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Huang J, Lu K, Xie D, Dong S, Zhu F, Lu B, Liu A. Correlation between plasma lipoprotein-associated phospholipase A2 levels and risk of ischaemic stroke recurrence by gender in the Chinese population. Neurol Res 2024; 46:679-689. [PMID: 38602308 DOI: 10.1080/01616412.2024.2340886] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/30/2023] [Accepted: 04/04/2024] [Indexed: 04/12/2024]
Abstract
OBJECTIVE To investigate the correlation between gender differences in plasma lipoprotein phospholipase A2 (Lp-PLA2) levels and the risk of recurrent stroke in patients with acute ischaemic stroke in China. METHODS We conducted a prospective follow-up study that included baselineLp-PLA2 levels and NIH Stroke Scale (NIHSS) scores in patients with ischaemic stroke upon admission. The diagnostic efficacy of the baseline Lp-PLA2 level for stroke recurrence was evaluated. And Kaplan‒Meier method was used to analyse the difference in the risk of recurrent stroke between these two groups among males and females. A paired t test was used to analyse the difference in Lp-PLA2 levels in male and female patients after follow-up. RESULTS Baseline plasma Lp-PLA2 was higher in men and women with recurrent stroke than in those without recurrent stroke. The correlation between baseline Lp-PLA2 and neurological impairment was higher in female than male stroke patients (R = 0.338 and 0.253, respectively). Although weakly correlated with neurological impairment, baseline Lp-PLA2 was more effective in predicting recurrent stroke (AUC = 0.705 in men, 0.788 in women). A Cox model was used to compare the risk of stroke between the high- and low-Lp-PLA2 groups (OR = 3.98 in men, 2.61 in women). According to the follow-up time of 6 months as the node, Lp-PLA2 will give different risk indicators. CONCLUSION Elevated plasma Lp-PLA2 is an independent risk factor for recurrent ischaemic stroke but is not strongly associated with the degree of cerebral damage. The predictive value of baseline Lp-PLA2 for stroke recurrence risk was higher in females than in males.
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Affiliation(s)
- Jie Huang
- Department of Clinical Laboratory, The Second People's Hospital of Foshan, Foshan, Guangdong, China
| | - Kunjie Lu
- Department of Clinical Laboratory, The First People's Hospital of Foshan, Foshan, Guangdong, China
| | - Dongde Xie
- Department of Clinical Laboratory, The Second People's Hospital of Foshan, Foshan, Guangdong, China
| | - Shaowen Dong
- Department of Clinical Laboratory, The Second People's Hospital of Foshan, Foshan, Guangdong, China
| | - Fangge Zhu
- Beijing Institute of Brain Disorders, Capital Medical University, Bejing, China
| | - Bingxian Lu
- Beijing Institute of Brain Disorders, Capital Medical University, Bejing, China
| | - Anqi Liu
- Department of Clinical Laboratory, The Second People's Hospital of Foshan, Foshan, Guangdong, China
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Schrenk D, Bignami M, Bodin L, del Mazo J, Grasl‐Kraupp B, Hogstrand C, Hoogenboom L(R, Leblanc J, Nebbia CS, Nielsen E, Ntzani E, Petersen A, Sand S, Schwerdtle T, Vleminckx C, Wallace H, Alexander J, Goldbeck C, Grob K, Gómez Ruiz JÁ, Mosbach‐Schulz O, Binaglia M, Chipman JK. Update of the risk assessment of mineral oil hydrocarbons in food. EFSA J 2023; 21:e08215. [PMID: 37711880 PMCID: PMC10498375 DOI: 10.2903/j.efsa.2023.8215] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 09/16/2023] Open
Abstract
Mineral oil hydrocarbons (MOH) are composed of saturated hydrocarbons (MOSH) and aromatic hydrocarbons (MOAH). Due to the complexity of the MOH composition, their complete chemical characterisation is not possible. MOSH accumulation is observed in various tissues, with species-specific differences. Formation of liver epithelioid lipogranulomas and inflammation, as well as increased liver and spleen weights, are observed in Fischer 344 (F344) rats, but not in Sprague-Dawley (SD) rats. These effects are related to specific accumulation of wax components in the liver of F344 rats, which is not observed in SD rats or humans. The CONTAM Panel concluded that F344 rats are not an appropriate model for effects of MOSH with wax components. A NOAEL of 236 mg/kg body weight (bw) per day, corresponding to the highest tested dose in F344 rats of a white mineral oil product virtually free of wax components, was selected as relevant reference point (RP). The highest dietary exposure to MOSH was estimated for the young population, with lower bound-upper bound (LB-UB) means and 95th percentiles of 0.085-0.126 and 0.157-0.212 mg/kg bw per day, respectively. Considering a margin of exposure approach, the Panel concluded that the present dietary exposure to MOSH does not raise concern for human health for all age classes. Genotoxicity and carcinogenicity are associated with MOAH with three or more aromatic rings. For this subfraction, a surrogate RP of 0.49 mg/kg bw per day, calculated from data on eight polycyclic aromatic hydrocarbons, was considered. The highest dietary exposure to MOAH was also in the young population, with LB-UB mean and 95th percentile estimations of 0.003-0.031 and 0.011-0.059 mg/kg bw per day, respectively. Based on two scenarios on three or more ring MOAH contents in the diet and lacking toxicological information on effects of 1 and 2 ring MOAH, a possible concern for human health was raised.
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Ridker PM, Rifai N, MacFadyen J, Glynn RJ, Jiao L, Steg PG, Miller M, Brinton EA, Jacobson TA, Tardif JC, Ballantyne CM, Mason RP, Bhatt DL. Effects of Randomized Treatment With Icosapent Ethyl and a Mineral Oil Comparator on Interleukin-1β, Interleukin-6, C-Reactive Protein, Oxidized Low-Density Lipoprotein Cholesterol, Homocysteine, Lipoprotein(a), and Lipoprotein-Associated Phospholipase A2: A REDUCE-IT Biomarker Substudy. Circulation 2022; 146:372-379. [PMID: 35762321 DOI: 10.1161/circulationaha.122.059410] [Citation(s) in RCA: 53] [Impact Index Per Article: 26.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/24/2023]
Abstract
BACKGROUND REDUCE-IT (Reduction of Cardiovascular Events With Icosapent Ethyl-Intervention Trial) reported a 25% relative risk reduction in major adverse cardiovascular events with use of icosapent ethyl compared with pharmaceutical grade mineral oil. The mechanisms underlying this benefit remain uncertain. We explored whether treatment allocation in REDUCE-IT might affect a series of biomarkers in pathways known to associate with atherosclerosis risk. METHODS Serum levels of interleukin-1β, interleukin-6, high-sensitivity C-reactive protein, oxidized low-density lipoprotein cholesterol, homocysteine, lipoprotein(a), and lipoprotein-associated phospholipase A2 (Lp-PLA2) were measured at baseline, at 12 months, at 24 months, and at the end-of-study visit among REDUCE-IT participants with triglyceride levels ≥135 mg/dL and <500 mg/dL who were randomly allocated to treatment with either 4 grams daily of icosapent ethyl or mineral oil used as a comparator. RESULTS At baseline, median levels of each biomarker were similar in the 2 treatment groups. The levels of biomarkers associated with atherosclerosis increased over time among those allocated to mineral oil treatment; in this group at 12 months, the median percent increases from baseline were 1.5% for homocysteine, 2.2% for lipoprotein(a), 10.9% for oxidized low-density lipoprotein cholesterol, 16.2% for interleukin-6, 18.5% for lipoprotein-associated phospholipase A2, 21.9% for high-sensitivity C-reactive protein, and 28.9% for interleukin-1β (all P values <0.001), with similar changes at 24 months. In the icosapent ethyl group, there were minimal changes in these biomarkers at 12 and 24 months. As such, at study conclusion, between-group treatment differences largely reflected increases in the mineral oil group with median percent differences of 2.4% for lipoprotein(a), 3.0% for homocysteine, 4.2% for oxidized low-density lipoprotein cholesterol, 19.8% for interleukin-6, 26.2% for Lp-PLA2, 38.5% for high-sensitivity C-reactive protein, and 48.7% for interleukin-1β (all P values ≤0.007). These data are consistent with previous REDUCE-IT results in which the median percent change for low-density lipoprotein cholesterol at 12 months was -1.2% among those allocated to icosapent ethyl and 10.9% among those allocated to the mineral oil comparator. CONCLUSIONS Among participants in REDUCE-IT, allocation to icosapent ethyl had minimal effects on a series of biomarkers associated with atherosclerotic disease, whereas levels increased among those allocated to mineral oil. The effect of these findings on interpretation of the overall risk reductions in clinical events observed within REDUCE-IT is uncertain. REGISTRATION URL: https://www. CLINICALTRIALS gov; Unique identifier: NCT01492361.
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Affiliation(s)
- Paul M Ridker
- Brigham and Women's Hospital, Boston, MA (P.M.R., J.M., R.J.G., R.P.M., D.L.B.)
| | - Nader Rifai
- Children's Hospital Medical Center, Boston, MA (N.R.)
| | - Jean MacFadyen
- Brigham and Women's Hospital, Boston, MA (P.M.R., J.M., R.J.G., R.P.M., D.L.B.)
| | - Robert J Glynn
- Brigham and Women's Hospital, Boston, MA (P.M.R., J.M., R.J.G., R.P.M., D.L.B.)
| | | | - Ph Gabriel Steg
- Université de Paris, FACT and INSERM-U1148, F75018 and Assistance Publique-Hôpitaux de Paris, Hôpital Bichat, France (P.G.S.)
| | - Michael Miller
- University of Maryland School of Medicine, Baltimore (M.M.)
| | | | | | | | | | - R Preston Mason
- Brigham and Women's Hospital, Boston, MA (P.M.R., J.M., R.J.G., R.P.M., D.L.B.)
| | - Deepak L Bhatt
- Brigham and Women's Hospital, Boston, MA (P.M.R., J.M., R.J.G., R.P.M., D.L.B.)
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Ruscica M, Sirtori CR, Carugo S, Calder PC, Corsini A. OMEGA-3 AND CARDIOVASCULAR PREVENTION – IS THIS STILL A CHOICE? Pharmacol Res 2022; 182:106342. [DOI: 10.1016/j.phrs.2022.106342] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/24/2022] [Revised: 07/01/2022] [Accepted: 07/01/2022] [Indexed: 02/07/2023]
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Wang Y, Liu G, Song H, Cao C, Ji X, Cao G. Elevated Lipoprotein-Associated Phospholipase A2 Is Associated With Intracranial Atherosclerosis. Front Neurol 2022; 13:858302. [PMID: 35756924 PMCID: PMC9226299 DOI: 10.3389/fneur.2022.858302] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/19/2022] [Accepted: 05/02/2022] [Indexed: 11/13/2022] Open
Abstract
Background Lipoprotein-associated phospholipase A2 (Lp-PLA2) is an inflammatory factor in the pathogenesis of atherosclerotic plaque and is associated with an increased risk of ischemic stroke. Whether Lp-PLA2 is associated with stenosis subtypes in acute ischemic stroke (AIS) has not been investigated. Methods A total of 126 eligible AIS patients were divided into four groups: (1) no cerebral artery stenosis (NCS); (2) intracranial artery stenosis (ICAS); (3) extracranial artery stenosis (ECAS); and (4) combined intracranial and extracranial artery stenosis (IECS). Associations between serum Lp-PLA2 levels and the stenosis subtypes were assessed. Results The ICAS group had a lower frequency of dyslipidemia as compared to the NCS group and the IECS group (35.3% vs. 70% vs. 71.8%, respectively, p = 0.001) and was more likely to be symptomatic than the ECAS group (76.5% vs. 43.8%, respectively, p = 0.014). Lp-PLA2 levels in the ICAS group were 112.2 ± 66.8 μg/L which are, higher than those in the NCS, ECAS, and IECS groups (81.7 ± 38.5, 106.1 ± 57.8, 89.3 ± 52.2 μg/L, respectively, p = 0.025). In the third and fourth quartiles of Lp-PLA2 levels, stenosis had occurred more frequently in the ICAS group than in the other three groups (third Q: 50.0% vs. 3.1% vs. 28.1% vs. 18.8%, p = 0.002; fourth Q: 48.4% vs. 16.1% vs. 25.8% vs. 9.7%, p = 0.014). Lp-PLA2 levels were higher in patients with more or severe stenosis in the ICAS group. Conclusions Elevated Lp-PLA2 levels were differentially associated with increased risk in AIS patients with ICAS compared to those with ECAS or no stenosis. Lp-PLA2 may be a promising biomarker and potential therapeutic target for ICAS.
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Affiliation(s)
- Yuan Wang
- Department of Neurology, Xuanwu Hospital, Capital Medicine University, Beijing, China
| | - Gang Liu
- Department of Neurology, Xuanwu Hospital, Capital Medicine University, Beijing, China
| | - Haiqing Song
- Department of Neurology, Xuanwu Hospital, Capital Medicine University, Beijing, China
| | - Catherine Cao
- Department of Neurology, University of Pittsburgh, Pittsburgh, PA, United States
| | - Xunming Ji
- Department of Neurosurgery, Xuanwu Hospital, Capital Medicine University, Beijing, China
| | - Guodong Cao
- Department of Neurology, University of Pittsburgh, Pittsburgh, PA, United States.,Geriatric Research Education and Clinical Center, VA Pittsburgh Healthcare System, Pittsburgh, PA, United States
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Wang X, Wang J, Wu S, Ni Q, Chen P. Association Between the Neutrophil Percentage-to-Albumin Ratio and Outcomes in Cardiac Intensive Care Unit Patients. Int J Gen Med 2021; 14:4933-4943. [PMID: 34483683 PMCID: PMC8409768 DOI: 10.2147/ijgm.s328882] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/11/2021] [Accepted: 08/02/2021] [Indexed: 01/10/2023] Open
Abstract
Background The neutrophil percentage-to-albumin ratio (NPAR) is a systemic inflammation-based predictor associated with many diseases' outcomes. Nevertheless, there are few studies on the relationship between NPAR and inflammatory markers, and more importantly, the prognostic value of NPAR in critically ill patients with cardiovascular disease (CVD) remains unknown. Methods The data of this retrospective cohort study were from the Medical Information Mart data for Intensive Care III database (MIMIC-III) and the Second Affiliated Hospital of Wenzhou Medical University. Linear regression, logistic regression model, and Cox regression model were used to assess the associations between NPAR levels and length of stay, renal replacement therapy (RRT) use, and 30-day, 90-day and one-year mortality, respectively. The Pearson correlation coefficient was used to present the correlation between NPAR and C-reactive protein (CRP). Results Our study included 1599 patients in MIMIC-III and 143 patients in the Second Affiliated Hospital of Wenzhou Medical University. The elevated NPAR was independently associated with increased 30-day, 90-day, and one-year all-cause mortality (adjusted HR, 95% CI:1.51 (1.02-2.24); 1.61 (1.14-2.28); 1.53 (1.15-2.03); P trend = 0.0297; 0.0053; 0.0023; respectively), and it was also associated with increase the length of stay in hospital and ICU (β, 95% CI: 2.76 (1.26-4.27); 1.54 (0.62-2.47), respectively, both P trend <0.001). We found that patients with higher NPAR were more likely to receive RRT (OR, 95% CI: 2.50 (1.28-4.89), P trend =0.0023). Moreover, we confirmed that NPAR was statistically positively correlated with CRP (correlation coefficient r = 0.406, P < 0.0001). Conclusion Elevated NPAR on admission was independently associated with increased all-cause mortality and length of stay among CICU patients. The results showed that CICU patients with higher NPAR were more likely to receive RRT. Besides, we also provided the evidence that there is a positive correlation between NPAR and inflammatory indicators (ie, CRP).
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Affiliation(s)
- Xue Wang
- Department of Cardiology, The Second Affiliated Hospital and Yuying Children's Hospital, Wenzhou Medical University, Wenzhou, 325000, Zhejiang, People's Republic of China
| | - Jie Wang
- Department of Cardiology, The Second Affiliated Hospital and Yuying Children's Hospital, Wenzhou Medical University, Wenzhou, 325000, Zhejiang, People's Republic of China
| | - Shujie Wu
- Department of Cardiology, The Second Affiliated Hospital and Yuying Children's Hospital, Wenzhou Medical University, Wenzhou, 325000, Zhejiang, People's Republic of China
| | - Qingwei Ni
- Department of Cardiology, The Second Affiliated Hospital and Yuying Children's Hospital, Wenzhou Medical University, Wenzhou, 325000, Zhejiang, People's Republic of China
| | - Peng Chen
- Department of Cardiology, The Second Affiliated Hospital and Yuying Children's Hospital, Wenzhou Medical University, Wenzhou, 325000, Zhejiang, People's Republic of China
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Abstract
BACKGROUND Lipoprotein-associated phospholipase A2 (Lp-PLA2), which is involved in the inflammatory atherosclerotic process, has emerged as an independent risk factor for atheromatous vascular events. Its impact on coronary disease has already been demonstrated, however, its influence in cerebrovascular etiology is still unknown. We aimed to observe and describe the potential association between Lp-PLA2 levels and the etiologic subtype of ischemic stroke. METHODS Unicentric, observational, and prospective cohort study of consecutive patients with acute ischemic stroke, admitted in a comprehensive stroke center. Patients with incomplete investigation or coexisting causes were excluded. Lp-PLA2 was dosed in peripheral blood between day 3 and 14 postevent with "Lp-PLA2-SNIBE" kit. Statistical significance was set for P<0.05. RESULTS A total of 96 patients were enrolled, with mean age of 75.31±11.88 years, 41 males (42.7%); 12.5% with lacunar stroke, 16.7% atherothrombotic, 46.9% cardioembolic, and 24% embolic stroke of undetermined source (ESUS). The level of Lp-PLA2 was different between etiologies (F=2.982, P=0.035), being lower in ESUS (143.3±42.8 ng/mL). There were no significant associations with previous vascular risk factors, history of ischemic stroke and modified-Rankin scale (mRS) score 3 months postevent. In ESUS patients, Lp-PLA2 was not associated with cervical ultrasound findings or frequent supraventricular extrasystoles. CONCLUSIONS Lp-PLA2 levels are different between etiologic subtypes of ischemic stroke, being lower in ESUS patients. The results of this study reinforce the existence of distinct pathophysiological mechanisms in patients with ESUS. Multicenter clinical trials with larger sample sizes are needed to clarify the role Lp-PLA2 on the etiology of stroke.
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Yang M, Wang A, Li J, Zhao X, Liu L, Meng X, Jing J, Zhang N, Johnston SC, Wang Y, Wang Y. Lp-PLA2 and dual antiplatelet agents in intracranial arterial stenosis. Neurology 2019; 94:e181-e189. [DOI: 10.1212/wnl.0000000000008733] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/08/2019] [Accepted: 07/08/2019] [Indexed: 11/15/2022] Open
Abstract
ObjectiveTo evaluate the interaction effect of lipoprotein-associated phospholipase A2 (Lp-PLA2) activity on the efficacy and safety of dual/single antiplatelet therapy in patients with and without intracranial arterial stenosis (ICAS) by the Clopidogrel in High-Risk Patients with Acute Non-disabling Cerebrovascular Events trial.MethodsPatients with both MRI analysis and Lp-PLA2 testing results were included in the current subanalysis. The interaction of Lp-PLA2 activity with the effects of dual and single antiplatelet therapy were analyzed through Cox proportional hazards regressions model.ResultsAmong the 797 patients, the mean age was 63.1 ± 10.8 years, 518 (65%) were men, 356 (44.7%) had ICAS, and 441 (55.3%) did not. There were significantly more patients with elevated Lp-PLA2 activity in the ICAS group than in the non-ICAS group (43.8% vs 35.4%, p = 0.02). There was significant interaction between Lp-PLA2 activity levels and the 2 antiplatelet therapies for prevention of stroke recurrences and combined vascular events even after adjustment for confounding factors exclusively for patients with ICAS (p = 0.017, 0.017, respectively), but not for those without (p = 0.332, 0.674, respectively). Compared with aspirin alone, dual antiplatelet therapy significantly reduced the risk of stroke recurrences and combined vascular events (adjusted hazard ratio 0.33 [0.12–0.89], p = 0.028; 0.33 [0.12–0.89], p = 0.028, respectively) for patients with ICAS and nonelevated Lp-PLA2 activity.ConclusionsPresence of both ICAS and nonelevated Lp-PLA2 activity may predict better response to dual antiplatelet therapy in prevention of recurrent strokes and combined vascular events for patients with minor stroke or high-risk TIA.Clinicaltrials.gov identifierNCT00979589.
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A Novel Anti-Inflammatory Role of Omega-3 PUFAs in Prevention and Treatment of Atherosclerosis and Vascular Cognitive Impairment and Dementia. Nutrients 2019; 11:nu11102279. [PMID: 31547601 PMCID: PMC6835717 DOI: 10.3390/nu11102279] [Citation(s) in RCA: 64] [Impact Index Per Article: 12.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/24/2019] [Revised: 09/11/2019] [Accepted: 09/19/2019] [Indexed: 12/13/2022] Open
Abstract
Atherosclerosis is an inflammatory chronic disease affecting arterial vessels and leading to vascular diseases, such as stroke and myocardial infarction. The relationship between atherosclerosis and risk of neurodegeneration has been established, in particular with vascular cognitive impairment and dementia (VCID). Systemic atherosclerosis increases the risk of VCID by inducing cerebral infarction, or through systemic or local inflammatory factors that underlie both atherosclerosis and cognition. Omega-3 and omega-6 polyunsaturated fatty acids (PUFAs) are involved in inflammatory processes, but with opposite roles. Specifically, omega-3 PUFAs exert anti-inflammatory properties by competing with omega-6 PUFAs and displacing arachidonic acid in membrane phospholipids, decreasing the production of pro-inflammatory eicosanoids. Experimental studies and some clinical trials have demonstrated that omega-3 PUFA supplementation may reduce the risk of different phenotypes of atherosclerosis and cardiovascular disease. This review describes the link between atherosclerosis, VCID and inflammation, as well as how omega-3 PUFA supplementation may be useful to prevent and treat inflammatory-related diseases.
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Tajfard M, Tavakoly Sany SB, Avan A, Latiff LA, Rahimi HR, Moohebati M, Hasanzadeh M, Ghazizadeh H, Esmaeily H, Doosti H, Taghipour A, Ghayour-Mobarhan M, Ferns GA, Emamian M, Bin Abd Mutalib MS. Relationship between serum high sensitivity C-reactive protein with angiographic severity of coronary artery disease and traditional cardiovascular risk factors. J Cell Physiol 2018; 234:10289-10299. [PMID: 30548615 DOI: 10.1002/jcp.27945] [Citation(s) in RCA: 20] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/15/2018] [Accepted: 10/09/2018] [Indexed: 12/25/2022]
Abstract
Serum high-sensitivity C-reactive protein (hs-CRP) is predictive of coronary artery disease (CAD). The aim of this study was to examine the possible association of hs-CRP with presence and severity of CAD and traditional CAD risk factors. This case-control study was carried out on 2,346 individuals from September 2011 to May 2013. Of these 1,187 had evidence of coronary disease, and were subject to coronary angiography, and the remainder were healthy controls (n = 1,159). Characteristics were determined using standard laboratory techniques and serum Hs-CRP levels were estimated using enzyme-linked immunosorbent assay (ELISA) kits, and severity of CAD was assessed according to the score of obstruction in coronary artery. Serum hs-CRP levels were higher in those with severe coronary disease, who had stenosis ≥ 50% stenosis of at least one coronary artery (all p < 0.001 vs. individuals in healthy control), and correlated significantly with the score for coronary artery disease (all p < 0.01). After adjustment for conventional risk factors, regression analysis revealed that smoking habits, fasting blood glucose, total cholesterol, high-density lipoprotein, hs-CRP, blood pressure, anxiety, dietary intake of vitamin E, and cholesterol remained as independent determinants for angiographic severity of CAD. The area under the receiving operating characteristic (ROC) curve for serum hs-CRP was 0.869 (CI 95% 0.721-0.872, p < 0.001). The optimal values for the cut-off point was a serum hs-CRP of 2.78 mg/l (sensitivity 80.20%, specificity 85%) to predict severity of CAD. Increased serum hs-CRP levels are significantly associated with angiographic severity of CAD, suggesting its value as a biomarkers for predicting CAD.
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Affiliation(s)
- Mohammad Tajfard
- Social Determinants of Health Research Center, Mashhad University of Medical Sciences, Mashhad, Iran.,Department of Health Education and Health Promotion, School of Health, Social Determinants of Health Research Center, Mashhad University of Medical Sciences, Mashhad, Iran
| | - Seyedeh Belin Tavakoly Sany
- Social Determinants of Health Research Center, Mashhad University of Medical Sciences, Mashhad, Iran.,Department of Health Education and Health Promotion, School of Health, Social Determinants of Health Research Center, Mashhad University of Medical Sciences, Mashhad, Iran
| | - Amir Avan
- Metabolic Syndrome Research Centre, Mashhad University of Medical Sciences, Mashhad, Iran
| | - Latiffah A Latiff
- Department of Community Health, Faculty of Medicine and Health Sciences, University Putra Malaysia, Seri Kembangan, Malaysia
| | - Hamid Reza Rahimi
- Department of Modern Sciences and Technologies, School of Medicine, Mashhad University of Medical Sciences, Mashhad, Iran.,Vascular and Endovascular Surgery Research Centre, Mashhad University of Medical Sciences, Mashhad, Iran
| | - Mohsen Moohebati
- Department of Cardiology, Ghaem Educational Hospital, Mashhad University of Medical Sciences, Mashhad, Iran
| | - Mehdi Hasanzadeh
- Department of Biostatistics and Epidemiology, Faculty of Health, Mashhad University of Medical Sciences, Mashhad, Iran
| | - Hamideh Ghazizadeh
- Metabolic Syndrome Research Centre, Mashhad University of Medical Sciences, Mashhad, Iran
| | - Habibollah Esmaeily
- Department of Biostatistics and Epidemiology, Faculty of Health, Mashhad University of Medical Sciences, Mashhad, Iran
| | - Hassan Doosti
- Department of Statistics, School of Health, Macquarie University, Sydney, Australia
| | - Ali Taghipour
- Department of Biostatistics and Epidemiology, Faculty of Health, Mashhad University of Medical Sciences, Mashhad, Iran
| | - Majid Ghayour-Mobarhan
- Metabolic Syndrome Research Centre, Mashhad University of Medical Sciences, Mashhad, Iran
| | - Gordon A Ferns
- Brighton & Sussex Medical School, Division of Medical Education, Falmer, Brighton, Sussex BN1 9PH, UK
| | - Marzie Emamian
- Biochemistry Department, School of Medicine, Mashhad University of Medical Science, Mashhad, Iran
| | - Mohd Sokhini Bin Abd Mutalib
- Department of Nutrition and Dietetics, Faculty of Medicine and Health Sciences, University Putra Malaysia, Malaysia
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Wang Y, Hu S, Ren L, Lei Z, Lan T, Cai J, Li C. Lp-PLA 2 as a risk factor of early neurological deterioration in acute ischemic stroke with TOAST type of large arterial atherosclerosis. Neurol Res 2018; 41:1-8. [PMID: 30296199 DOI: 10.1080/01616412.2018.1493850] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/29/2023]
Abstract
Introduction: Lipoprotein-associated phospholipase A2 (Lp-PLA2) is a well-known risk factor of atherosclerotic vascular diseases. Nevertheless, its role in the acute phase of ischemic stroke is still unclear. The aim of this study is to identify the relationship between Lp-PLA2 levels and early neurological deterioration (END) in acute ischemic stroke patients with Trial of Org 10 172 in Acute Stroke Treatment (TOAST) subtype of large arterial atherosclerosis (LAA). Methods: We enrolled Chinese patients with first ever acute ischemic stroke admitted to Neurology Department of Shenzhen Second People's Hospital within 48 h from onset of symptoms during January - November 2015. Demographic and laboratory information were collected while END was defined as an increase in the National Institute of Health Stroke Scale score by ≥ 1 point in motor power, or ≥ 2 points in the total score within 10 days after admission. Results: Overall 181 patients were involved; END was diagnosed in 30 patients within 10 days after admission. The odds ratio for END increased with increasing levels of Lp-PLA2 (intermediate level, OR = 1.96, 95%CI 1.02-4.27, p = 0.041; high level, OR = 2.99, 95%CI 1.26-5.73, p = 0.023). Conclution: Intermediate and high level of Lp-PLA2 was identified as independent predictor of END in multivariate analysis. Lp-PLA2 could be valued as a risk factor of END in patients with acute ischemic stroke with TOAST subtype of LAA.
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Affiliation(s)
- Yang Wang
- a Department of Neurology , Shenzhen University 1st Affiliated Hospital , Guangdong , China
| | - Shiyu Hu
- a Department of Neurology , Shenzhen University 1st Affiliated Hospital , Guangdong , China
| | - Lijie Ren
- a Department of Neurology , Shenzhen University 1st Affiliated Hospital , Guangdong , China
| | - Zhihao Lei
- a Department of Neurology , Shenzhen University 1st Affiliated Hospital , Guangdong , China
| | - Tao Lan
- b Department of Orthopaedics , Shenzhen University 1st Affiliated Hospital , Guangdong , China
| | - Jingjing Cai
- a Department of Neurology , Shenzhen University 1st Affiliated Hospital , Guangdong , China
| | - Chao Li
- a Department of Neurology , Shenzhen University 1st Affiliated Hospital , Guangdong , China
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12
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Zhou F, Liu Y, Shi H, Huang Q, Zhou J. Relation between lipoprotein-associated phospholipase A 2 mass and incident ischemic stroke severity. Neurol Sci 2018; 39:1591-1596. [PMID: 29938341 DOI: 10.1007/s10072-018-3474-3] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/19/2018] [Accepted: 06/09/2018] [Indexed: 11/24/2022]
Abstract
BACKGROUND Manifestations of ischemic stroke vary widely, and serum biomarkers may be useful for stratification of risk of severe stroke. This study evaluated the association of lipoprotein-associated phospholipase A2 (Lp-PLA2) mass and initial severity. METHODS We employed a retrospective analysis on our hospital-based registry and recruited 488 first-onset ischemic stroke patients admitted within 24 h after onset and with Lp-PLA2 mass measured. Stroke severities evaluated by National Institutes of Health Stroke Scale (NIHSS) were compared between Lp-PLA2 categories dichotomized by median. Multivariate logistic regression was used to detect the independent risk factors of severe stroke (NIHSS ≥ 7) and receiver operator curve (ROC) was constructed to detect the value of addition of Lp-PLA2 to the model of other risk factors for predicting severe stroke. RESULTS Of the overall patients, the median admission NIHSS scores was 3 and 28.1% had severe manifestation. Admission NIHSS scores were different between patients of Lp-PLA2 above and under the median (median NIHSS 4 vs. 3, P < 0.001). Lp-PLA2 levels was correlated with admission NIHSS (r = 0.268, P < 0.001). Logistic regression showed Lp-PLA2 category (OR 2.37, 95%CI 1.44-3.90, P < 0.001) and levels per 100 ng/ml (OR 1.69, 95%CI 1.35-2.11, P < 0.001) were both independently associated with severe stroke. Addition of Lp-PLA2 category and levels to other independent risk factors both increased the area under curves (from 0.676 to 0.718 with category and 0.734 with levels). CONCLUSION Lp-PLA2 was independently related to admission severity in ischemic stroke patients, implying a potential predictive value of Lp-PLA2 for severe stroke in prevention.
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Affiliation(s)
- Feng Zhou
- Nanjing First Hospital, Nanjing Medical University, Nanjing, China
| | - Yukai Liu
- Nanjing First Hospital, Nanjing Medical University, Nanjing, China
| | - Hongchao Shi
- Nanjing First Hospital, Nanjing Medical University, Nanjing, China
| | - Qing Huang
- Nanjing First Hospital, Nanjing Medical University, Nanjing, China
| | - Junshan Zhou
- Nanjing First Hospital, Nanjing Medical University, Nanjing, China.
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Avan A, Tavakoly Sany SB, Ghayour‐Mobarhan M, Rahimi HR, Tajfard M, Ferns G. Serum C‐reactive protein in the prediction of cardiovascular diseases: Overview of the latest clinical studies and public health practice. J Cell Physiol 2018; 233:8508-8525. [DOI: 10.1002/jcp.26791] [Citation(s) in RCA: 83] [Impact Index Per Article: 13.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/21/2018] [Accepted: 04/30/2018] [Indexed: 12/14/2022]
Affiliation(s)
- Amir Avan
- Department of Modern Sciences and Technologies School of Medicine, Mashhad University of Medical Sciences Mashhad Iran
| | - Seyedeh Belin Tavakoly Sany
- Social Determinants of Health Research Center Mashhad University of Medical Sciences Mashhad Iran
- Department of Health Education and Health Promotion Faculty of Health, Mashhad University of Medical Sciences Mashhad Iran
| | - Majid Ghayour‐Mobarhan
- Department of Modern Sciences and Technologies School of Medicine, Mashhad University of Medical Sciences Mashhad Iran
| | - Hamid Reza Rahimi
- Department of Modern Sciences and Technologies School of Medicine, Mashhad University of Medical Sciences Mashhad Iran
| | - Mohammad Tajfard
- Social Determinants of Health Research Center Mashhad University of Medical Sciences Mashhad Iran
- Department of Health Education and Health Promotion Faculty of Health, Mashhad University of Medical Sciences Mashhad Iran
| | - Gordon Ferns
- Medical Education and Metabolic Medicine Head, Department of Medical Education, Brighton and Sussex Medical School University of Brighton Falmer Campus, Brighton UK
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14
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The elevated lipoprotein-associated phospholipase A2 activity is associated with the occurrence and recurrence of acute cerebral infarction. Neuroreport 2018; 28:325-330. [PMID: 28272264 DOI: 10.1097/wnr.0000000000000765] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/06/2023]
Abstract
There is a strong association between lipoprotein-associated phospholipase A2 (Lp-PLA2) levels and atherosclerosis-related diseases. The aim of this study was to investigate the role of Lp-PLA2 in the ischemic stroke and further offer clinical evidence that measuring Lp-PLA2 helps predict the risk of stroke occurrence and recurrence. A total of 328 hospitalized patients were recruited, including 179 cases of acute cerebral infarction (ACI) and 149 non-ACI controls. The serum level of Lp-PLA2 in ACI was significantly higher than non-ACI. The serum level of Lp-PLA2 in the recurrence of ACI was significantly higher than the nonrecurrence. The serum levels of Lp-PLA2 in large-artery atherosclerosis subtype were the highest among the subtypes of the Trial of Org 10172 in Acute Stroke Treatment and non-ACI controls. The level of Lp-PLA2 in large-artery atherosclerosis and the cardioembolism group was statistically significantly higher than that of the control cases. There was no statistically significant difference between the small-vessel occlusion group and the control cases. The present study confirmed that the elevated Lp-PLA2 level can be a risk factor for ischemic stroke in the Chinese population. The serum level of Lp-PLA2 may be a predictive factor for the recurrence of ACI.
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Moise L, Marta D, Raşcu A, Moldoveanu E. SERUM LIPOPROTEIN-ASSOCIATED PHOSPHOLIPASE A2 IN MALES WITH METABOLIC SYNDROME AND OBSTRUCTIVE SLEEP APNEA. ACTA ENDOCRINOLOGICA (BUCHAREST, ROMANIA : 2005) 2018; 14:36-42. [PMID: 31149234 PMCID: PMC6516608 DOI: 10.4183/aeb.2018.36] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
Abstract
CONTEXT Lipoprotein-associated phospholipase A2 (Lp-PLA2) is a novel biomarker for cardiovascular diseases (CVD) risk estimation with high specificity for vascular inflammation. Few studies have investigated Lp-PLA2 levels in patients with metabolic syndrome (MetS) and obstructive sleep apnea syndrome (OSAS). OBJECTIVE This study aimed to evaluate the role of Lp-PLA2 levels as a marker of vascular inflammation that contributes to cardiometabolic dysfunction in patients with MetS and OSAS. DESIGN This is a prospective case-control study. SUBJECTS AND METHODS 83 men were enrolled. Following anthropometric measurements, laboratory analysis and overnight sleep study, patients were divided into three groups: MetS, OSAS with/without MetS. Serum Lp-PLA2 levels were determined by ELISA method. RESULTS Serum Lp-PLA2 levels were statistically significant among the three groups and were higher in OSAS with MetS group than those without MetS. A significant positive relationship between increased Lp-PLA2 level and CRP (C-reactive protein) and apnea-hypopnea index (AHI) was found. Average oxygen saturation (AvO2) and the lowest oxygen saturation were negatively correlated with Lp-PLA2. The number of desaturation events, oxygen desaturation index, AvO2, AHI and CRP were significant predictors of Lp-PLA2. CONCLUSIONS Lp-PLA2 levels are associated with OSAS severity and might play an important role in predicting CVD in OSAS with/without MetS.
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Affiliation(s)
- L.G. Moise
- “Carol Davila” University of Medicine and Pharmacy - Occupational Medicine Department, Bucharest, Romania
| | - D.S. Marta
- “Victor Babes” National Institute of Pathology - Ultrastructural Pathology Department, Bucharest, Romania
| | - A. Raşcu
- “Carol Davila” University of Medicine and Pharmacy - Occupational Medicine Department, Bucharest, Romania
- Colentina Clinical Hospital - Occupational Medicine Department, Bucharest, Romania
| | - E. Moldoveanu
- “Titu Maiorescu” University - Faculty of Medicine, Bucharest, Romania
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Ren Y, Zhu H, Fan Z, Gao Y, Tian N. Comparison of the effect of rosuvastatin versus rosuvastatin/ezetimibe on markers of inflammation in patients with acute myocardial infarction. Exp Ther Med 2017; 14:4942-4950. [PMID: 29201198 PMCID: PMC5704334 DOI: 10.3892/etm.2017.5175] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/05/2016] [Accepted: 06/22/2017] [Indexed: 12/21/2022] Open
Abstract
Statins lower low-density lipoprotein cholesterol (LDL-C) and high-sensitivity C-reactive protein (hsCRP), and the addition of ezetimibe to statins further reduces LDL-C and hsCRP. Lipoprotein-associated phospholipase A2 (Lp-PLA2) is a potentially important pathogenic factor participating in the progression of atherosclerosis. The aim of current study was to investigate how the addition of ezetimibe to rosuvastatin treatment affects reductions in LDL-C, hsCRP and Lp-PLA2 in patients with acute myocardial infarction (AMI). A total of 135 patients were enrolled in the study within 24 h of AMI, and were randomized to receive 10 mg rosuvastatin or 10 mg rosuvastatin plus 10 mg ezetimibe daily. HsCRP, Lp-PLA2, total cholesterol (TC), triglycerides (TG), LDL-C and high-density lipoprotein cholesterol (HDL-C) were determined at baseline and after 1, 3, 6 and 12 months of treatment. The addition of ezetimibe to rosuvastatin led to greater reduction of LDL-C compared with rosuvastatin monotherapy (from 3.00 to 1.19 mmol/l vs. 2.93 to 1.49 mmol/l, respectively; P<0.05), as well as reduced levels of hsCRP (from 5.15 to 0.68 mg/l vs. 4.33 to 1.49 mg/l, respectively; P<0.05) and Lp-PLA2 (from 333.13 to 79.07 mg/l vs. 327.95 to 123.62 mg/l, respectively; P<0.05). A positive association was identified between reductions of Lp-PLA2 and the changes of LDL-C (r=0.367; P=0.002). However, no significant correlation was observed between changes in Lp-PLA2 and hsCRP (r=0.264; P=0.512). The values of hsCRP and Lp-PLA2 appeared to increase during the first week after randomization, but dropped steeply to a lower level and remained stable thereafter. In conclusion, the addition of ezetimibe to rosuvastatin was demonstrated to further reduce LDL-C, hsCRP and Lp-PLA2 compared with rosuvastatin monotherapy in patients with AMI.
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Affiliation(s)
- Yizhi Ren
- Department of Cardiology, Nanjing First Hospital, Nanjing Medical University, Nanjing, Jiangsu 210006, P.R. China
| | - Hao Zhu
- Department of Cardiology, Nanjing First Hospital, Nanjing Medical University, Nanjing, Jiangsu 210006, P.R. China.,Department of Cardiology, Nanjing Heart Center, Nanjing, Jiangsu 210006, P.R. China
| | - Zhongguo Fan
- Department of Cardiology, Nanjing First Hospital, Nanjing Medical University, Nanjing, Jiangsu 210006, P.R. China
| | - Yali Gao
- Department of Cardiology, Nanjing First Hospital, Nanjing Medical University, Nanjing, Jiangsu 210006, P.R. China
| | - Nailiang Tian
- Department of Cardiology, Nanjing First Hospital, Nanjing Medical University, Nanjing, Jiangsu 210006, P.R. China.,Department of Cardiology, Nanjing Heart Center, Nanjing, Jiangsu 210006, P.R. China
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Han L, Zhong C, Bu X, Xu T, Wang A, Peng Y, Xu T, Wang J, Peng H, Li Q, Ju Z, Geng D, Zhang Y, He J. Prognostic value of lipoprotein-associated phospholipase A 2 mass for all-cause mortality and vascular events within one year after acute ischemic stroke. Atherosclerosis 2017; 266:1-7. [PMID: 28934604 DOI: 10.1016/j.atherosclerosis.2017.09.013] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/04/2017] [Revised: 08/08/2017] [Accepted: 09/12/2017] [Indexed: 10/18/2022]
Abstract
BACKGROUND AND AIMS We performed a prospective investigation of the longer-term prognostic value of lipoprotein-associated phospholipase A2 (Lp-PLA2) mass for all-cause mortality and vascular events within one year after acute ischemic stroke. METHODS We examined the Lp-PLA2 mass among 3401 participants enrolled in the China Antihypertensive Trial in Acute Ischemic Stroke. The primary outcome was all-cause mortality. Cox proportional hazard ratios (HRs) and 95% confidence intervals (95% CIs) were constructed to assess the independent associations between the baseline Lp-PLA2 mass and the outcomes after adjustment for variables in models 1, 2, and 3 [further adjusted for low-density lipoprotein cholesterol (LDL-C)]. RESULTS Overall, 3278 patients completed the follow-up, during which, 188 all-cause death events occurred. The Kaplan-Meier survival curve showed that the cumulative incidence rate of all-cause mortality increased across quartiles of Lp-PLA2 mass (log-rank p = 0.018). Compared with the lowest quartile of Lp-PLA2, the HRs (95% CIs) for the highest quartile of Lp-PLA2 were 1.89 (1.22-2.91), 2.16 (1.31-3.55), and 2.17 (1.32-3.58) for all-cause mortality after adjusting for the covariables in models 1, 2, and 3, respectively. In addition, patients in the highest quartile of Lp-PLA2 mass coupled with higher LDL-C had significantly highest risk of all-cause mortality (HR, 1.81; 95% CI, 1.05 to 3.11; p = 0.032). CONCLUSIONS The elevated Lp-PLA2 mass was associated with all cause-death independently of other risk factors within one year after acute ischemic stroke.
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Affiliation(s)
- Liyuan Han
- Department of Epidemiology, School of Public Health and Jiangsu Key Laboratory of Preventive and Translational Medicine for Geriatric Diseases, Medical College of Soochow University, Suzhou, Jiangsu, China; Department of Preventive Medicine, Zhejiang Provincial Key Laboratory of Pathophysiology, School of Medicine, Ningbo University, Ningbo, China; Department of Epidemiology, Tulane University School of Public Health and Tropical Medicine, New Orleans, LA, USA
| | - Chongke Zhong
- Department of Epidemiology, School of Public Health and Jiangsu Key Laboratory of Preventive and Translational Medicine for Geriatric Diseases, Medical College of Soochow University, Suzhou, Jiangsu, China; Department of Epidemiology, Tulane University School of Public Health and Tropical Medicine, New Orleans, LA, USA
| | - Xiaoqing Bu
- Department of Epidemiology, School of Public Health and Jiangsu Key Laboratory of Preventive and Translational Medicine for Geriatric Diseases, Medical College of Soochow University, Suzhou, Jiangsu, China
| | - Tan Xu
- Department of Epidemiology, School of Public Health and Jiangsu Key Laboratory of Preventive and Translational Medicine for Geriatric Diseases, Medical College of Soochow University, Suzhou, Jiangsu, China
| | - Aili Wang
- Department of Epidemiology, School of Public Health and Jiangsu Key Laboratory of Preventive and Translational Medicine for Geriatric Diseases, Medical College of Soochow University, Suzhou, Jiangsu, China
| | - Yanbo Peng
- Department of Neurology, Affiliated Hospital of North China University of Science and Technology, Tangshan, Hebei, China
| | - Tian Xu
- Department of Epidemiology, School of Public Health and Jiangsu Key Laboratory of Preventive and Translational Medicine for Geriatric Diseases, Medical College of Soochow University, Suzhou, Jiangsu, China; Department of Neurology, Affiliated Hospital of Nantong University, Nantong, Jiangsu, China
| | - Jinchao Wang
- Department of Neurology, Yutian County Hospital, Tangshan, Hebei, China
| | - Hao Peng
- Department of Epidemiology, School of Public Health and Jiangsu Key Laboratory of Preventive and Translational Medicine for Geriatric Diseases, Medical College of Soochow University, Suzhou, Jiangsu, China
| | - Qunwei Li
- Department of Epidemiology, School of Public Health, Taishan Medical College, Taian, Shandong, China
| | - Zhong Ju
- Department of Neurology, Kerqin District First People's Hospital of Tongliao City, Tongliao, Inner Mongolia, China
| | - Deqing Geng
- Department of Neurology, Affiliated Hospital of Xuzhou Medical University, Xuzhou, Jiangsu, China
| | - Yonghong Zhang
- Department of Epidemiology, School of Public Health and Jiangsu Key Laboratory of Preventive and Translational Medicine for Geriatric Diseases, Medical College of Soochow University, Suzhou, Jiangsu, China; Department of Epidemiology, Tulane University School of Public Health and Tropical Medicine, New Orleans, LA, USA.
| | - Jiang He
- Department of Epidemiology, School of Public Health and Jiangsu Key Laboratory of Preventive and Translational Medicine for Geriatric Diseases, Medical College of Soochow University, Suzhou, Jiangsu, China; Department of Epidemiology, Tulane University School of Public Health and Tropical Medicine, New Orleans, LA, USA.
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18
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Kocak S, Ertekin B, Girisgin AS, Dundar ZD, Ergin M, Mehmetoglu I, Bodur S, Cander B. Lipoprotein-associated phospholipase-A 2 activity and its diagnostic potential in patients with acute coronary syndrome and acute ischemic stroke. Turk J Emerg Med 2017; 17:56-60. [PMID: 28616616 PMCID: PMC5459519 DOI: 10.1016/j.tjem.2016.10.001] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/18/2016] [Revised: 10/09/2016] [Accepted: 10/11/2016] [Indexed: 11/28/2022] Open
Abstract
BACKGROUND The study examined the Lp-PLA2 activity at the patients presented to the emergency department with acute coronary syndrome (ACS) or acute ischemic stroke (AIS), as well as its diagnostic value. METHODS The prospective study included consecutive male and female patients aged >18 years that presented to the our emergency department with ACS or AIS between November 2009 and January 2010. Blood samples were obtained immediately following diagnosis in the ACS and AIS groups. The diagnostic value of Lp-PLA2 was determined based on receiver operating characteristic curves, sensitivity, specificity, predictive values, likelihood ratios and accuracy rates. RESULTS In all, 34 ACS and 32 AIS patients were included in the study, and the control group included 35 patients. Lp-PLA2 enzyme activity was significantly lower in the ACS and AIS groups than in the control group (26.7 ± 13.8, 31.4 ± 13.6, and 41.4 ± 8.1 nmol min-1·mL-1, respectively; p < 0.0001, p = 0.022). In the ACS group the area under the curve (AUC) was 0.825 (95%CI: 0.722-0.929), sensitivity was 71% for an optimal Lp-PLA2 cut-off value of 31.4 nmol min-1·mL-1, and specificity was 91%, whereas in the AIS group the AUC was 0.768 (95%CI: 0.652-0.884), sensitivity was 75% for an optimal Lp-PLA2 cut-off value of 38.1 nmol min-1·mL-1, and specificity was 74%. CONCLUSIONS Lp-PLA2 enzyme activity was significantly lower during the early stage of both ACS and AIS. The obtained statistic data suggest that low Lp-PLA2 enzyme activity can be used for diagnostic purposes.
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Affiliation(s)
- Sedat Kocak
- Emergency Department, Necmettin Erbakan University, Meram Faculty of Medicine, Konya, Turkey
| | - Birsen Ertekin
- Emergency Department, Beyhekim State Hospital, Konya, Turkey
| | - Abdullah Sadik Girisgin
- Emergency Department, Necmettin Erbakan University, Meram Faculty of Medicine, Konya, Turkey
| | - Zerrin Defne Dundar
- Emergency Department, Necmettin Erbakan University, Meram Faculty of Medicine, Konya, Turkey
| | - Mehmet Ergin
- Emergency Department, Necmettin Erbakan University, Meram Faculty of Medicine, Konya, Turkey
| | - Idris Mehmetoglu
- Biochemistry Department, Necmettin Erbakan University, Meram Faculty of Medicine, Konya, Turkey
| | - Said Bodur
- Public Health Department, Balıkesir University Faculty of Medicine, Balıkesir, Turkey
| | - Basar Cander
- Emergency Department, Necmettin Erbakan University, Meram Faculty of Medicine, Konya, Turkey
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Li YM, Liu XY. Molecular mechanisms underlying application of serum procalcitonin and stool miR-637 in prognosis of acute ischemic stroke. Am J Transl Res 2016; 8:4242-4249. [PMID: 27830008 PMCID: PMC5095317] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/06/2016] [Accepted: 03/06/2016] [Indexed: 06/06/2023]
Abstract
We and others have reported that the serum procalcitonin (PCT) level has a demonstrative role in predicting the long-term mortality after acute ischemic stroke (AIS) in Chinese population. Nevertheless, the underlying mechanisms remain ill-defined. In the current study, we further detected a close association of stool microRNA-637 (miR-637) levels with the long-term mortality after AIS in Chinese population. Moreover, the serum PCT and stool miR-637 levels appeared to be inversely correlated. AIS patients with lower levels of stool miR-637 appeared to predict more severe mortality in the long-term. Since PCT has been shown to be mainly produced by the neuroendocrine cells in the intestine, we used an intestine neuroendocrine cell line to study the relationship between miR-637 and PCT. Bioinformatics analyses showed that miR-637 targeted the 3'-UTR of PCT mRNA to inhibit its translation, and thus the levels of PCT protein production and secretion, which was proved by luciferase reporter assay. Together, our data reveal that the molecular mechanisms underlying application of serum PCT and stool miR-637 in prognosis of AIS, in which miR-637 in intestine neuroendocrine cells may be reduced during AIS to allow more PCT to be released into serum to be detected.
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Affiliation(s)
- You-Mei Li
- Department of Neurology, Yangpu Hospital, Tongji University School of MedicineShanghai 20090, China
| | - Xue-Yuan Liu
- Department of Neurology, Shanghai Tenth People’s Hospital of Tongji UniversityShanghai 200072, China
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20
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Li J, Zhao X, Meng X, Lin J, Liu L, Wang C, Wang A, Wang Y, Wang Y. High-Sensitive C-Reactive Protein Predicts Recurrent Stroke and Poor Functional Outcome: Subanalysis of the Clopidogrel in High-Risk Patients With Acute Nondisabling Cerebrovascular Events Trial. Stroke 2016; 47:2025-30. [PMID: 27328699 DOI: 10.1161/strokeaha.116.012901] [Citation(s) in RCA: 51] [Impact Index Per Article: 6.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/22/2016] [Accepted: 05/27/2016] [Indexed: 11/16/2022]
Abstract
BACKGROUND AND PURPOSE Minor stroke and transient ischemic attack are common disorders with high rate of subsequent disabling stroke. We aim to investigate the role of high-sensitive C-reactive protein (hsCRP) in predicting recurrent stroke and poor functional outcome. METHODS In the Clopidogrel in High-Risk Patients With Acute Nondisabling Cerebrovascular Events (CHANCE) trial, 3044 (59%) consecutive patients from 73 (64%) prespecified centers had hsCRP levels measured. The primary outcome was any stroke within 90 days. The secondary outcome included combined vascular events and dependence or death defined as modified Rankin Scale score of 2 to 6 at 90 days and a new vascular event during 1-year follow-up. The associations of hsCRP with recurrent stroke and functional outcome were analyzed by using Cox proportional hazards and logistic regression models. RESULTS Elevated hsCRP (>3.0 mg/L) was observed in 32% of the study population. Patients with hsCRP >3 mg/L had an increased risk of recurrent stroke (adjusted hazard ratio, 1.46; 95% confidence interval, 1.08-1.98; P=0.039), ischemic stroke and combined vascular events, and poor functional outcome (adjusted odds ratio, 1.68; 95% confidence interval, 1.22-2.32; P=0.002) compared with those with hsCRP <1 mg/L within 90-day follow-up period. High hsCRP levels also independently predicted recurrent stroke during 1-year follow-up. There was no interaction of hsCRP levels with randomized antiplatelet therapy. CONCLUSIONS High hsCRP levels predict recurrent stroke and poor functional outcome in acute patients with minor stroke or transient ischemic attack. CLINICAL TRIAL REGISTRATION URL: http://www.clinicaltrials.gov. Unique identifier: NCT00979589.
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Affiliation(s)
- Jiejie Li
- From the Department of Neurology, Beijing Tiantan Hospital, Capital Medical University, Beijing, China; China National Clinical Research Center for Neurological Diseases, Beijing, China; Center of Stroke, Beijing Institute for Brain Disorders, Beijing, China; and Beijing Key Laboratory of Translational Medicine for Cerebrovascular Disease, China
| | - Xingquan Zhao
- From the Department of Neurology, Beijing Tiantan Hospital, Capital Medical University, Beijing, China; China National Clinical Research Center for Neurological Diseases, Beijing, China; Center of Stroke, Beijing Institute for Brain Disorders, Beijing, China; and Beijing Key Laboratory of Translational Medicine for Cerebrovascular Disease, China
| | - Xia Meng
- From the Department of Neurology, Beijing Tiantan Hospital, Capital Medical University, Beijing, China; China National Clinical Research Center for Neurological Diseases, Beijing, China; Center of Stroke, Beijing Institute for Brain Disorders, Beijing, China; and Beijing Key Laboratory of Translational Medicine for Cerebrovascular Disease, China
| | - Jinxi Lin
- From the Department of Neurology, Beijing Tiantan Hospital, Capital Medical University, Beijing, China; China National Clinical Research Center for Neurological Diseases, Beijing, China; Center of Stroke, Beijing Institute for Brain Disorders, Beijing, China; and Beijing Key Laboratory of Translational Medicine for Cerebrovascular Disease, China
| | - Liping Liu
- From the Department of Neurology, Beijing Tiantan Hospital, Capital Medical University, Beijing, China; China National Clinical Research Center for Neurological Diseases, Beijing, China; Center of Stroke, Beijing Institute for Brain Disorders, Beijing, China; and Beijing Key Laboratory of Translational Medicine for Cerebrovascular Disease, China
| | - Chunxue Wang
- From the Department of Neurology, Beijing Tiantan Hospital, Capital Medical University, Beijing, China; China National Clinical Research Center for Neurological Diseases, Beijing, China; Center of Stroke, Beijing Institute for Brain Disorders, Beijing, China; and Beijing Key Laboratory of Translational Medicine for Cerebrovascular Disease, China
| | - Anxin Wang
- From the Department of Neurology, Beijing Tiantan Hospital, Capital Medical University, Beijing, China; China National Clinical Research Center for Neurological Diseases, Beijing, China; Center of Stroke, Beijing Institute for Brain Disorders, Beijing, China; and Beijing Key Laboratory of Translational Medicine for Cerebrovascular Disease, China
| | - Yilong Wang
- From the Department of Neurology, Beijing Tiantan Hospital, Capital Medical University, Beijing, China; China National Clinical Research Center for Neurological Diseases, Beijing, China; Center of Stroke, Beijing Institute for Brain Disorders, Beijing, China; and Beijing Key Laboratory of Translational Medicine for Cerebrovascular Disease, China.
| | - Yongjun Wang
- From the Department of Neurology, Beijing Tiantan Hospital, Capital Medical University, Beijing, China; China National Clinical Research Center for Neurological Diseases, Beijing, China; Center of Stroke, Beijing Institute for Brain Disorders, Beijing, China; and Beijing Key Laboratory of Translational Medicine for Cerebrovascular Disease, China.
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Boillot A, Demmer RT, Mallat Z, Sacco RL, Jacobs DR, Benessiano J, Tedgui A, Rundek T, Papapanou PN, Desvarieux M. Periodontal microbiota and phospholipases: the Oral Infections and Vascular Disease Epidemiology Study (INVEST). Atherosclerosis 2015; 242:418-23. [PMID: 26282947 PMCID: PMC4862208 DOI: 10.1016/j.atherosclerosis.2015.07.039] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/03/2015] [Revised: 07/02/2015] [Accepted: 07/20/2015] [Indexed: 11/18/2022]
Abstract
OBJECTIVE Periodontal infections have been linked to cardiovascular disease, including atherosclerosis, and systemic inflammation has been proposed as a possible mediator. Secretory phospholipase A2 (s-PLA2) and Lipoprotein-associated PLA2 (Lp-PLA2) are inflammatory enzymes associated with atherosclerosis. No data are available on the association between oral microbiota and PLA2s. We studied whether a relationship exists between periodontal microbiota and the activities of these enzymes. METHODS The Oral Infection and Vascular Disease Epidemiology Study (INVEST) collected subgingival biofilms and serum samples from 593 dentate men and women (age 68.7 ± 8.6 years). 4561 biofilm samples were collected in the two most posterior teeth of each quadrant (average 7/participant) for quantitative assessment of 11 bacterial species using DNA-DNA checkerboard hybridization. Mean concentration of s-PLA2 and activities of s-PLA2 and Lp-PLA2 were regressed on tertiles of etiologic dominance (ED). ED is defined as the level of presumed periodontopathic species/combined level of all eleven species measured, and represents the relative abundance of periodontopathic organisms. Analyses were adjusted for age, sex, race/ethnicity, education, smoking, BMI, diabetes, LDL cholesterol and HDL cholesterol, and systolic blood pressure. RESULTS Higher levels of s-PLA2 activity were observed across increasing tertiles of etiologic dominance (0.66 ± 0.04 nmol ml(-1) min(-1), 0.73 ± 0.04 nmol ml(-1) min(-1), 0.89 ± 0.04 nmol ml-1 min-1; p < 0.001), with also a trend of association between Lp-PLA2 activity and ED (p = 0.07), while s-PLA2 concentration was unrelated to ED. CONCLUSION Increasingly greater s-PLA2 activity at higher tertiles of etiologic dominance may provide a mechanistic explanatory link of the relationship between periodontal microbiota and vascular diseases. Additional studies investigating the role of s-PLA2 are needed.
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Affiliation(s)
- Adrien Boillot
- Department of Periodontology, Rothschild Hospital (AP-HP); University Paris 7, 5 Rue Santerre, Paris, France; INSERM U1018, University of Versailles St Quentin. Centre for research in Epidemiology and Population Health, Villejuif, France
| | - Ryan T Demmer
- Department of Epidemiology, Mailman School of Public Health, Columbia University, New York, NY, USA
| | - Ziad Mallat
- Inserm U970; Cardiovascular Research Center, and Université Paris-Descartes University, F-75015, Paris, France; Department of Medicine, University of Cambridge, Cambridge, United Kingdom
| | - Ralph L Sacco
- Department of Neurology, Miller School of Medicine, University of Miami, Miami, FL, USA
| | - David R Jacobs
- Department of Epidemiology and Community Health, School of Public Health, University of Minnesota, Minneapolis, MN, USA; Department of Nutrition, University of Oslo, Oslo, Norway
| | - Joelle Benessiano
- Service de Biochimie, Hôpital Bichat, Assistance Publique-Hôpitaux de Paris, Paris, France
| | - Alain Tedgui
- Inserm U970; Cardiovascular Research Center, and Université Paris-Descartes University, F-75015, Paris, France
| | - Tatjana Rundek
- Department of Neurology, Miller School of Medicine, University of Miami, Miami, FL, USA
| | - Panos N Papapanou
- Division of Periodontics, Section of Oral and Diagnostic Sciences, College of Dental Medicine, Columbia University, New York, NY, USA
| | - Moïse Desvarieux
- Department of Epidemiology, Mailman School of Public Health, Columbia University, New York, NY, USA; INSERM Epidemiology and Biostatistics Research Center, Sorbonne Paris Cité, INSERM UMR 1153, Paris, France.
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22
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Lin J, Zheng H, Cucchiara BL, Li J, Zhao X, Liang X, Wang C, Li H, Mullen MT, Johnston SC, Wang Y, Wang Y. Association of Lp-PLA2-A and early recurrence of vascular events after TIA and minor stroke. Neurology 2015; 85:1585-91. [PMID: 26311748 DOI: 10.1212/wnl.0000000000001938] [Citation(s) in RCA: 38] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/09/2015] [Accepted: 07/02/2015] [Indexed: 01/28/2023] Open
Abstract
OBJECTIVE To determine the association of lipoprotein-associated phospholipase A2 (Lp-PLA2) measured in the acute period and the short-term risk of recurrent vascular events in patients with TIA or minor stroke. METHODS We measured Lp-PLA2 activity (Lp-PLA2-A) in a subset of 3,201 participants enrolled in the CHANCE (Clopidogrel in High-Risk Patients with Acute Non-disabling Cerebrovascular Events) trial. Participants with TIA or minor stroke were enrolled within 24 hours of symptom onset and randomized to single or dual antiplatelet therapy. In the current analysis, the primary outcome was defined as the composite of ischemic stroke, myocardial infarction, or death within 90 days. RESULTS The composite endpoint occurred in 299 of 3,021 participants (9.9%). The population average Lp-PLA2-A level was 209 ± 59 nmol/min/mL (95% confidence interval [CI] 207-211). Older age, male sex, and current smoking were associated with higher Lp-PLA2-A levels. Lp-PLA2-A was significantly associated with the primary endpoint (adjusted hazard ratio 1.07, 95% CI 1.01-1.13 for every 30 nmol/min/mL increase). Similar results were seen for ischemic stroke alone. Adjustment for low-density lipoprotein cholesterol attenuated the association between Lp-PLA2-A and the primary endpoint (adjusted hazard ratio 1.04, 95% CI 0.97-1.11 for every 30 nmol/min/mL increase). CONCLUSIONS Higher levels of Lp-PLA2-A in the acute period are associated with increased short-term risk of recurrent vascular events.
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Affiliation(s)
- Jinxi Lin
- From the Department of Neurology (J. Lin, H.Z., J. Li, X.Z., X.L., C.W., H.L., Yilong Wang, Yongjun Wang), Beijing Tiantan Hospital, Capital Medical University; China National Clinical Research Center for Neurological Diseases (J. Lin, J. Li, X.Z., X.L., C.W., H.L., Yilong Wang, Yongjun Wang); Center of Stroke (J. Lin, H.Z., J. Li, X.Z., X.L., C.W., H.L., Yilong Wang, Yongjun Wang), Beijing Institute for Brain Disorders; Beijing Key Laboratory of Translational Medicine for Cerebrovascular Disease (J. Lin, J. Li, X.Z., X.L., C.W., H.L., Yilong Wang, Yongjun Wang), China; Department of Neurology (B.L.C., M.T.M.), University of Pennsylvania, Philadelphia; and Dell Medical School (S.C.J.), University of Texas-Austin, TX
| | - Hongwei Zheng
- From the Department of Neurology (J. Lin, H.Z., J. Li, X.Z., X.L., C.W., H.L., Yilong Wang, Yongjun Wang), Beijing Tiantan Hospital, Capital Medical University; China National Clinical Research Center for Neurological Diseases (J. Lin, J. Li, X.Z., X.L., C.W., H.L., Yilong Wang, Yongjun Wang); Center of Stroke (J. Lin, H.Z., J. Li, X.Z., X.L., C.W., H.L., Yilong Wang, Yongjun Wang), Beijing Institute for Brain Disorders; Beijing Key Laboratory of Translational Medicine for Cerebrovascular Disease (J. Lin, J. Li, X.Z., X.L., C.W., H.L., Yilong Wang, Yongjun Wang), China; Department of Neurology (B.L.C., M.T.M.), University of Pennsylvania, Philadelphia; and Dell Medical School (S.C.J.), University of Texas-Austin, TX
| | - Brett L Cucchiara
- From the Department of Neurology (J. Lin, H.Z., J. Li, X.Z., X.L., C.W., H.L., Yilong Wang, Yongjun Wang), Beijing Tiantan Hospital, Capital Medical University; China National Clinical Research Center for Neurological Diseases (J. Lin, J. Li, X.Z., X.L., C.W., H.L., Yilong Wang, Yongjun Wang); Center of Stroke (J. Lin, H.Z., J. Li, X.Z., X.L., C.W., H.L., Yilong Wang, Yongjun Wang), Beijing Institute for Brain Disorders; Beijing Key Laboratory of Translational Medicine for Cerebrovascular Disease (J. Lin, J. Li, X.Z., X.L., C.W., H.L., Yilong Wang, Yongjun Wang), China; Department of Neurology (B.L.C., M.T.M.), University of Pennsylvania, Philadelphia; and Dell Medical School (S.C.J.), University of Texas-Austin, TX
| | - Jiejie Li
- From the Department of Neurology (J. Lin, H.Z., J. Li, X.Z., X.L., C.W., H.L., Yilong Wang, Yongjun Wang), Beijing Tiantan Hospital, Capital Medical University; China National Clinical Research Center for Neurological Diseases (J. Lin, J. Li, X.Z., X.L., C.W., H.L., Yilong Wang, Yongjun Wang); Center of Stroke (J. Lin, H.Z., J. Li, X.Z., X.L., C.W., H.L., Yilong Wang, Yongjun Wang), Beijing Institute for Brain Disorders; Beijing Key Laboratory of Translational Medicine for Cerebrovascular Disease (J. Lin, J. Li, X.Z., X.L., C.W., H.L., Yilong Wang, Yongjun Wang), China; Department of Neurology (B.L.C., M.T.M.), University of Pennsylvania, Philadelphia; and Dell Medical School (S.C.J.), University of Texas-Austin, TX
| | - Xingquan Zhao
- From the Department of Neurology (J. Lin, H.Z., J. Li, X.Z., X.L., C.W., H.L., Yilong Wang, Yongjun Wang), Beijing Tiantan Hospital, Capital Medical University; China National Clinical Research Center for Neurological Diseases (J. Lin, J. Li, X.Z., X.L., C.W., H.L., Yilong Wang, Yongjun Wang); Center of Stroke (J. Lin, H.Z., J. Li, X.Z., X.L., C.W., H.L., Yilong Wang, Yongjun Wang), Beijing Institute for Brain Disorders; Beijing Key Laboratory of Translational Medicine for Cerebrovascular Disease (J. Lin, J. Li, X.Z., X.L., C.W., H.L., Yilong Wang, Yongjun Wang), China; Department of Neurology (B.L.C., M.T.M.), University of Pennsylvania, Philadelphia; and Dell Medical School (S.C.J.), University of Texas-Austin, TX
| | - Xianhong Liang
- From the Department of Neurology (J. Lin, H.Z., J. Li, X.Z., X.L., C.W., H.L., Yilong Wang, Yongjun Wang), Beijing Tiantan Hospital, Capital Medical University; China National Clinical Research Center for Neurological Diseases (J. Lin, J. Li, X.Z., X.L., C.W., H.L., Yilong Wang, Yongjun Wang); Center of Stroke (J. Lin, H.Z., J. Li, X.Z., X.L., C.W., H.L., Yilong Wang, Yongjun Wang), Beijing Institute for Brain Disorders; Beijing Key Laboratory of Translational Medicine for Cerebrovascular Disease (J. Lin, J. Li, X.Z., X.L., C.W., H.L., Yilong Wang, Yongjun Wang), China; Department of Neurology (B.L.C., M.T.M.), University of Pennsylvania, Philadelphia; and Dell Medical School (S.C.J.), University of Texas-Austin, TX
| | - Chunxue Wang
- From the Department of Neurology (J. Lin, H.Z., J. Li, X.Z., X.L., C.W., H.L., Yilong Wang, Yongjun Wang), Beijing Tiantan Hospital, Capital Medical University; China National Clinical Research Center for Neurological Diseases (J. Lin, J. Li, X.Z., X.L., C.W., H.L., Yilong Wang, Yongjun Wang); Center of Stroke (J. Lin, H.Z., J. Li, X.Z., X.L., C.W., H.L., Yilong Wang, Yongjun Wang), Beijing Institute for Brain Disorders; Beijing Key Laboratory of Translational Medicine for Cerebrovascular Disease (J. Lin, J. Li, X.Z., X.L., C.W., H.L., Yilong Wang, Yongjun Wang), China; Department of Neurology (B.L.C., M.T.M.), University of Pennsylvania, Philadelphia; and Dell Medical School (S.C.J.), University of Texas-Austin, TX
| | - Hao Li
- From the Department of Neurology (J. Lin, H.Z., J. Li, X.Z., X.L., C.W., H.L., Yilong Wang, Yongjun Wang), Beijing Tiantan Hospital, Capital Medical University; China National Clinical Research Center for Neurological Diseases (J. Lin, J. Li, X.Z., X.L., C.W., H.L., Yilong Wang, Yongjun Wang); Center of Stroke (J. Lin, H.Z., J. Li, X.Z., X.L., C.W., H.L., Yilong Wang, Yongjun Wang), Beijing Institute for Brain Disorders; Beijing Key Laboratory of Translational Medicine for Cerebrovascular Disease (J. Lin, J. Li, X.Z., X.L., C.W., H.L., Yilong Wang, Yongjun Wang), China; Department of Neurology (B.L.C., M.T.M.), University of Pennsylvania, Philadelphia; and Dell Medical School (S.C.J.), University of Texas-Austin, TX
| | - Michael T Mullen
- From the Department of Neurology (J. Lin, H.Z., J. Li, X.Z., X.L., C.W., H.L., Yilong Wang, Yongjun Wang), Beijing Tiantan Hospital, Capital Medical University; China National Clinical Research Center for Neurological Diseases (J. Lin, J. Li, X.Z., X.L., C.W., H.L., Yilong Wang, Yongjun Wang); Center of Stroke (J. Lin, H.Z., J. Li, X.Z., X.L., C.W., H.L., Yilong Wang, Yongjun Wang), Beijing Institute for Brain Disorders; Beijing Key Laboratory of Translational Medicine for Cerebrovascular Disease (J. Lin, J. Li, X.Z., X.L., C.W., H.L., Yilong Wang, Yongjun Wang), China; Department of Neurology (B.L.C., M.T.M.), University of Pennsylvania, Philadelphia; and Dell Medical School (S.C.J.), University of Texas-Austin, TX
| | - S Claiborne Johnston
- From the Department of Neurology (J. Lin, H.Z., J. Li, X.Z., X.L., C.W., H.L., Yilong Wang, Yongjun Wang), Beijing Tiantan Hospital, Capital Medical University; China National Clinical Research Center for Neurological Diseases (J. Lin, J. Li, X.Z., X.L., C.W., H.L., Yilong Wang, Yongjun Wang); Center of Stroke (J. Lin, H.Z., J. Li, X.Z., X.L., C.W., H.L., Yilong Wang, Yongjun Wang), Beijing Institute for Brain Disorders; Beijing Key Laboratory of Translational Medicine for Cerebrovascular Disease (J. Lin, J. Li, X.Z., X.L., C.W., H.L., Yilong Wang, Yongjun Wang), China; Department of Neurology (B.L.C., M.T.M.), University of Pennsylvania, Philadelphia; and Dell Medical School (S.C.J.), University of Texas-Austin, TX
| | - Yilong Wang
- From the Department of Neurology (J. Lin, H.Z., J. Li, X.Z., X.L., C.W., H.L., Yilong Wang, Yongjun Wang), Beijing Tiantan Hospital, Capital Medical University; China National Clinical Research Center for Neurological Diseases (J. Lin, J. Li, X.Z., X.L., C.W., H.L., Yilong Wang, Yongjun Wang); Center of Stroke (J. Lin, H.Z., J. Li, X.Z., X.L., C.W., H.L., Yilong Wang, Yongjun Wang), Beijing Institute for Brain Disorders; Beijing Key Laboratory of Translational Medicine for Cerebrovascular Disease (J. Lin, J. Li, X.Z., X.L., C.W., H.L., Yilong Wang, Yongjun Wang), China; Department of Neurology (B.L.C., M.T.M.), University of Pennsylvania, Philadelphia; and Dell Medical School (S.C.J.), University of Texas-Austin, TX.
| | - Yongjun Wang
- From the Department of Neurology (J. Lin, H.Z., J. Li, X.Z., X.L., C.W., H.L., Yilong Wang, Yongjun Wang), Beijing Tiantan Hospital, Capital Medical University; China National Clinical Research Center for Neurological Diseases (J. Lin, J. Li, X.Z., X.L., C.W., H.L., Yilong Wang, Yongjun Wang); Center of Stroke (J. Lin, H.Z., J. Li, X.Z., X.L., C.W., H.L., Yilong Wang, Yongjun Wang), Beijing Institute for Brain Disorders; Beijing Key Laboratory of Translational Medicine for Cerebrovascular Disease (J. Lin, J. Li, X.Z., X.L., C.W., H.L., Yilong Wang, Yongjun Wang), China; Department of Neurology (B.L.C., M.T.M.), University of Pennsylvania, Philadelphia; and Dell Medical School (S.C.J.), University of Texas-Austin, TX.
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Tai W, Garcia M, Mlynash M, Kemp S, Albers GW, Olivot JM. Lipoprotein phospholipase A2 mass and activity are not associated with the diagnosis of acute brain ischemia. Cerebrovasc Dis 2014; 38:324-7. [PMID: 25428761 DOI: 10.1159/000368218] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/27/2014] [Accepted: 09/08/2014] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND Elevated lipoprotein-associated phospholipase A2 (Lp-PLA2) levels are associated with both coronary artery and cerebrovascular diseases. The clinical diagnosis of neurovascular events, specifically transient ischemic attack can be challenging, although there is disagreement among vascular trained neurologists regarding this. Currently, there is no single accurate biomarker for the diagnosis of acute brain ischemia. AIM We studied the relationship between Lp-PLA2 mass and activity levels and the diagnosis of acute brain ischemia in the acute phase among patients evaluated in the emergency department following transient focal neurological symptoms. METHODS Patients evaluated in our academic center for transient neurological symptoms of possible ischemic mechanism were enrolled with informed consent. Lp-PLA2 mass and activity levels were performed by DiaDexus, Inc. RESULTS 100 patients were enrolled: 58 were ischemic (30 stroke, 28 TIA), 10 were unknown, and 28 were non-ischemic. Blood samples were collected after a median delay of 23 h (IQR: 17, 36) after symptom onset. The median levels of Lp-PLA2 activity level for ischemic (stroke and TIA) versus non-ischemic events were 186.5 nmol/ml/min (IQR = 153, 216.3) and 169 nmol/ml/min (IQR = 137, 212.5), respectively. The median levels of Lp-PLA2 mass level for ischemic versus non-ischemic events were 202 ng/ml (IQR = 171.6, 226.1) and 192 ng/ml (167.8, 230). The differences in median Lp-PLA2 mass and activity levels were not statistically significant in the ischemic versus non-ischemic patients. Vessel imaging revealed a symptomatic stenosis in 14 patients (10 intracranial and 4 cervical). The median Lp-PLA2 mass and activity levels among patients with a symptomatic stenosis were not significantly higher than the levels measured in TIA/stroke patients without stenosis. CONCLUSION The results of our study do not support the early measurement of Lp-PLA2 mass or activity levels for confirming an ischemic etiology in patients experiencing minor or transient focal neurological events.
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Riba-Llena I, Penalba A, Pelegrí D, Vilar A, Jarca CI, Filomena J, Montaner J, Delgado P. Role of lipoprotein-associated phospholipase A2 activity for the prediction of silent brain infarcts in women. Atherosclerosis 2014; 237:811-5. [PMID: 25463126 DOI: 10.1016/j.atherosclerosis.2014.11.003] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/21/2014] [Revised: 10/15/2014] [Accepted: 11/04/2014] [Indexed: 11/29/2022]
Abstract
OBJECTIVES Lipoprotein-associated phospholipase A2 (Lp-PLA2), predicts risk of coronary events and stroke and might be associated with cerebral small vessel disease. We aimed to determine whether silent brain infarcts relate to Lp-PLA2 activity and also, whether the addition of Lp-PLA2 activity to prognostic clinical models improves silent brain infarcts' discrimination. METHODS Cross-sectional study in 921 stroke-free individuals. On baseline, demographic and vascular risk factors were collected and a brain magnetic resonance was performed to assess for the presence of silent brain infarcts. Serum Lp-PLA2 activity was tested by an enzymatic assay (PLAC Test for activity) for all study participants and 49 healthy individuals free of vascular risk factors. Multivariate analysis and Integrated Discrimination Improvement were performed to assess whether Lp-PLA2 activity was independently associated with silent brain infarcts and improved their discrimination added to clinical variables. RESULTS Lp-PLA2 activity was independently associated with silent brain infarcts in women (OR per one standard deviation increase: 2.14, from 1.31 to 3.50) but not in men (OR = 1.09, from 0.81 to 1.48) after adjustment by age, diastolic blood pressure, total cholesterol, statin treatment and other potential confounders. Adding Lp-PLA2 to clinical information for SBIs diagnosis resulted in a non-significant and mild improvement in discrimination (IDI = 3.1%) in women. CONCLUSIONS Although Lp-PLA2 is independently associated with silent brain infarcts in women, its addition to clinical variables does not lead to any improvement in their prediction.
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Affiliation(s)
- Iolanda Riba-Llena
- Neurovascular Research Lab, Institut de Recerca Vall d'Hebron (VHIR), Universitat Autònoma de Barcelona (UAB), Barcelona, Spain
| | - Anna Penalba
- Neurovascular Research Lab, Institut de Recerca Vall d'Hebron (VHIR), Universitat Autònoma de Barcelona (UAB), Barcelona, Spain
| | - Dolors Pelegrí
- Clinical Biochemistry Unit, Hospital Universitari Vall d'Hebron, Barcelona, Spain
| | - Andrea Vilar
- Neurovascular Research Lab, Institut de Recerca Vall d'Hebron (VHIR), Universitat Autònoma de Barcelona (UAB), Barcelona, Spain
| | | | - Josefina Filomena
- Clot Primary Care Center, Institut Català de Salut, Barcelona, Spain
| | - Joan Montaner
- Neurovascular Research Lab, Institut de Recerca Vall d'Hebron (VHIR), Universitat Autònoma de Barcelona (UAB), Barcelona, Spain; Stroke Unit and Neurology Department, Hospital Universitari Vall d'Hebron, Barcelona, Spain
| | - Pilar Delgado
- Neurovascular Research Lab, Institut de Recerca Vall d'Hebron (VHIR), Universitat Autònoma de Barcelona (UAB), Barcelona, Spain.
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Karlinski M, Bembenek J, Grabska K, Kobayashi A, Baranowska A, Litwin T, Czlonkowska A. Routine serum C-reactive protein and stroke outcome after intravenous thrombolysis. Acta Neurol Scand 2014; 130:305-11. [PMID: 24571644 DOI: 10.1111/ane.12227] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/14/2014] [Indexed: 02/03/2023]
Abstract
OBJECTIVES The clinical usefulness of blood biomarkers in acute stroke is not yet fully established, especially after thrombolytic therapy. Our aim was to investigate the association between routine serum C-reactive protein (CRP) measured within 24 h after admission and outcome in ischaemic stroke patients treated with intravenous thrombolysis, adjusting for a history of recent infection. METHODS We analysed the data of consecutive stroke patients who received intravenous alteplase in our centre between October 2003 and December 2011, collected in a detailed prospective registry. Routine serum CRP was measured within 24 h from admission; concentration >5 ng/ml was considered elevated. RESULTS Serum CRP was measured in 341 of 406 stroke patients treated with alteplase. Patients with elevated CRP (135/341, 42.5%) compared to those with normal CRP values, were significantly older, more frequently presented with a preexisting disability, comorbidities and suffered more severe strokes. They had a higher proportion of symptomatic intracranial haemorrhage according to ECASS II definition (7.2% vs 1.6%, P = 0.010), higher 3-month mortality (25.6% vs 11.3%, P = 0.001), and were less frequently alive and independent after 3 months (45.9% vs 63.7%, P = 0.002). However, those associations were not confirmed after adjustment for age, stroke severity, diabetes, congestive heart failure, lack of prestroke disability and signs of recent infection. CONCLUSIONS According to our findings, elevated routine serum CRP measured within 24 h after admission does not seem to independently affect the outcome in patients receiving intravenous thrombolysis for stroke. However, further studies of blood samples taken directly before the treatment are needed.
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Affiliation(s)
- M. Karlinski
- 2nd Department of Neurology; Institute of Psychiatry and Neurology; Warsaw Poland
| | - J. Bembenek
- 2nd Department of Neurology; Institute of Psychiatry and Neurology; Warsaw Poland
| | - K. Grabska
- 2nd Department of Neurology; Institute of Psychiatry and Neurology; Warsaw Poland
| | - A. Kobayashi
- 2nd Department of Neurology; Institute of Psychiatry and Neurology; Warsaw Poland
- Interventional Stroke Treatment Centre; Institute of Psychiatry and Neurology; Warsaw Poland
| | - A. Baranowska
- 2nd Department of Neurology; Institute of Psychiatry and Neurology; Warsaw Poland
| | - T. Litwin
- 2nd Department of Neurology; Institute of Psychiatry and Neurology; Warsaw Poland
| | - A. Czlonkowska
- 2nd Department of Neurology; Institute of Psychiatry and Neurology; Warsaw Poland
- Department of Experimental and Clinical Pharmacology; Medical University of Warsaw; Warsaw Poland
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Elkind MSV, Luna JM, McClure LA, Zhang Y, Coffey CS, Roldan A, Del Brutto OH, Pretell EJ, Pettigrew LC, Meyer BC, Tapia J, White C, Benavente OR. C-reactive protein as a prognostic marker after lacunar stroke: levels of inflammatory markers in the treatment of stroke study. Stroke 2014; 45:707-16. [PMID: 24523037 DOI: 10.1161/strokeaha.113.004562] [Citation(s) in RCA: 61] [Impact Index Per Article: 6.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
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.
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Affiliation(s)
- Mitchell S V Elkind
- 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 of Medicine, Universidad Espíritu Santo-Ecuador, Guayaquil, Ecuador (O.H.D.B.); Department of Neurology, Hospital Alberto Sabogal, Lima, Peru (E.J.P.); Department of Neurology, University of Kentucky, Lexington, KY (L.C.P.); Department of Neurology, University of San Diego, San Diego, CA (B.C.M.); Department of Neurology, Pontificia Universidad Católica de Chile, Santiago, Chile (J.T.); School of Nursing and Secondary Prevention of Small Subcortical Strokes (SPS3) Coordinating Center, University of Texas Health Science Center at San Antonio, San Antonio, TX (C.W.); and Department of Medicine, Division of Neurology, University of British Columbia, Vancouver, BC, Canada (O.R.B.)
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Di Napoli M, Elkind MSV, Godoy DA, Singh P, Papa F, Popa-Wagner A. Role of C-reactive protein in cerebrovascular disease: a critical review. Expert Rev Cardiovasc Ther 2014; 9:1565-84. [DOI: 10.1586/erc.11.159] [Citation(s) in RCA: 52] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/08/2023]
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Cheung CYL, Tay WT, Ikram MK, Ong YT, De Silva DA, Chow KY, Wong TY. Retinal Microvascular Changes and Risk of Stroke. Stroke 2013; 44:2402-8. [DOI: 10.1161/strokeaha.113.001738] [Citation(s) in RCA: 86] [Impact Index Per Article: 7.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Background and Purpose—
To examine the relationship between retinal microvascular measures and incident stroke in an Asian Malay population.
Methods—
We conducted a prospective, population-based cohort study of Asian Malay persons 40 to 80 years at baseline. Retinal microvascular signs were assessed from baseline retinal photographs including quantitative retinal microvascular parameters (caliber, branching angle, tortuosity, and fractal dimension) and qualitative retinopathy signs. Incident stroke cases were identified during the follow-up period. Cox proportional-hazards regression and incremental usefulness analysis (calibration, discrimination, and reclassification) were performed.
Results—
A total of 3189 participants were free of prevalent stroke at baseline. During the follow-up (median, 4.41 years), 51 (1.93%) participants had an incident stroke event. In Cox proportional-hazards models adjusting for established stroke predictors (age, sex, systolic blood pressure, total cholesterol, low-density lipoprotein cholesterol, smoking, glycosylated hemoglobin, and antihypertensive medication), retinopathy (hazard ratio, 1.94; 95% confidence interval, 1.01–3.72) and larger retinal venular caliber (hazard ratio, 3.28; 95% confidence interval, 1.30–8.26, comparing fourth versus first quartiles) were associated with risk of stroke. Compared with the model with only established risk factors, the addition of retinal measures improved the prediction of stroke (C-Statistic 0.826 versus 0.792;
P
=0.017) and correctly reclassified 5.9% of participants with incident stroke and 3.4% of participants with no incident stroke.
Conclusions—
Retinal microvascular changes are related to an increased risk of stroke in Asian Malay, consistent with data from white populations. Retinal imaging improves the discrimination and stratification of stroke risk beyond that of established risk factors by a significant but small margin.
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Affiliation(s)
- Carol Yim-lui Cheung
- From the Singapore Eye Research Institute, Singapore National Eye Centre, Singapore (C.Y.C., W.T.T., M.K.I., Y.T.O., T.Y.W.); Department of Ophthalmology, Yong Loo Lin School of Medicine, National University of Singapore, Singapore (C.Y.C., M.K.I., Y.T.O., T.Y.W.); Centre for Quantitative Medicine, Duke-NUS Graduate Medical School, Singapore (C.Y.C.); Memory Aging and Cognition Centre, National University Health System, Singapore (M.K.I.); Department of Neurology, Singapore General Hospital Campus,
| | - Wan Ting Tay
- From the Singapore Eye Research Institute, Singapore National Eye Centre, Singapore (C.Y.C., W.T.T., M.K.I., Y.T.O., T.Y.W.); Department of Ophthalmology, Yong Loo Lin School of Medicine, National University of Singapore, Singapore (C.Y.C., M.K.I., Y.T.O., T.Y.W.); Centre for Quantitative Medicine, Duke-NUS Graduate Medical School, Singapore (C.Y.C.); Memory Aging and Cognition Centre, National University Health System, Singapore (M.K.I.); Department of Neurology, Singapore General Hospital Campus,
| | - M. Kamran Ikram
- From the Singapore Eye Research Institute, Singapore National Eye Centre, Singapore (C.Y.C., W.T.T., M.K.I., Y.T.O., T.Y.W.); Department of Ophthalmology, Yong Loo Lin School of Medicine, National University of Singapore, Singapore (C.Y.C., M.K.I., Y.T.O., T.Y.W.); Centre for Quantitative Medicine, Duke-NUS Graduate Medical School, Singapore (C.Y.C.); Memory Aging and Cognition Centre, National University Health System, Singapore (M.K.I.); Department of Neurology, Singapore General Hospital Campus,
| | - Yi Ting Ong
- From the Singapore Eye Research Institute, Singapore National Eye Centre, Singapore (C.Y.C., W.T.T., M.K.I., Y.T.O., T.Y.W.); Department of Ophthalmology, Yong Loo Lin School of Medicine, National University of Singapore, Singapore (C.Y.C., M.K.I., Y.T.O., T.Y.W.); Centre for Quantitative Medicine, Duke-NUS Graduate Medical School, Singapore (C.Y.C.); Memory Aging and Cognition Centre, National University Health System, Singapore (M.K.I.); Department of Neurology, Singapore General Hospital Campus,
| | - Deidre A. De Silva
- From the Singapore Eye Research Institute, Singapore National Eye Centre, Singapore (C.Y.C., W.T.T., M.K.I., Y.T.O., T.Y.W.); Department of Ophthalmology, Yong Loo Lin School of Medicine, National University of Singapore, Singapore (C.Y.C., M.K.I., Y.T.O., T.Y.W.); Centre for Quantitative Medicine, Duke-NUS Graduate Medical School, Singapore (C.Y.C.); Memory Aging and Cognition Centre, National University Health System, Singapore (M.K.I.); Department of Neurology, Singapore General Hospital Campus,
| | - Khuan Yew Chow
- From the Singapore Eye Research Institute, Singapore National Eye Centre, Singapore (C.Y.C., W.T.T., M.K.I., Y.T.O., T.Y.W.); Department of Ophthalmology, Yong Loo Lin School of Medicine, National University of Singapore, Singapore (C.Y.C., M.K.I., Y.T.O., T.Y.W.); Centre for Quantitative Medicine, Duke-NUS Graduate Medical School, Singapore (C.Y.C.); Memory Aging and Cognition Centre, National University Health System, Singapore (M.K.I.); Department of Neurology, Singapore General Hospital Campus,
| | - Tien Yin Wong
- From the Singapore Eye Research Institute, Singapore National Eye Centre, Singapore (C.Y.C., W.T.T., M.K.I., Y.T.O., T.Y.W.); Department of Ophthalmology, Yong Loo Lin School of Medicine, National University of Singapore, Singapore (C.Y.C., M.K.I., Y.T.O., T.Y.W.); Centre for Quantitative Medicine, Duke-NUS Graduate Medical School, Singapore (C.Y.C.); Memory Aging and Cognition Centre, National University Health System, Singapore (M.K.I.); Department of Neurology, Singapore General Hospital Campus,
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Martínez-Rodríguez JE, Munné-Collado J, Rasal R, Cuadrado E, Roig L, Ois A, Muntasell A, Baro T, Alameda F, Roquer J, López-Botet M. Expansion of the NKG2C+ natural killer-cell subset is associated with high-risk carotid atherosclerotic plaques in seropositive patients for human cytomegalovirus. Arterioscler Thromb Vasc Biol 2013; 33:2653-9. [PMID: 23968979 DOI: 10.1161/atvbaha.113.302163] [Citation(s) in RCA: 30] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
OBJECTIVE Human cytomegalovirus (HCMV), a pathogen involved in the development and progression of atherosclerosis, promotes in some individuals a marked reconfiguration of the natural killer (NK)-cell compartment whose hallmark is a persistent expansion of a peripheral blood NK-cell subset expressing the CD94/NKG2C NK receptor. We aimed to evaluate whether the HCMV-associated NK-cell compartment reconfiguration is related to carotid atherosclerotic plaque (CAP) instability. APPROACH AND RESULTS NK receptor expression (ie, LILRB1, NKG2A, NKG2C, and killer immunoglobulin-like receptors [KIR]) by peripheral NK and T cells was evaluated in 40 patients with HCMV+ with CAP, including nonatherosclerotic strokes (n=15) and healthy subjects (n=11) as controls. High-risk CAP (n=16), defined as carotid stenosis >50% with ipsilateral neurological symptomatology in the previous 180 days, compared with non-high-risk CAP had higher %NKG2C+ NK cells (29.5 ± 22.4% versus 16.3 ± 13.2%; P=0.026; odds ratio, 1.053; 95% confidence interval, 1.002-1.106; P=0.042), with a corresponding reduction in the NKG2A+ NK subset (31.7 ± 17.8% versus 41.8 ± 15.8%; P=0.072). The proportions of NKG2C+ NK cells in high-risk CAP were inversely correlated with the CD4+/CD8+ ratio (R(Spearman)=-0.629; P=0.009) and directly with high-sensitivity C-reactive protein levels (R(Pearson) = 0.591; P=0.012), consistent with higher subclinical systemic inflammation. The intraplaque inflammatory infiltrate, evaluated in 27 CAP obtained after endarterectomy, showed a higher presence of subintimal CD3+ lymphocytes in those patients with HCMV-induced changes in the peripheral NK- and T-cell compartments. CONCLUSIONS The expansion of NKG2C+ NK cells in patients with CAP seems to be associated with an increased risk of plaque destabilization in some patients with chronic HCMV infection.
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Affiliation(s)
- Jose Enrique Martínez-Rodríguez
- From the Neurology Service (J.E.M.-R., R.R., E.C., A.O., J.R.) and Immunology Unit (A.M., M.L.-B.), Hospital del Mar Medical Research Institute (IMIM), Universitat Pompeu Fabra, Barcelona, Spain; and Department of Pathology (J.M.-C., T.B., F.A.) and Vascular Surgery Department (L.R.), Hospital del Mar, Universidad Autónoma de Barcelona, Barcelona, Spain
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Therapeutic Options to Reduce Lp-PLA2 Levels and the Potential Impact on Vascular Risk Reduction. CURRENT TREATMENT OPTIONS IN CARDIOVASCULAR MEDICINE 2013; 15:313-21. [DOI: 10.1007/s11936-013-0239-4] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
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Maravic-Stojkovic V, Lausevic-Vuk LJ, Obradovic M, Jovanovic P, Tanaskovic S, Stojkovic B, Isenovic RE, Radak DJ. Copeptin Level After Carotid Endarterectomy and Perioperative Stroke. Angiology 2013; 65:122-9. [DOI: 10.1177/0003319712473637] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/09/2023]
Abstract
We evaluated the prognostic value of copeptin levels in a cohort of surgical patients after elective carotid endarterectomy (CEA). Twenty-one patients with perioperative stroke were prospectively recruited. The diagnosis of cerebrovascular event (CVE) was confirmed by computed tomography. Additionally, 21 patients with CEA without any complications (control patients) were enrolled. Blood samples were taken within 3 hours of the symptom onset. Circulating copeptin level was significantly higher in patients with CVE when compared to controls ( P = .025), and significantly higher in nonsurvivors than in survivors ( P = .030) after CVE. Plasma concentrations of interleukin 6 (IL-6) and C-reactive protein (CRP) were also elevated in patients with CVE (IL-6: P = .043; CRP: P = .002). We conclude that the activation of the stress axis in patients with CEA results with copeptin elevation, but more so in patients with perioperative stroke. Copeptin may be a helpful biomarker for stroke risk assessment in patients after CEA.
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Affiliation(s)
- Vera Maravic-Stojkovic
- Dedinje Cardiovascular Institute, Belgrade University School of Medicine, Belgrade, Serbia
| | - L. J. Lausevic-Vuk
- Dedinje Cardiovascular Institute, Belgrade University School of Medicine, Belgrade, Serbia
| | - M. Obradovic
- Vinca Institute, Laboratory for Molecular Genetics and Radiobiology, University of Belgrade, Serbia
| | - P. Jovanovic
- Dedinje Cardiovascular Institute, Belgrade University School of Medicine, Belgrade, Serbia
| | - S. Tanaskovic
- Dedinje Cardiovascular Institute, Belgrade University School of Medicine, Belgrade, Serbia
| | - B. Stojkovic
- SRC, Belgrade University School of Medicine, Belgrade, Serbia
| | - R. E. Isenovic
- Vinca Institute, Laboratory for Molecular Genetics and Radiobiology, University of Belgrade, Serbia
| | - D. J. Radak
- Dedinje Cardiovascular Institute, Belgrade University School of Medicine, Belgrade, Serbia
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W van Lammeren G, L Moll F, Borst GJD, de Kleijn DPV, P M de Vries JP, Pasterkamp G. Atherosclerotic plaque biomarkers: beyond the horizon of the vulnerable plaque. Curr Cardiol Rev 2012; 7:22-7. [PMID: 22294971 PMCID: PMC3131712 DOI: 10.2174/157340311795677680] [Citation(s) in RCA: 27] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/16/2010] [Revised: 10/16/2010] [Accepted: 01/07/2011] [Indexed: 01/28/2023] Open
Abstract
Cardiovascular disease (CVD) is the number one cause of death globally, and the majority of CVD is caused by atherosclerosis. Atherosclerosis is a systemic inflammatory disease that leads to myocardial infarction, stroke and lower limb ischemia. Pathological studies have given insight to development of atherosclerosis and the importance of local plaque vulnerability, leading to thrombus formation and cardiovascular events. Due to the burden of cardiovascular disease, identification of patients at risk for cardiovascular events and treatment stratification is needed. The predictive power of classical risk factors is limited, especially in patients with manifest atherosclerosis. Imaging modalities have focused on the characteristics of the vulnerable plaque. However, it has become evident that not all so-called vulnerable plaques lead to rupture and subsequent thrombosis. The latter obviously limits the positive predictive value for imaging assessment of plaques and patients at risk. Serum biomarkers have also been studied extensively, but have very limited application in a clinical setting for risk stratification. In line with the important relation between vulnerable plaques and cardiovascular events, plaque biomarker studies have been initiated. These longitudinal studies are based on the concept, that a vulnerable plaque contains predictive information for future cardiovascular events, also in other territories of the vascular tree. Results look promising and plaque markers can be used to develop imaging modalities to identify patients at risk, or to monitor treatment effect. Plaque biomarker studies do not challenge the definition of the vulnerable plaque, but use its concept in favor of prediction improvement for vascular patients.
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Affiliation(s)
- Guus W van Lammeren
- Experimental Cardiology Laboratory, University Medical Center Utrecht, The Netherlands
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Gregson J, Stirnadel-Farrant HA, Doobaree IU, Koro C. Variation of lipoprotein associated phospholipase A2 across demographic characteristics and cardiovascular risk factors: a systematic review of the literature. Atherosclerosis 2012; 225:11-21. [PMID: 22784637 DOI: 10.1016/j.atherosclerosis.2012.06.020] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/26/2012] [Revised: 06/11/2012] [Accepted: 06/13/2012] [Indexed: 12/23/2022]
Abstract
BACKGROUND Lipoprotein association phospholipase A2 (Lp-PLA(2)), an enzyme which has been found in atherosclerotic plaque is currently under investigation in large Phase III clinical trials of vascular disease prevention. We assessed in a variety of different population settings variation of Lp-PLA(2) mass and activity across gender, ethnicity, diabetes, kidney disease and metabolic syndrome. We also assessed correlations with measures of circulating lipids, systemic inflammation and adiposity. METHODS Systematic review of studies measuring Lp-PLA(2) and at least one of the relevant characteristics in >50 participants. RESULTS We identified a total of 77 studies involving 102,499 participants meeting the inclusion criteria. Lp-PLA(2) mass and activity were consistently approximately 10% higher in males than females and 15% higher in Caucasians than African Americans or Hispanics. There were no clear associations of Lp-PLA(2) mass or activity with type II diabetes, markers of systemic inflammation (C-reactive protein, fibrinogen) or with body mass index. Correlations of Lp-PLA(2) mass or activity with low density lipoprotein cholesterol and apolipoprotein B were moderate and positive, whilst correlations with high density lipoprotein cholesterol were negative and moderate to weak. There was no clear differences in associations with any of the above characteristics in groups defined based upon prevalent cardiovascular disease or its risk factors. CONCLUSIONS Despite considerable variability in absolute levels of Lp-PLA(2) across studies, the variability of Lp-PLA(2) across gender, ethnicity, and levels of circulating lipids and markers of systemic inflammation are more consistent and appear not to vary importantly across categories defined by CVD or its risk factors.
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Affiliation(s)
- John Gregson
- Department of Public Healthy and Primary Care, University of Cambridge, Cambridge CB1 8RN, United Kingdom.
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Temporal profile and prognostic value of Lp-PLA2 mass and activity in the acute stroke setting. Atherosclerosis 2012; 220:532-6. [DOI: 10.1016/j.atherosclerosis.2011.11.016] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/01/2011] [Revised: 10/11/2011] [Accepted: 11/08/2011] [Indexed: 11/18/2022]
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Delgado P, Chacón P, Penalba A, Pelegri D, García-Berrocoso T, Giralt D, Santamarina E, Ribó M, Maisterra O, Alvarez-Sabín J, Rosell A, Montaner J. Lipoprotein-Associated Phospholipase A 2 Activity Is Associated with Large-Artery Atherosclerotic Etiology and Recurrent Stroke in TIA Patients. Cerebrovasc Dis 2012; 33:150-8. [DOI: 10.1159/000334193] [Citation(s) in RCA: 32] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/25/2011] [Accepted: 09/30/2011] [Indexed: 11/19/2022] Open
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Massot A, Pelegri D, Penalba A, Arenillas J, Boada C, Giralt D, Ribó M, Molina CA, Rosell A, Alvarez-Sabín J, Chacón P, Rovira A, Delgado P, Montaner J. Lipoprotein-associated phospholipase A2 testing usefulness among patients with symptomatic intracranial atherosclerotic disease. Atherosclerosis 2011; 218:181-7. [PMID: 21620406 DOI: 10.1016/j.atherosclerosis.2011.04.031] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/27/2010] [Revised: 04/14/2011] [Accepted: 04/21/2011] [Indexed: 10/18/2022]
Abstract
BACKGROUND AND PURPOSE Circulating lipoprotein-associated phospholipase A(2) (Lp-PLA(2)) has emerged as a novel biomarker for cardiovascular diseases. Our aim was to determine Lp-PLA(2) mass and activity in a selected cohort of first-ever transient ischemic attack (TIA) or ischemic stroke patients with intracranial atherosclerotic disease (ICAD) and to investigate its relationship with the presence of classical vascular risk factors, response to secondary prevention treatments and risk of recurrent vascular events. METHODS Lp-PLA(2) mass and activity were measured 3 months after TIA or stroke by means of the PLAC test and CAM-assay (diaDexus, Inc.) respectively in 75 patients. Classic vascular risk factors, preventive treatments and clinical characteristics at the time of the index event were recorded. Follow-up transcranial Doppler ultrasonography (TCD) was performed and the presence of a new vascular event was assessed every 6 months. RESULTS Several preventive treatments (statins and clopidogrel) were significantly associated with lower Lp-PLA(2) mass and activity. During follow-up (median time 23 months), eighteen patients (24%) suffered a new vascular event. Baseline factors associated with new vascular events were: history of coronary artery disease, number of intracranial stenoses detected by TCD and also Lp-PLA(2) activity, which was the only independent predictor for new vascular events (hazard ratio 2.89; 95% CI 1.029 to 8.096; p=0.044) after multivariate analysis (Cox regression). CONCLUSIONS Lp-PLA(2) activity might be a useful tool to identify intracranial large-artery occlusive disease patients at higher risk of suffering new vascular events.
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Affiliation(s)
- Andreu Massot
- Neurovascular Research Laboratory, Department of Neurology, Autonomous University of Barcelona, Vall d'Hebron Hospital, Barcelona, Spain
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Abstract
Systems biology applies advances in technology and new fields of study including genomics, transcriptomics, proteomics, and metabolomics to the development of new treatments and approaches of care for the critically ill and injured patient. An understanding of systems biology enhances a nurse's ability to implement evidence-based practice and to educate patients and families on novel testing and therapies. Systems biology is an integrated and holistic view of humans in relationship with the environment. Biomarkers are used to measure the presence and severity of disease and are rapidly expanding in systems biology endeavors. A systems biology approach using predictive, preventive, and participatory involvement is being utilized in a plethora of conditions of critical illness and injury including sepsis, cancer, pulmonary disease, and traumatic injuries.
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Abstract
Basic and clinical research provides evidence that inflammatory mechanisms play a central role in the pathogenesis and progression of atherosclerosis, plaque rupture, thrombosis, and stroke. Inflammatory biomarkers such as high-sensitivity C-reactive protein have been identified as predictors of first stroke and prognosis after stroke. The value of high-sensitivity C-reactive protein and other markers may depend on the characteristics of the study population; their utility may be less among populations with high vascular risk. A recent randomized, clinical trial suggests that the use of rosuvastatin therapy in otherwise healthy patients with high-sensitivity C-reactive protein >2 mg/dL can reduce the risk of a first stroke by 50%. The prognostic role of high-sensitivity C-reactive protein among patients after stroke, however, is less clear, and other biomarkers, including lipoprotein-associated phospholipase A(2), may provide complementary information about the risk of stroke recurrence. Infections, moreover, may contribute to inflammation and stroke risk. Although no single infectious organism is likely to be identified as the direct cause of atherosclerosis, summary measures of multiple chronic infectious exposures, or "infectious burden," have been associated with the risk of stroke and atherosclerosis affecting the carotid arteries. Acute infections have also been found to serve as stroke triggers in epidemiologic studies. Recommendations to vaccinate patients with cardiovascular disease against influenza represent the first specific anti-infective strategy to be used in vascular prophylaxis. Further studies are needed to determine the role of treatment of inflammation and infection in stroke prevention.
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Affiliation(s)
- Mitchell S V Elkind
- Departments of Neurology and Epidemiology, Columbia University and New York-Presbyterian Hospital, New York, NY, USA.
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Abstract
Biomarkers are biological parameters that can be objectively measured and quantified as indicators of normal biologic processes, pathogenic processes, or responses to a therapeutic intervention. Typically thought of as disease process screening, diagnosing, or monitoring tools, biomarkers may also be used to determine disease susceptibility and eligibility for specific therapies. Cardiac biomarkers are protein components of cell structures that are released into circulation when myocardial injury occurs. They play a pivotal role in the diagnosis, risk stratification, and treatment of patients with chest pain and suspected acute coronary syndrome and those with acute exacerbations of heart failure. Cardiac markers are central to the new definition of acute myocardial infarction put forward by the American College of Cardiology and the European Society of Cardiology. Active investigation has brought forward an increasingly large number of novel candidate markers but few have withstood the test of time and become integrated into contemporary clinical care because of their readily apparent diagnostic, prognostic, or therapeutic utility.
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van Lammeren G, de Vries JPPM, Vink A, de Kleijn D, Moll F, Pasterkamp G. New Predictors of Adverse Cardiovascular Events Following Vascular Surgery. Semin Cardiothorac Vasc Anesth 2010; 14:148-53. [DOI: 10.1177/1089253210371518] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
With the aging population and the increasing number of patients suffering from diabetes, the incidence of clinical manifestations of atherosclerotic disease is rising. Risk factors for development of atherosclerosis have been described and it is a challenge to develop risk scores that can be applied for individual patients. Specific predictors for progression of atherosclerosis and secondary manifestations of the disease are lacking. The search for new serological and genetic markers predictive for cardiovascular events is an emerging research field. Local plaque instability can give rise to thromboembolic cardiovascular events, which suggests that certain information might be enclosed in local atherosclerotic tissue. Because of the systemic character of atherosclerosis, it can be hypothesized that local plaque characteristics encompass information of other atherosclerotic lesions throughout the vascular tree. Biobank studies with a longitudinal design have been initiated to investigate the link between characteristics of local atherosclerotic tissue and outcome during follow up. These studies might reveal new insights in predictors for cardiovascular outcome for vascular patients at an individual level.
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Affiliation(s)
| | | | - A. Vink
- University Medical Center Utrecht, Utrecht, The Netherlands
| | | | - F.L. Moll
- University Medical Center Utrecht, Utrecht, The Netherlands
| | - G. Pasterkamp
- University Medical Center Utrecht, Utrecht, The Netherlands,
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Elkind MSV, Luna JM, Moon YP, Liu KM, Spitalnik SL, Paik MC, Sacco RL. High-sensitivity C-reactive protein predicts mortality but not stroke: the Northern Manhattan Study. Neurology 2009; 73:1300-7. [PMID: 19841382 DOI: 10.1212/wnl.0b013e3181bd10bc] [Citation(s) in RCA: 65] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022] Open
Abstract
OBJECTIVE To determine whether high-sensitivity C-reactive protein (hsCRP) and serum amyloid A (SAA) predict stroke, vascular events, and mortality in a prospective cohort study. BACKGROUND Markers of inflammation have been associated with risk of myocardial infarction (MI). Their association with stroke is controversial. METHODS The Northern Manhattan Study includes a stroke-free community-based cohort study in participants aged > or =40 years (median follow-up 7.9 years). hsCRP and SAA were measured using nephelometry. Cox proportional hazards models were used to calculate hazard ratios (HR) and 95% confidence intervals (CI) for the association of markers with risk of ischemic stroke and other outcomes after adjusting for demographics and risk factors. RESULTS hsCRP measurements were available in 2,240 participants (mean age 68.9 +/- 10.1 years; 64.2% women; 18.8% white, 23.5% black, and 55.1% Hispanic). The median hsCRP was 2.5 mg/L. Compared with those with hsCRP <1 mg/L, those with hsCRP >3 mg/L were at increased risk of ischemic stroke in a model adjusted for demographics (HR = 1.60, 95% CI 1.06-2.41), but the effect was attenuated after adjusting for other risk factors (adjusted HR = 1.20, 95% CI 0.78-1.86). hsCRP >3 mg/L was associated with risk of MI (adjusted HR = 1.70, 95% CI 1.04-2.77) and death (adjusted HR = 1.55, 95% CI 1.23-1.96). SAA was not associated with stroke risk. CONCLUSION In this multiethnic cohort, high-sensitivity C-reactive protein (hsCRP) was not associated with ischemic stroke, but was modestly associated with myocardial infarction and mortality. The value of hsCRP and serum amyloid A may depend on population characteristics such as age and other risk factors.
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Affiliation(s)
- M S V Elkind
- Department of Neurology, Columbia University College of Physicians and Surgeons, New York, NY 10032, USA.
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Wright CB, Moon Y, Paik MC, Brown TR, Rabbani L, Yoshita M, DeCarli C, Sacco R, Elkind MSV. Inflammatory biomarkers of vascular risk as correlates of leukoariosis. Stroke 2009; 40:3466-71. [PMID: 19696417 DOI: 10.1161/strokeaha.109.559567] [Citation(s) in RCA: 71] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
Abstract
BACKGROUND AND PURPOSE Inflammatory biomarkers, including lipoprotein-associated phospholipase A2 (Lp-PLA2), myeloperoxidase (MPO), and high-sensitivity C-reactive protein (hsCRP) are associated with ischemic stroke risk. White matter hyperintensities (WMH) seen on brain MRI scans are associated with vascular risk factors and an increased risk of incident stroke, but their relation to inflammatory biomarkers is unclear. METHODS The Northern Manhattan Study includes a stroke-free community-based sample of Hispanic, black, and white participants with quantitative measurement of WMH volume (WMHV) and inflammatory biomarkers. We measured the association between Lp-PLA2, MPO, and hsCRP levels, and log-transformed WMHV after adjusting for sociodemographic and vascular risk factors. RESULTS The hsCRP (median, 2.42 mg/L; IQR, 1.04, 5.19), Lp-PLA2 (median, 220.97 ng/mL; IQR, 185.77, 268.05), and MPO (median, 15.14 ng/mL; IQR, 12.32, 19.69) levels were available in 527 The Northern Manhattan Study participants with WMHV data but no subclinical infarcts. Those with hsCRP in the upper quartile (Q4 >4.92 mg/L or >3 mg/L), Lp-PLA2 in Q4 (>or=264.9 ng/mL), or MPO levels in Q3 (15.04-19.39 ng/mL) or Q4 (>19.39 ng/mL) each had greater WMHV, adjusting for sociodemographic and vascular risk factors. Adjusting for all biomarkers simultaneously, WMHV was 1.3-fold greater for Lp-PLA2 levels in Q4 compared to Q1 (beta=0.28; P=0.008) and 1.25-fold greater for MPO levels above the median compared to below (beta=0.22; P=0.02), but hsCRP was not associated with WMHV. CONCLUSIONS Relative elevations of the inflammatory markers Lp-PLA2 and MPO were associated with a greater burden of WMH independent of hsCRP.
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Affiliation(s)
- Clinton B Wright
- Department of Neurology, Miller School of Medicine, University of Miami, Evelyn F McKnight Center for Age-related Memory Loss, Miami, FL 33136, USA.
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