorial design to aspirin versus aspirin plus clopidogrel, and higher versus lower blood pressure targets. Patients had blood samples collected at enrollment and hsCRP measured using nephelometry at a central laboratory. Cox proportional hazard models were used to calculate hazard ratios (HRs) and 95% confidence intervals (95% CIs) for recurrence risks before and after adjusting for demographics, comorbidities, and statin use.
Results—
Among 1244 patients with lacunar stroke (mean age, 63.3±10.8 years), median hsCRP was 2.16 mg/L. There were 83 recurrent ischemic strokes (including 45 lacunes) and 115 major vascular events (stroke, myocardial infarction, and vascular death). Compared with the bottom quartile, those in the top quartile (hsCRP >4.86 mg/L) were at increased risk of recurrent ischemic stroke (unadjusted HR, 2.54; 95% CI, 1.30–4.96), even after adjusting for demographics and risk factors (adjusted HR, 2.32; 95% CI, 1.15–4.68). hsCRP predicted increased risk of major vascular events (top quartile adjusted HR, 2.04; 95% CI, 1.14–3.67). There was no interaction with randomized antiplatelet treatment.
Conclusions—
Among recent lacunar stroke patients, hsCRP levels predict the risk of recurrent strokes and other vascular events. hsCRP did not predict the response to dual antiplatelets.
Clinical Trial Registration—
URL:
http://www.clinicaltrials.gov
. Unique identifier: NCT00059306.
Publisher
Ovid Technologies (Wolters Kluwer Health)
Subject
Advanced and Specialised Nursing,Cardiology and Cardiovascular Medicine,Clinical Neurology
Cited by
76 articles.
订阅此论文施引文献
订阅此论文施引文献，注册后可以免费订阅5篇论文的施引文献，订阅后可以查看论文全部施引文献
|
|