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Mitchell S. V. Elkind, MD, MS; Wanling Tai, BS; Kristen Coates, BS; Myunghee C. Paik, PhD; Ralph L. Sacco, MD, MS

Arch Intern Med. 2006;166:2073-2080.

Background  Inflammatory markers have been associated with ischemic stroke risk and prognosis after cardiac events. Their relationship to prognosis after stroke is unsettled.

Methods  A population-based study of stroke risk factors in 467 patients with first ischemic stroke was undertaken to determine whether levels of high-sensitivity C-reactive protein (hs-CRP) and lipoprotein-associated phospholipase A₂ (Lp-PLA2) predict risk of stroke recurrence, other vascular events, and death.

Results  Levels of Lp-PLA2 and hs-CRP were weakly correlated (r = 0.09; P = .045). High-sensitivity CRP, but not Lp-PLA2, was associated with stroke severity. After adjusting for age, sex, race and ethnicity, history of coronary artery disease, diabetes mellitus, hypertension, hyperlipidemia, atrial fibrillation, smoking, and hs-CRP level, compared with the lowest quartile of Lp-PLA2, those in the highest quartile had an increased risk of recurrent stroke (adjusted hazard ratio, 2.08; 95% confidence interval, 1.04-4.18) and of the combined outcome of recurrent stroke, MI, or vascular death (adjusted hazard ratio, 1.86; 95% confidence interval, 1.01-3.42). After adjusting for confounders, hs-CRP was not associated with risk of recurrent stroke or recurrent stroke, myocardial infarction, or vascular death but was associated with risk of death (adjusted hazard ratio, 2.11; 95% confidence interval, 1.18-3.75).

Conclusions  Inflammatory markers are associated with prognosis after first ischemic stroke and may offer complementary information. Lipoprotein-associated phospholipase A₂ may be a stronger predictor of recurrent stroke risk. Levels of hs-CRP, an acute-phase reactant, increase with stroke severity and may be associated with mortality to a greater degree than recurrence.

Author Affiliations: Department of Neurology (Drs Elkind and Sacco and Ms Coates) and Sergievsky Center (Drs Elkind and Sacco), College of Physicians and Surgeons, and Divisions of Biostatistics (Mr Tai and Dr Paik) and Epidemiology (Dr Sacco), Joseph P. Mailman School of Public Health, Columbia University; and the Columbia-Presbyterian Medical Center of New York Presbyterian Hospital (Drs Elkind and Sacco and Ms Coates), New York, NY.