Plasma concentrations of C-reactive protein and fibrinogen in ischaemic stroke

Insulin Resistance and Risk of Cerebral Infarction in a Japanese General Population

The aim of the study was to investigate the relation between insulin resistance and risk of cerebral infarction in a Japanese general population. The subjects were 2610 men and women without past history of stroke or myocardial infarction and who were under treatment for diabetes. Subjects were divided into quartiles by the homeostasis model assessment of insulin resistance (HOMA-IR), and Cox’s proportional hazard model was used to calculate hazard ratios (HRs) for cerebral infarction. In men, the multivariate-adjusted HRs were 2.51 (95% confidence interval [CI] = 0.98-6.42) in quartile 1 (Q1), 1.43 (95% CI = 0.54-3.82) in Q2, and 2.13 (95% CI = 0.82-5.51) in Q4, using Q3 as the reference. In women, the multivariate-adjusted HRs were 2.12 (95% CI = 0.72-6.31) in Q1, 2.96 (95% CI = 1.06-8.26) in Q3, and 2.31 (95% CI = 0.80-6.69) in Q4, using Q2 as the reference. The association between risk of cerebral infarction and HOMA-IR was not dose dependent.

Biomarkers and functional outcomes from ischaemic cerebral events in women: a prospective cohort study

BACKGROUND AND PURPOSE

Several biomarkers have been associated with an increased risk of ischaemic stroke. However, the association between these biomarkers and functional outcome from cerebral ischaemic events is unclear. We aimed to assess the patterns of association between cardiovascular disease biomarkers and functional outcomes after incident ischaemic cerebral events in women.

METHODS

Prospective cohort study of 27,728 women enrolled in the Women's Health Study who provided information on blood samples and were free of stroke or transient ischaemic attack (TIA) at baseline. Multinomial logistic regression was used to determine the association between elevated biomarker levels and functional outcomes from ischaemic cerebral events. Possible functional outcomes included TIA and ischaemic stroke with modified Rankin Scale (mRS) score of 0-1, 2-3, or 4-6.

RESULTS

After a mean follow-up of 15.1 years, 461 TIAs and 380 ischaemic strokes occurred. Elevated levels of total cholesterol were associated with the highest risk of poor functional outcome (mRS 4-6) after incident cerebral ischaemic events (relative risk = 2.02, 95% CI = 1.18-3.46). We observed significant associations between elevated levels of total cholesterol, Lp(a), C-reactive protein, and triglycerides, and mild or moderate functional outcomes after ischaemic cerebral events. Elevations in all other biomarkers were not significantly associated with functional outcomes.

CONCLUSIONS

Whilst total cholesterol level was associated with highest risks of poor functional outcome after stroke, we overall observed an inconsistent pattern of association between biomarkers linked with an increased risk of vascular events and more impaired functional outcomes from stroke.

Serum high-sensitivity C-reactive protein and heat shock protein 27 antibody titers in patients with stroke and 6-month prognosis

Serum heat shock protein 27 immunoglobulin G (IgG) antibody titers (anti-HSP27) and high-sensitivity C-reactive protein (hsCRP) concentrations were measured in samples from 168 patients in the first 24 hours after the onset of stroke and 80 age-and sex-matched control participants. In patients with stroke, median serum anti-HSP27 titer was significantly higher than that of the control group (0.18 [0.14-0.28] vs 0.08 [0.04-0.12], P < .001). Median serum hsCRP concentration was also significantly higher in patients compared with the control group (11.43 [8.07-13.53] vs 3.23 [1.66-6.24], P < .001). Serum anti-HSP27 and hsCRP concentrations did not differ significantly among patients with different stroke types. Neither serum anti-HSP27 nor hsCRP levels predicted 6-month prognosis in the patients with stroke. We conclude that serum anti-HSP27 titers and hsCRP concentrations are elevated in patients with stroke but do not distinguish between stroke types or predict 6-month prognosis.

Valor predictivo de la lipoproteína (a) y la apolipoproteína A1 en pacientes con obstrucción coronaria valorada angiográficamente

BACKGROUND AND OBJECTIVE

To examine the relationship between blood levels of lipids, hemostatic and inflammatory markers and the presence of angiographycally evaluated coronary stenosis.

PATIENTS AND METHOD

We included 397 consecutive patients (267 males and 130 females) who were admitted to the hospital because of an acute episode of chest pain. Each patient underwent a coronariography using the Seldinger technique. A blood sample was drawn to analyze lipids -total cholesterol, high density lipoproteins-cholesterol (HDLc), triglycerides, low density lipoproteins-cholesterol (LDLc), apolipoprotein A1, apolipoprotein B100, lipoprotein (a)-, hemostatic (fibrinogen, D-dimmer), and inflammatory (C-reactive protein, leukocyte count) markers. To evaluate the differences between mean values of quantitative variables, the Student's t-test was used for parametric variables and the Mann Whitney U test for non-parametric variables. Categorical variables were compared using the chi-square test. A logistic regression analysis was employed to determine the influence of high levels of the studied parameters on the presence of coronary obstruction.

RESULTS

295 patients had coronary stenosis (group 1) and 102 had not a significant obstruction (group 2). Patients with coronary stenosis had higher values of lipoprotein (a), D-dimmer, C-reactive protein and leukocyte count and lower HDLc, apolipoprotein A1 and total cholesterol. When markers were dichotomized in high values (fourth quartile) and low (first-third quartile), high lipoprotein (a) (odds ratio [OR] = 2.508; 95% confidence interval [CI], 1.222-5.145) and apolipoprotein A1 levels (OR = 0.472; 95% CI, 0.267-0.837) were significant using the multivariate logistic regression model adjusted sex, tobacco and age.

CONCLUSIONS

Among patients undergoing coronary angiography, high lipoprotein (a) levels are independently associated with the presence of coronary obstruction whereas high apolipoprotein A1 values show a protective effect.

Evidence of hypercoagulability and inflammation in young patients long after acute cerebral ischaemia

INTRODUCTION

Young subjects with acute cerebral ischaemia - stroke or transient ischaemic attack - form an etiologically heterogeneous and often not clearly explained group of patients. The aim was to investigate possible disturbances in haemostasis and inflammation long after an acute cerebral ischaemic event.

MATERIALS AND METHODS

Forty-four consecutive patients referred after having suffered from acute cerebral ischaemia before the age of 45 participated 1 to 9 years (median value 5 years) after the event. At the time of blood sampling 33 (75%) patients were receiving antithrombotic treatment. Forty-six apparently healthy subjects of the same age group served as controls. In all subjects global haemostasis parameters (overall haemostasis, coagulation and fibrinolytic potential), thrombophilia, several markers of haemostasis activation and inflammation were determined.

RESULTS

Patients did not differ from controls in most of the conventional risk factors and the presence of most forms of thrombophilia, although in seven (17.5%) patients the weak presence of lupus anticoagulants was observed. Patients had significantly increased overall haemostasis and coagulation potential, increased soluble P-selectin and D-dimer, decreased overall fibrinolysis potential and increased fibrinogen and C-reactive protein compared to controls. The subgroups of patients receiving antiplatelet treatment, with thrombophilia and recurrent acute cerebral ischaemia, did not differ significantly from the other patients.

CONCLUSIONS

In young patients long after acute cerebral ischaemia an imbalance in the haemostatic system and a minor, but significant degree of inflammation was detected. The mechanisms behind haemostatic imbalance seem to be enhanced thrombin generation, platelet activation and depressed fibrinolysis.

Increased plasma fibrinogen predicts one-year mortality in patients with acute ischemic stroke

BACKGROUND AND PURPOSE

Increased plasma fibrinogen is a risk factor for vascular diseases related to atherosclerosis. Its long-term predictive value in stroke survivors is not established. We conducted this study to establish the significance of hyperfibrinogenemia as the possible predictor of 30-day and one-year mortality in patients with acute ischemic stroke.

METHODS

We studied 900 unselected patients with ischemic stroke admitted to the hospital within 24 h after onset of symptoms. We noted demographic data, risk factors for stroke, neurological deficit and disturbances of consciousness on admission. We measured plasma concentration of fibrinogen and the body temperature on day 1 and registered vital status at 1, 3, 6 and 12 months after stroke.

RESULTS

Mean concentration of plasma fibrinogen was 2.9 g/L and 25.2% of patients had increased plasma concentration of fibrinogen (i.e. > or = 3.5 g/L) on day 1. Patients with hyperfibrinogenemia were more likely to die after 1, 3, 6 and 12 months than those with normal plasma fibrinogen (21.1% vs. 15.6%, 36.4% vs. 24.6%, 42.6% vs. 27.3%, 45.7% vs. 31.2%, respectively; P < 0.001 for the last three differences). Hyperfibrinogenemia did not predict short-term case-fatality, but increased concentration of plasma fibrinogen was an independent predictor of one-year case-fatality (P = 0.013; OR: 1.69 (95% CI 1.12-2.55)). Other independent predictors of one-year case-fatality were: neurological deficit on admission, age, white blood cell count, and body temperature on day 1.

CONCLUSIONS

Increased concentration of plasma fibrinogen shortly after ischemic stroke independently increases risk of death within one year after stroke.

Evaluation of C-Reactive Protein Measurement for Assessing the Risk and Prognosis in Ischemic Stroke

Background and Purpose— Several studies have shown, in different populations, that modest elevation of plasma C-reactive protein (CRP) in the range seen in apparently healthy individuals is a strong predictor of future vascular events. Elevated plasma CRP concentrations are also associated with an increased risk of cerebrovascular events and an increased risk of fatal and nonfatal cardiovascular events in ischemic stroke patients. These epidemiological and clinical observations suggest that determination of plasma CRP concentrations could be used as an adjunct for risk assessment in primary and secondary prevention of cerebrovascular disease and be of prognostic value. The aim of this review is to summarize the evidence for CRP as an independent predictor of cerebrovascular events in at-risk individuals and ischemic stroke patients and to consider its usefulness in evaluating prognosis after stroke.

Summary of Review— CRP fulfils most of the requirements of a new risk and prognostic predictor, but several issues await further confirmation and clarification before this marker can be included in the routine evaluation of stroke patients and subjects at risk for cerebrovascular disease. Potentially important associations have been established between elevated plasma CRP concentrations and increased efficacy of established therapies, particularly lipid-lowering therapy with statins.

Conclusion— At present, there is not sufficient evidence to recommend measurement of CRP in the routine evaluation of cerebrovascular disease risk in primary prevention, because there is insufficient evidence as to whether early detection, or intervention based on detection, improves health outcomes, although shared risk of cardiovascular disease indicates this may be of value. In secondary prevention of stroke, elevated CRP adds to existing prognostic markers, but it remains to be established whether specific therapeutic options can be derived from this.

Association between inflammation and hemostatic markers in atherothrombotic stroke

INTRODUCTION

It has been reported that the influence of fibrinogen on the incidence of ischemic events is related to inflammation processes and reflects an association with advance atherosclerosis. The aim of this study was to evaluate the association of thrombogenic and inflammatory profiles in patients who have suffered a stroke.

MATERIALS AND METHODS

The study involved 17 patients with atherothrombotic stroke and 34 healthy subjects as control group. The patients were examined 48 h, 3 and 6 months after the stroke occurred. To determine the inflammatory and thrombogenic profiles, plasma levels of fibrinogen, total sialic acid (TSA), C-reactive protein (CRP), tissue factor (TF) and fibrin D-dimer (D-dimer) were measured.

RESULTS

The study showed that at 48 h and 3 months the levels of fibrinogen, TF, D-dimer, TSA and CRP were significantly higher than control group. TF, D-dimer and TSA remains significantly elevated throughout the entire study period. TF and D-dimer decreased over time without reaching the normal values. The multiple regression analysis showed that, at 48 h, 68% of the variance of fibrinogen and 22% of the variance of TF could be explained by the influence of CRP. At 3 and 6 months, 78% of the variance of fibrinogen could be explained by the influence of TSA.

CONCLUSIONS

The results suggest a relation among inflammation markers, fibrinogen and TF in the acute phase of stroke. As TF and D-dimer are still elevated at 6 months, an increased thrombogenicity for a longer period following the acute event is present.