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Kawamoto R, Kikuchi A, Niomiya D, Kumagi T. High-sensitivity C-reactive protein is a predictor of all-cause mortality in a rural Japanese population. J Clin Lab Anal 2024; 38:e25015. [PMID: 38419270 PMCID: PMC10943256 DOI: 10.1002/jcla.25015] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/24/2023] [Revised: 01/01/2024] [Accepted: 01/24/2024] [Indexed: 03/02/2024] Open
Abstract
BACKGROUND High-sensitivity C-reactive protein (hsCRP) is a sensitive marker of inflammation. This study aimed to determine whether increased hsCRP levels are associated with all-cause mortality rate. METHODS We examined data for participants from the 2002 Nomura Cohort Study who attended follow-ups for 20 years (follow-up rate: 93.3%). Of these, 793 were male (aged 61 ± 14 years) and 1040 were female (aged 63 ± 11 years). The Japanese Basic Resident Registry provided data on adjusted relative hazards for all-cause mortality. The data were subjected to a Cox regression analysis using a time variable of age and confounding risk factors. RESULTS The median (interquartile range) follow-up period was 6548 days (6094-7452 days). The follow-up confirmed that there were 632 (34.8%) deaths, of which 319 were male (40.2% of all males) and 313 were female (30.6% of all females). Multivariable-adjusted hazard ratio (1.27; 95% confidence interval, 1.01-1.59) in the highest hsCRP category was also significantly higher compared with reference. A higher hsCRP was associated with a greater risk of all-cause mortality in male participants aged ≥65 years, a BMI < 25 kg/m2 , and no history of CVD or diabetes, and this association was particularly significant among participants with both of the latter two risk factors (p = 0.004 and 0.022 for interaction, respectively). CONCLUSIONS Our results indicate a significant association between hsCRP levels and all-cause mortality in a rural Japanese population. Specifically, hsCRP appears to be a crucial biomarker for predicting long-term survival, particularly among older persons.
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Affiliation(s)
- Ryuichi Kawamoto
- Department of Community MedicineEhime University Graduate School of MedicineToon‐CityEhimeJapan
- Department of Internal MedicineSeiyo Municipal Nomura HospitalSeiyo‐CityEhimeJapan
| | - Asuka Kikuchi
- Department of Community MedicineEhime University Graduate School of MedicineToon‐CityEhimeJapan
- Department of Internal MedicineSeiyo Municipal Nomura HospitalSeiyo‐CityEhimeJapan
| | - Daisuke Niomiya
- Department of Community MedicineEhime University Graduate School of MedicineToon‐CityEhimeJapan
- Department of Internal MedicineSeiyo Municipal Nomura HospitalSeiyo‐CityEhimeJapan
| | - Teru Kumagi
- Department of Community MedicineEhime University Graduate School of MedicineToon‐CityEhimeJapan
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Olesen TB, Pareek M, Vishram-Nielsen JKK, Olsen MH. The influence of age and sex on the prognostic importance of traditional cardiovascular risk factors, selected circulating biomarkers and other markers of subclinical cardiovascular damage. Curr Opin Cardiol 2023; 38:21-31. [PMID: 36598446 DOI: 10.1097/hco.0000000000001005] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/05/2023]
Abstract
PURPOSE OF REVIEW There is an increasing need for improved risk stratification to better individualize cardiovascular preventive measures. Although age and sex are strong and easily obtained cardiovascular risk factors (CVRFs), their influence on the prognostic importance of other CVRF, circulating biomarkers and other markers of subclinical cardiovascular damage has not previously been systematically and critically appraised. Therefore, we have revisited the European MORGAM and the Danish MONI10 cohorts. RECENT FINDINGS Theoretically, the relative risk of many CVRF is expected to be lower in older healthy individuals due to a combination of selection bias by disease, higher absolute risk primarily due to older age, and the fact that the CVRF and markers may primarily influence or reflect early parts of the cardiovascular disease process. This influence of age may vary between sexes, as the cardiovascular disease process is delayed and possibly different in women compared with men. SUMMARY Adjusted for the remaining Systematic COronary Risk Evaluation (SCORE) CVRF, higher SBP, serum cholesterol, soluble urokinase-type plasminogen activator receptor, left ventricular mass index and atherosclerotic plaques were more closely associated with outcomes in individuals younger than 52 years with some sex-specific differences, whereas higher N-terminal pro-brain natriuretic peptide and urine albumin/creatine ratio were more closely associated with outcomes in subjects aged 61 or 71 years.
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Affiliation(s)
| | - Manan Pareek
- Centre for Translational Cardiology and Pragmatic Randomized Trials, Department of Biomedical Sciences, Faculty of Health and Medical Sciences, University of Copenhagen
- Department of Cardiology, Rigshospitalet, University of Copenhagen, Copenhagen
| | - Julie K K Vishram-Nielsen
- Department of Cardiology, Rigshospitalet, University of Copenhagen, Copenhagen
- Centre for Clinical Research and Prevention, Bispebjerg and Frederiksberg Hospital, The Capital Region of Denmark
| | - Michael Hecht Olsen
- Department of Internal Medicine 1, Steno Diabetes Centre Zealand, Holbaek Hospital, Holbaek
- Department of Regional Health Research, University of Southern Denmark, Odense, Denmark
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3
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Chen Z, Jiang F, Yang M, Yang J. Relationship between CRP gene polymorphisms and ischemic stroke risk: A systematic review and meta-analysis. Open Life Sci 2022; 17:1519-1530. [DOI: 10.1515/biol-2022-0505] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/19/2022] [Revised: 08/28/2022] [Accepted: 09/04/2022] [Indexed: 11/17/2022] Open
Abstract
Abstract
Ischemic stroke (IS), usually caused due to an abrupt blockage of an artery, is the leading cause of disability and the second leading cause of death worldwide. The association of the C-reactive protein (CRP) gene (s3093059 T/C and rs1205 C/T) polymorphisms and IS susceptibility has been widely studied, but the results remain inconsistent. Our study aimed to assess the association between CRP gene (s3093059 T/C and rs1205 C/T) polymorphisms and IS risk. PubMed, Embase, Cochrane Library, Web of Science, China National Knowledge Infrastructure, and WanFang databases were searched up to April 2022 to identify eligible studies. The Newcastle-Ottawa scale (NOS) score was calculated to assess study quality. The odd ratios (ORs) with a 95% confidence interval (CI) were calculated to assess the association between CRP gene (rs3093059 T/C and rs1205 C/T) polymorphisms and IS risk. Eighteen case–control studies with 6339 cases and 29580 controls were identified. We found that CRP (s3093059 T/C and rs1205 C/T) polymorphism was not significantly associated with the risk of IS in any genetic model (recessive model: OR 1.00, 95% CI 0.79–1.26; OR 1.06, 95% CI 0.90–1.25). When stratified analysis by country, genotype method, source of controls, and NOS score, still no statistically significant association was found. Our study indicated that the CRP (rs3093059 T/C and rs1205 C/T) polymorphisms were not associated with the susceptibility to IS.
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Affiliation(s)
- Zhizhi Chen
- Department of Neurology, The Quzhou Affiliated Hospital of Wenzhou Medical University, Quzhou People’s Hospital , Quzhou 324000 , Zhejiang , China
| | - Feifei Jiang
- Department of Neurology, The Quzhou Affiliated Hospital of Wenzhou Medical University, Quzhou People’s Hospital , Quzhou 324000 , Zhejiang , China
| | - Ming Yang
- Department of Neurology, The Quzhou Affiliated Hospital of Wenzhou Medical University, Quzhou People’s Hospital , Quzhou 324000 , Zhejiang , China
| | - Jie Yang
- Department of Rehabilitation Medicine, The Quzhou Affiliated Hospital of Wenzhou Medical University, Quzhou People’s Hospital , 100 Minjiang Road , Quzhou 324000 , Zhejiang , China
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4
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Chen PL, Li ZH, Yang HL, Cao ZJ, Cheng X, Zhao F, Zhang XR, Lv YB, Li FR, Zhou YF, Li HN, Qu YL, Yin ZX, Liu L, Wu XB, Shi XM, Mao C. Associations Between High-Sensitivity C-Reactive Protein and All-Cause Mortality Among Oldest-Old in Chinese Longevity Areas: A Community-Based Cohort Study. Front Public Health 2022; 10:824783. [PMID: 35211447 PMCID: PMC8861080 DOI: 10.3389/fpubh.2022.824783] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/29/2021] [Accepted: 01/13/2022] [Indexed: 12/20/2022] Open
Abstract
Background The association between high-sensitivity C-reactive protein (hsCRP) levels and all-cause mortality for the oldest-old (aged 80 years or older) remains unclear. We aimed to investigate the associations between hsCRP concentrations and the risks of all-cause mortality, and further identify the potential modifying factors affecting these associations among the oldest-old. Methods This prospective, community-based cohort study included 2,206 participants aged 80 years or older (median age 93.0 years) from the Healthy Aging and Biomarkers Cohort Study. Cox proportional hazards regression models were used to estimate hazard ratios (HRs) with 95% confidential intervals (95% CIs) for all-cause mortality according to hsCRP quartiles and recommendation for relative risk categories of hsCRP levels (< 1.0, 1.0–3.0, and > 3.0 mg/L), with adjustment for sociodemographic information, lifestyle, physical examination, medical history, and other potential confounders. Results During a median follow-up period of 3.1 years (IQR: 1.6–3.9 years), 1,106 deaths were verified. After full adjustment for potential confounders, a higher hsCRP concentration was positively associated with an increased risk of all-cause mortality (P for trend < 0.001). Compared with the lowest quartile, the fully adjusted HRs of the second, third, and fourth quartiles were 1.17 (95% CI: 0.94, 1.46), 1.28 (95% CI: 1.01, 1.61), and 1.49 (95% CI: 1.20, 1.87), respectively. The association of hsCRP with all-cause mortality was modified by smoking status (P for interaction = 0.011), an increased risk of hsCRP with all-cause mortality showed among non-current smokers (HR: 1.17; 95% CI: 1.07, 1.28), but no significance was observed in current smokers (HR: 0.83; 95% CI: 0.66, 1.18). Conclusions Our study indicated that elevated hsCRP concentrations were associated with a higher risk of all-cause mortality among Chinese oldest-old. Future studies investigating additional factors of disease and aging processes are needed to obtain a better understanding of the mechanisms.
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Affiliation(s)
- Pei-Liang Chen
- Department of Epidemiology, School of Public Health, Southern Medical University, Guangzhou, China
| | - Zhi-Hao Li
- Department of Epidemiology, School of Public Health, Southern Medical University, Guangzhou, China
| | - Hai-Lian Yang
- Department of Epidemiology, School of Public Health, Southern Medical University, Guangzhou, China
| | - Zhao-Jin Cao
- Chinese Center for Disease Control and Prevention, National Institute of Environmental Health, Beijing, China
| | - Xin Cheng
- Department of Epidemiology, School of Public Health, Southern Medical University, Guangzhou, China
| | - Feng Zhao
- Chinese Center for Disease Control and Prevention, National Institute of Environmental Health, Beijing, China
| | - Xi-Ru Zhang
- Department of Epidemiology, School of Public Health, Southern Medical University, Guangzhou, China
| | - Yue-Bin Lv
- Chinese Center for Disease Control and Prevention, National Institute of Environmental Health, Beijing, China
| | - Fu-Rong Li
- Department of Epidemiology, School of Public Health, Southern Medical University, Guangzhou, China
| | - Yuan-Feng Zhou
- Department of Epidemiology, School of Public Health, Southern Medical University, Guangzhou, China
| | - Hao-Nan Li
- Department of Epidemiology, School of Public Health, Southern Medical University, Guangzhou, China
| | - Ying-Li Qu
- Chinese Center for Disease Control and Prevention, National Institute of Environmental Health, Beijing, China
| | - Zhao-Xue Yin
- Chinese Center for Disease Control and Prevention, National Institute of Environmental Health, Beijing, China
| | - Ling Liu
- Chinese Center for Disease Control and Prevention, National Institute of Environmental Health, Beijing, China
| | - Xian-Bo Wu
- Department of Epidemiology, School of Public Health, Southern Medical University, Guangzhou, China
| | - Xiao-Ming Shi
- Chinese Center for Disease Control and Prevention, National Institute of Environmental Health, Beijing, China
| | - Chen Mao
- Department of Epidemiology, School of Public Health, Southern Medical University, Guangzhou, China
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High-Sensitivity C-Reactive Protein and Ischemic Stroke in Patients with Nonalcoholic Fatty Liver Disease: A Prospective Study. JOURNAL OF HEALTHCARE ENGINEERING 2022; 2022:9711712. [PMID: 35399841 PMCID: PMC8986405 DOI: 10.1155/2022/9711712] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 11/03/2021] [Accepted: 12/14/2021] [Indexed: 11/20/2022]
Abstract
Background and Aims Inflammation is involved in the pathophysiology of ischemic stroke. The aim of this prospective study was to evaluate the association of hs-CRP with incident ischemic stroke in patients with nonalcoholic fatty liver disease (NAFLD). Methods A sample of 318 participants without previous strokes was included in this study. Hs-CRP levels and other potential confounding factors were measured at baseline. NAFLD was performed by abdominal ultrasound after excluding secondary causes for fat accumulation. According to baseline hs-CRP concentrations, participants were categorized into 3 groups: level 1 (<1.0 mg/L), level 2 (1.0 to <3.0 mg/L), and level 3 (≥3.0 mg/L). The outcome of interest was the first occurrence of an ischemic stroke. Cox proportional hazards models were used to analyze hazard ratios (HRs) and 95% confidence intervals (CIs) of incident ischemic stroke, after adjusting for potential confounders. Results The mean age of 318 participants with NAFLD was 71.1 ± 6.7 years, and 55.3% of them were male. Among 318 individuals with NAFLD, 115 (36.2%) of them had an hs-CRP value <1 mg/L (level 1), 105 (33.0%) had an hs-CRP value between 1 and 3 mg/L (level 2), and 98 (30.8%) belonged to level 3 (hs-CRP ≥3 mg/L). Over a median of 5.60 years of follow-up, 47 incident ischemic stroke events were documented in 318 patients with NAFLD. After full adjustment for confounding factors, compared with participants in the level 1 group (hs-CRP<1.0 mg/L), the HRs of those in the level 2 group (1.0 to <3.0 mg/L) and the level 3 group (≥3.0 mg/L) were 1.77 (95% CI: 0.94–2.98) and 2.45 (95% CI: 1.37–5.77) for developing ischemic stroke, respectively. Conclusions Elevated hs-CRP levels were associated with an increased risk of ischemic stroke among patients with NAFLD.
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Elkind MSV. From the Heart to the Brain: Building Bridges to a Better Future. Stroke 2022; 53:1037-1042. [PMID: 35012329 PMCID: PMC8885844 DOI: 10.1161/strokeaha.121.036763] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
This Presidential Address was delivered at the International Stroke Conference in March 2021, during the coronavirus pandemic. Dr Elkind, the President of the American Heart Association (AHA) at the time, is a vascular neurologist with a research focus on stroke epidemiology. This address interweaves personal reflections on a career in clinical neurology, stroke research, and public health with a discussion of the role of the AHA in improving cardiovascular health at multiple levels. Throughout its history, the AHA has had leaders representing many different areas of cardiovascular science and medicine, including stroke. More recently, its focus has expanded from a traditional emphasis on cardiovascular events illness and events, like heart disease and stroke, to an appreciation of the role of the vascular system in brain health, healthy aging, cognitive decline, and dementia. During the pandemic, as the bidirectional effects of the coronavirus on cardiovascular disease has been elucidated, the benefits of a broad and multidisciplinary approach to cardiovascular disease and public health have become more apparent than ever. In addition, with growing awareness of the disproportionate effects of the pandemic on communities of color in the United States and globally, the AHA has redoubled its focus on addressing the social determinants of health, including structural racism. Central to these efforts is the construction of bridges between the generation of scientific knowledge and action for the public good. Our success will depend on the combination of basic, translational, clinical and population research with programs of public and professional education, advocacy, and social action.
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Affiliation(s)
- Mitchell S. V. Elkind
- Department of Neurology, Vagelos College of Physicians and Surgeons, Columbia University, New York, NY, USA,Department of Epidemiology, Mailman School of Public Health, Columbia University, New York, NY, USA
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7
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Samuel LJ, Szanton SL, Wolff JL, Gaskin DJ. Supplemental nutrition assistance program 2009 expansion and cardiometabolic markers among low-income adults. Prev Med 2021; 150:106678. [PMID: 34097951 PMCID: PMC8316430 DOI: 10.1016/j.ypmed.2021.106678] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/15/2020] [Revised: 05/17/2021] [Accepted: 05/29/2021] [Indexed: 11/17/2022]
Abstract
A 2009 Supplemental Nutrition Assistance Program (SNAP) policy change that expanded eligibility and increased benefit amounts has been associated with reduced food insecurity. This study tests the hypothesis that the SNAP policy change corresponds with improved stress- and nutrition-sensitive cardiometabolic markers. This study included non-pregnant participants aged 18-59 with annual family incomes ≤185% of the federal poverty guideline from the repeated cross-sectional NHANES study. Those living in SNAP eligible households (income ≤130% of the poverty guideline) were compared to those who were likely non-eligible (income 131%-≤185%). Difference-in-differences analyses compared hemoglobin A1c (%), CRP (mg/dL), total cholesterol (mg/dL), LDL (mg/dL) and waist circumference (cm) across groups before (2007-2008) and after (2009-2010) the SNAP policy change. Sampling weights were applied. Adjusting for demographic, socioeconomic, household and health factors, there were statistically significant difference-in-differences estimates for hemoglobin A1c (p = 0.003, n = 3723) and total cholesterol (p = 0.028, n = 3710). SNAP eligible adults had no difference in hemoglobin A1c after the policy change and, among those less than 40 years of age, 5 mg/dL lower total cholesterol levels whereas likely non-SNAP eligible adults had 0.14% higher hemoglobin A1c and no difference in total cholesterol after the policy change. The 2009 SNAP expansion was associated with improved nutrition-sensitive cardiometabolic markers in SNAP-eligible adults. This study found less of an upward trend in hemoglobin A1c levels for young and middle aged adults and decreased total cholesterol for young adults. These results highlight the potential role of SNAP to prevent costly chronic conditions among low-income U.S. adults.
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Affiliation(s)
| | - Sarah L Szanton
- Johns Hopkins University School of Nursing, USA; Johns Hopkins Bloomberg School of Public Health, Department of Health Policy and Management, USA.
| | - Jennifer L Wolff
- Johns Hopkins Bloomberg School of Public Health, Department of Health Policy and Management, USA.
| | - Darrell J Gaskin
- Johns Hopkins Bloomberg School of Public Health, Department of Health Policy and Management, USA.
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Yang X, Zhang D, Zhao Y, Liu D, Li Q, Guo C, Tian G, Han M, Qie R, Huang S, Zhou Q, Zhao Y, Feng Y, Wu X, Zhang Y, Li Y, Wu Y, Cheng C, Hu D, Sun L. Association between serum level of C-reactive protein and risk of cardiovascular events based on cohort studies. J Hum Hypertens 2021; 35:1149-1158. [PMID: 33980977 DOI: 10.1038/s41371-021-00546-z] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/25/2020] [Revised: 04/06/2021] [Accepted: 04/23/2021] [Indexed: 11/09/2022]
Abstract
Although the association between serum level of C-reactive protein (CRP) and risk of cardiovascular events (CVEs) has been reported, the comprehensive assessment of the quantitative association of CRP level with risk of CVEs has not been reported. Our meta-analysis aims to quantitatively evaluate the association of CRP level and risk of CVEs. We searched PubMed and Embase databases for articles published up to December 6, 2019. Studies with data on men and women, different types of CVEs and multiple cohorts within a study were treated as independent studies. Generalized least-squares regression models were used to assess the quantitative association between CRP level and risk of CVEs. Restricted cubic splines were used to model the possible linear association between CRP and CVEs. We included 36 articles (60 studies; 227,715 participants) in the analysis. The pooled relative risks (RRs) of high versus low CRP level for cardiovascular disease (CVD), stroke and coronary heart disease (CHD) were 1.64 (95% confidence interval [CI], 1.49-1.82), 1.46 (95% CI, 1.35-1.58), and 1.55 (95% CI, 1.47-1.63), respectively. A linear association was found between CRP level and CVD (P = 0.429), stroke (P = 0.940), and CHD (P = 0.931); with each 1-mg/L increase in CRP level, the pooled RRs for CVD, stroke, and CHD were 1.18 (95% CI, 1.12-1.24), 1.07 (95% CI, 1.04-1.09), and 1.12 (95% CI, 1.08-1.16), respectively. This meta-analysis suggests that risk of CVEs increases with increasing serum CRP level.
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Affiliation(s)
- Xingjin Yang
- Department of Epidemiology and Health Statistics, College of Public Health, Zhengzhou University, Zhengzhou, Henan, People's Republic of China
| | - Dongdong Zhang
- Department of Nutrition and Food Hygiene, College of Public Health, Zhengzhou University, Zhengzhou, Henan, People's Republic of China
| | - Yang Zhao
- Department of Epidemiology and Health Statistics, College of Public Health, Zhengzhou University, Zhengzhou, Henan, People's Republic of China
| | - Dechen Liu
- Department of Epidemiology and Health Statistics, College of Public Health, Zhengzhou University, Zhengzhou, Henan, People's Republic of China.,Department of Biostatistics and Epidemiology, School of Public Health, Shenzhen University Health Science Center, Shenzhen, Guangdong, People's Republic of China
| | - Quanman Li
- Department of Epidemiology and Health Statistics, College of Public Health, Zhengzhou University, Zhengzhou, Henan, People's Republic of China
| | - Chunmei Guo
- Department of Epidemiology and Health Statistics, College of Public Health, Zhengzhou University, Zhengzhou, Henan, People's Republic of China
| | - Gang Tian
- Department of Epidemiology and Health Statistics, College of Public Health, Zhengzhou University, Zhengzhou, Henan, People's Republic of China
| | - Minghui Han
- Department of Epidemiology and Health Statistics, College of Public Health, Zhengzhou University, Zhengzhou, Henan, People's Republic of China
| | - Ranran Qie
- Department of Epidemiology and Health Statistics, College of Public Health, Zhengzhou University, Zhengzhou, Henan, People's Republic of China
| | - Shengbing Huang
- Department of Epidemiology and Health Statistics, College of Public Health, Zhengzhou University, Zhengzhou, Henan, People's Republic of China
| | - Qionggui Zhou
- Department of Biostatistics and Epidemiology, School of Public Health, Shenzhen University Health Science Center, Shenzhen, Guangdong, People's Republic of China
| | - Yang Zhao
- Department of Epidemiology and Health Statistics, College of Public Health, Zhengzhou University, Zhengzhou, Henan, People's Republic of China
| | - Yifei Feng
- Department of Epidemiology and Health Statistics, College of Public Health, Zhengzhou University, Zhengzhou, Henan, People's Republic of China
| | - Xiaoyan Wu
- Department of Biostatistics and Epidemiology, School of Public Health, Shenzhen University Health Science Center, Shenzhen, Guangdong, People's Republic of China
| | - Yanyan Zhang
- Department of Biostatistics and Epidemiology, School of Public Health, Shenzhen University Health Science Center, Shenzhen, Guangdong, People's Republic of China
| | - Yang Li
- Department of Biostatistics and Epidemiology, School of Public Health, Shenzhen University Health Science Center, Shenzhen, Guangdong, People's Republic of China
| | - Yuying Wu
- Department of Biostatistics and Epidemiology, School of Public Health, Shenzhen University Health Science Center, Shenzhen, Guangdong, People's Republic of China
| | - Cheng Cheng
- Department of Epidemiology and Health Statistics, College of Public Health, Zhengzhou University, Zhengzhou, Henan, People's Republic of China
| | - Dongsheng Hu
- Department of Epidemiology and Health Statistics, College of Public Health, Zhengzhou University, Zhengzhou, Henan, People's Republic of China.
| | - Liang Sun
- Department of Epidemiology and Health Statistics, College of Public Health, Zhengzhou University, Zhengzhou, Henan, People's Republic of China.
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Chen Z, Mo J, Xu J, Wang A, Dai L, Cheng A, Yalkun G, Meng X, Zhao X, Li H, Wu S, Wang Y. Effects of individual and integrated cumulative burden of blood pressure, glucose, low-density lipoprotein cholesterol, and C-reactive protein on cardiovascular risk. Eur J Prev Cardiol 2020; 29:127-135. [PMID: 33624037 DOI: 10.1093/eurjpc/zwaa052] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/16/2019] [Revised: 07/18/2020] [Accepted: 08/13/2020] [Indexed: 11/13/2022]
Abstract
Abstract
Aim
This study aimed to demonstrate the impact of cumulative burden of cardiovascular risk factors (CVRFs) on risk of cardiovascular events (CVEs).
Methods and results
A total of 34 959 participants were enrolled who participated in the four surveys during 2006–2013. Cumulative CVRF burden was calculated as number of years (2006–2013) multiplied by the values of CVRFs including systolic blood pressure, fasting blood glucose (FBG), low-density lipoprotein cholesterol (LDL-C), and high-sensitive C-reactive protein (hs-CRP). The primary outcome was defined as the CVE during 2012–2017, including ischaemic stroke, myocardial infarction, and all-cause mortality. During 4.62 (±0.71) years follow-up on average, there were 2118 (6.06%) CVE, including 847 (2.42%) ischaemic stroke, 221 (0.63%) myocardial infarction, and 1185 (3.39%) all-cause mortality. Higher cumulative burden of individual CVRF was significantly associated with increased risk of outcomes, except for LDL-C for all-cause mortality, FBG for myocardial infarction, and hs-CRP for ischaemic stroke. In Cox proportional hazards model, compared with the group, of the lower quartile of integrated cumulative burden, the hazard ratio (95% confidence intervals) of the upper quartile was 2.45 (2.03–2.94) for CVE, 3.65 (2.68–4.96) for ischaemic stroke, 4.51 (2.19–9.27) for myocardial infarction, and 1.73 (1.36–2.21) for all-cause mortality.
Conclusion
We demonstrated the correlation between cumulative burden of CVRFs and cardiovascular risk, except for cumulative burden of hs-CRP and ischaemic stroke. Thus, our study suggests the necessity to extend the observation duration of CVRFs in order to elucidate the life-course cumulative effect.
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Affiliation(s)
| | - Jinglin Mo
- Department of Neurology, Beijing Tiantan Hospital, Capital Medical University, No. 119 South 4th Ring West Road, Fengtai District, Beijing 100070, China
- China National Clinical Research Center for Neurological Diseases, No.119 Nansihuanxilu, Fengtai District, Beijing 100070, China
| | - Jie Xu
- Department of Neurology, Beijing Tiantan Hospital, Capital Medical University, No. 119 South 4th Ring West Road, Fengtai District, Beijing 100070, China
- China National Clinical Research Center for Neurological Diseases, No.119 Nansihuanxilu, Fengtai District, Beijing 100070, China
| | - Anxin Wang
- Department of Neurology, Beijing Tiantan Hospital, Capital Medical University, No. 119 South 4th Ring West Road, Fengtai District, Beijing 100070, China
- China National Clinical Research Center for Neurological Diseases, No.119 Nansihuanxilu, Fengtai District, Beijing 100070, China
| | - Liye Dai
- Department of Neurology, Beijing Tiantan Hospital, Capital Medical University, No. 119 South 4th Ring West Road, Fengtai District, Beijing 100070, China
- China National Clinical Research Center for Neurological Diseases, No.119 Nansihuanxilu, Fengtai District, Beijing 100070, China
| | - Aichun Cheng
- Department of Neurology, Beijing Tiantan Hospital, Capital Medical University, No. 119 South 4th Ring West Road, Fengtai District, Beijing 100070, China
- China National Clinical Research Center for Neurological Diseases, No.119 Nansihuanxilu, Fengtai District, Beijing 100070, China
| | - Gulbahram Yalkun
- Department of Neurology, Beijing Tiantan Hospital, Capital Medical University, No. 119 South 4th Ring West Road, Fengtai District, Beijing 100070, China
- China National Clinical Research Center for Neurological Diseases, No.119 Nansihuanxilu, Fengtai District, Beijing 100070, China
| | - Xia Meng
- Department of Neurology, Beijing Tiantan Hospital, Capital Medical University, No. 119 South 4th Ring West Road, Fengtai District, Beijing 100070, China
- China National Clinical Research Center for Neurological Diseases, No.119 Nansihuanxilu, Fengtai District, Beijing 100070, China
| | - Xingquan Zhao
- Department of Neurology, Beijing Tiantan Hospital, Capital Medical University, No. 119 South 4th Ring West Road, Fengtai District, Beijing 100070, China
- China National Clinical Research Center for Neurological Diseases, No.119 Nansihuanxilu, Fengtai District, Beijing 100070, China
| | - Hao Li
- Department of Neurology, Beijing Tiantan Hospital, Capital Medical University, No. 119 South 4th Ring West Road, Fengtai District, Beijing 100070, China
- China National Clinical Research Center for Neurological Diseases, No.119 Nansihuanxilu, Fengtai District, Beijing 100070, China
| | - Shouling Wu
- Department of Cardiology, Kailuan General Hospital, 57 Xin Hua East Rd, Tangshan 063000, China
| | - Yongjun Wang
- Department of Neurology, Beijing Tiantan Hospital, Capital Medical University, No. 119 South 4th Ring West Road, Fengtai District, Beijing 100070, China
- China National Clinical Research Center for Neurological Diseases, No.119 Nansihuanxilu, Fengtai District, Beijing 100070, China
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Wang L, Wu L, Lang Y, Wu D, Chen J, Zhao W, Li C, Ji X. Association between high-sensitivity C-reactive protein levels and clinical outcomes in acute ischemic stroke patients treated with endovascular therapy. ANNALS OF TRANSLATIONAL MEDICINE 2020; 8:1379. [PMID: 33313124 PMCID: PMC7723633 DOI: 10.21037/atm-20-3820] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Abstract
Background Increasing evidence demonstrates that high-sensitivity C-reactive protein (hs-CRP) is an independent prognostic predictor in acute ischemic stroke (AIS) patients. The purpose of this study is to investigate the association between hs-CRP levels and clinical outcomes in AIS patients receiving endovascular therapy (EVT). Methods This observational study was based on a prospective registry study. AIS patients receiving EVT from December 2012 to January 2019 were included. The modified Rankin Scale (mRS) scores at the 90-day and long-term follow-up were evaluated as clinical outcomes. Multivariable logistic regression analysis was conducted to adjust for confounders. Receiver operating characteristic (ROC) curve analysis was performed based on significant predictors of favorable outcomes in the logistic regression analysis. Patients were divided into two groups according to the cutoff value. Clinical outcomes were compared between groups. Survival probability was assessed using Kaplan-Meier survival analysis. Results Multivariable logistic regression analysis of the 362 enrolled AIS patients demonstrated that age (P=0.030), National Institutes of Health Stroke Scale (NIHSS) score (P=0.023), hs-CRP levels (P<0.001), and symptomatic intracranial hemorrhage (sICH) (P=0.006) were independently predictive of favorable outcomes. ROC curve analysis indicated that the hs-CRP level was predictive of favorable outcomes at the 90-day follow-up with a cutoff value of 8.255 mg/L. The mRS scores between patients with hs-CRP <8.255 mg/L and patients with hs-CRP ≥8.255 mg/L at the 90-day [2 (IQR, 1–2) vs. 4 (IQR, 3–6), P<0.001] and long-term follow-up [1 (IQR, 0–2) vs. 4 (IQR, 2–6), P<0.001] were significantly different. Patients with hs-CRP ≥8.255 mg/L had significantly increased risk of poor clinical outcomes at the 90-day and long-term follow-up compared with those with hs-CRP <8.255 mg/L (P<0.001 each). Conclusions Elevated hs-CRP levels were associated with poor clinical outcomes in AIS patients receiving EVT.
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Affiliation(s)
- Luling Wang
- Department of Neurology and China-America Institute of Neuroscience, Xuanwu Hospital, Capital Medical University, Beijing, China
| | - Longfei Wu
- Department of Neurology and China-America Institute of Neuroscience, Xuanwu Hospital, Capital Medical University, Beijing, China
| | - Ye Lang
- Department of Neurology, Shengli Oilfield Central Hospital, Dongying, China
| | - Di Wu
- Department of Neurology and China-America Institute of Neuroscience, Xuanwu Hospital, Capital Medical University, Beijing, China
| | - Jian Chen
- Department of Neurosurgery, Xuanwu Hospital, Capital Medical University, Beijing, China
| | - Wenbo Zhao
- Department of Neurology and China-America Institute of Neuroscience, Xuanwu Hospital, Capital Medical University, Beijing, China
| | - Chuanhui Li
- Department of Emergency, Xuanwu Hospital, Capital Medical University, Beijing, China
| | - Xunming Ji
- Department of Neurosurgery, Xuanwu Hospital, Capital Medical University, Beijing, China
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Dose-response association between C-reactive protein and risk of all-cause and cause-specific mortality: a systematic review and meta-analysis of cohort studies. Ann Epidemiol 2020; 51:20-27.e11. [PMID: 32702432 DOI: 10.1016/j.annepidem.2020.07.005] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/10/2020] [Revised: 07/10/2020] [Accepted: 07/14/2020] [Indexed: 12/13/2022]
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12
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Ongen İpek B, Karadeniz A, Sitar ME. The Effects of Initial Procalcitonin Levels on Mortality Rates in Geriatric Patients Undergoing Surgery. Cureus 2020; 12:e7613. [PMID: 32399347 PMCID: PMC7213668 DOI: 10.7759/cureus.7613] [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] [Indexed: 11/06/2022] Open
Abstract
Introduction The aim of the current study is to investigate the relationship between mortality rate in geriatric patients undergoing surgery with preoperative serum levels of procalcitonin, C-reactive protein, and erythrocyte sedimentation rate. Methods This was a single-center retrospective study, including three groups with 101 patients, who are older than 65 years of age. A retrospective investigation was carried out from the laboratory information system for all groups from January to December 2018. Group 1 included patients who had surgery and then mortality within 30 days after surgery. Group 2 included hospitalized patients who had surgery and no mortality within 30 days after surgery. Group 3 included outpatient patients, who had suspicion for a bacterial infection and then no surgery or no mortality within 30 days. Results When three group comparisons were made for procalcitonin, C-reactive protein, and erythrocyte sedimentation rate values, the p-value of one-way analysis of variance (ANOVA) was higher than 0.05 for procalcitonin and lower than 0.05 for C-reactive protein and erythrocyte sedimentation rate, suggesting that one or more groups were significantly different. When post-hoc multiple comparison methods were applied, there were statistically significant differences between Groups 1 and 3 for C-reactive protein and erythrocyte sedimentation rate. Conclusions Procalcitonin levels do not predict mortality following surgery. C-reactive protein and erythrocyte sedimentation rate are more useful biomarkers predicting mortality in geriatric patients undergoing surgery.
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Affiliation(s)
- Belkiz Ongen İpek
- Medical Biochemistry, Maltepe University Faculty of Medicine, İstanbul, TUR
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13
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Yusuff OT, Kolawole BA, Ikem RT, Soyoye DO, Amjo OO. Cardiovascular Risk Indices and Their Impact on Outcome in Patients with Hyperglycaemic Emergencies in a Nigerian Hospital. J Natl Med Assoc 2020; 112:28-35. [PMID: 31973880 DOI: 10.1016/j.jnma.2019.12.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/18/2019] [Revised: 12/14/2019] [Accepted: 12/24/2019] [Indexed: 10/25/2022]
Abstract
BACKGROUND High sensitivity C-reactive protein (hsCRP) and Plasminogen Activator Inhibitor-1 (PAI-1) are recognised independent novel risk factors for cardiovascular disease. Few studies have assessed cardiovascular risk factors in patients with hyperglycaemic emergencies (HE), despite it being a major cause of death in diabetics. OBJECTIVE The objective of this study was to determine cardiovascular risk indices in patients with hyperglycaemic emergencies and related these with outcome. METHODS This cross sectional study involved 45 patients that presented with HE and 45 age and sex matched diabetics without HE who served as controls. Historical features, physical findings and laboratory parameters including hsCRP and PAI-1 were compared between subjects and controls. RESULTS The mean values of serum hsCRP and PAI-1 were significantly higher in patients with HE compared to diabetic control. (49.52 ± 13.6 vs. 2.4 ± 1.35, 51.2 ± 28.7 vs. 33.2 ± 10.7 respectively). Traditional cardiovascular risk factors such as HbA1c, Atherogenic Index and microalbuminuria were also significantly higher in them. Mortality was associated with increasing age, higher values of waist circumference, pulse rate, respiratory rate, hsCRP, Atherogenic index and lower blood pressure and HDL values. CONCLUSION Cardiovascular risk indices are higher in patients with HE.
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Affiliation(s)
- Olaoluwatomi T Yusuff
- Department of Medicine, Obafemi Awolowo University Teaching Hospital, Ile Ife, Nigeria.
| | - Babatope A Kolawole
- Department of Medicine, Obafemi Awolowo University Teaching Hospital, Ile Ife, Nigeria
| | - Rosemary T Ikem
- Department of Medicine, Obafemi Awolowo University Teaching Hospital, Ile Ife, Nigeria
| | - David O Soyoye
- Department of Medicine, Obafemi Awolowo University Teaching Hospital, Ile Ife, Nigeria
| | - Oluwadamilola O Amjo
- Department of Medicine, Obafemi Awolowo University Teaching Hospital, Ile Ife, Nigeria
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14
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Lin J, Wang Y, Wang Y, Pan Y. Inflammatory biomarkers and risk of ischemic stroke and subtypes: A 2-sample Mendelian randomization study. Neurol Res 2020; 42:118-125. [PMID: 31900081 DOI: 10.1080/01616412.2019.1710404] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
Objective: Chronic inflammation is considered as playing an important role in the pathophysiology of atherosclerosis, but the exact contributing inflammatory pathway on stroke is not clear. We aimed to examine the causal association of inflammatory biomarkers, such as interleukin-1 receptor antagonist (IL-1Ra), soluble interleukin-6 receptor (sIL-6R) and C-reactive protein (CRP), with the risk of ischemic stroke and its subtypes.Methods: Two-sample mendelian randomization analyses were performed using IL-1Ra, sIL-6R and CRP related genetic variants as instrumental variables. Summary-level data on ischemic stroke and its subtypes were obtained from the largest GWAS meta-analysis on stroke to date - the Multiancestry Genome-wide Association Study of Stroke (MEGASTROKE) consortium. Associations of IL-1Ra with stroke or its subtypes were estimated using inverse-variance weighted (IVW) method with SNPs rs6743376 and rs1542176 as instruments. Wald ratio method with SNP rs2228145 as the instrument was used for sIL-6R and IVW, MR-Egger, simple and weighted median approaches with 4- or 18-SNPs instruments were used for CRP.Results: Genetically elevated ln(IL-1Ra), ln(sIL-6R) and ln(CRP) levels were not causally associated with ischemic stroke (OR = 1.00, 95% CI: 0.97-1.04, p = 0.80; OR = 0.93, 95% CI: 0.87-0.99, p = 0.03; OR = 1.01, 95% CI: 0.94-1.09, p = 0.78). No significant association was observed between ln(IL-1Ra), ln(sIL-6R) and ln(CRP) level and ischemic stroke subtypes.Conclusions: Our study did not find convincing evidence to support that inflammatory biomarkers like IL-1Ra, sIL-6R and CRP are causally associated with the risk of ischemic stroke or its subtypes.
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Affiliation(s)
- Jinxi Lin
- Department of Neurology, Beijing Tiantan Hospital, Capital Medical University, Beijing, China.,China National Clinical Research Center for Neurological Diseases, Beijing, China
| | - Yilong Wang
- Department of Neurology, Beijing Tiantan Hospital, Capital Medical University, Beijing, China.,China National Clinical Research Center for Neurological Diseases, Beijing, China
| | - Yongjun Wang
- Department of Neurology, Beijing Tiantan Hospital, Capital Medical University, Beijing, China.,China National Clinical Research Center for Neurological Diseases, Beijing, China
| | - Yuesong Pan
- Department of Neurology, Beijing Tiantan Hospital, Capital Medical University, Beijing, China.,China National Clinical Research Center for Neurological Diseases, Beijing, China
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IL-1α and IL-6 predict vascular events or death in patients with cerebral small vessel disease-Data from the SHEF-CSVD study. Adv Med Sci 2019; 64:258-266. [PMID: 30844663 DOI: 10.1016/j.advms.2019.02.003] [Citation(s) in RCA: 17] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/03/2018] [Revised: 09/02/2018] [Accepted: 02/21/2019] [Indexed: 11/20/2022]
Abstract
PURPOSE The natural clinical course of cerebral small vessel disease (CSVD) was not thoroughly described. The aim of this single center cohort study was to establish biochemical predictors of vascular events and death in CSVD patients during a 24-month follow-up. PATIENTS AND METHODS A total of 130 functionally independent patients with marked MRI features of CSVD and recent lacunar stroke (n = 52,LS), vascular Parkinsonism (n = 28,VaP) or dementia (n = 50,VaD) were prospectively recruited. Serum markers of endothelial dysfunction, inflammation and hemostasis were determined at baseline. The primary outcome was defined as occurrence of death or any vascular events during the observation. RESULTS The mean age was 72 ± 8.1 years, and 37.6% of the patients were women. The mean follow-up time was 22.3 ± 4.3 months, and 84.6% of patients had extensive white matter lesions on baseline MRI. The overall mortality rate was 6.9%, and vascular events or death occurred in 27% of the patients. Kaplan-Meier survival curves revealed no significant differences between CSVD groups (log rank p = 0.49). Cox regression analysis revealed that IL-1α (HR 1.4; 95%CI 1.09-1.8), IL-6 (1.4;1.1-2.2), hs-CRP (1.1;1.06-1.9), homocysteine (1.4;1.1-1.8), fibrinogen (1.4;1.05-2), and d-dimer (2.7;1.6-4.5) were significantly associated with the primary outcome. IL-1α (1.3;1.07-1.8), IL-6 (1.4;1.02-2.2), d-dimer (2.8;1.6-5) and homocysteine (1.4;1.1-1.8) remained significant after adjusting for age, sex and CSVD radiological markers. CONCLUSIONS Our study demonstrated the important prognostic role of various circulation markers of inflammation in individuals with different clinical signs and radiological markers of CSVD. The strongest association occurred between IL-1α, IL-6 and recurrent stroke, other vascular events and death.
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Yao H, Mizoguchi Y, Monji A, Yakushiji Y, Takashima Y, Uchino A, Yuzuriha T, Hashimoto M. Low-Grade Inflammation Is Associated with Apathy Indirectly via Deep White Matter Lesions in Community-Dwelling Older Adults: The Sefuri Study. Int J Mol Sci 2019; 20:ijms20081905. [PMID: 30999680 PMCID: PMC6514652 DOI: 10.3390/ijms20081905] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/09/2019] [Accepted: 04/15/2019] [Indexed: 01/22/2023] Open
Abstract
Low-grade inflammation is implicated in the pathogenesis of atherosclerosis, metabolic syndrome, and apathy as a form of vascular depression. We analyzed the brain magnetic resonance imaging findings in 259 community-dwelling older adults (122 men and 137 women, with a mean age of 68.4 years). The serum concentrations of high-sensitivity C-reactive protein (hsCRP) were measured by a quantitative enzyme-linked immunosorbent assay. Logistic regression analysis revealed that the log10 hsCRP value and the presence of a metabolic syndrome were independently associated with confluent but not punctate deep white matter lesions (DWMLs). Path analysis based on structural equation modeling (SEM) indicated that the direct path from the log10 hsCRP to the DWMLs was significant (β = 0.119, p = 0.039). The direct paths from the metabolic syndrome to the log10 hsCRP and to the DWMLs were also significant. The direct path from the DWMLs to apathy (β = −0.165, p = 0.007) was significant, but the direct path from the log10 hsCRP to apathy was not significant. Inflammation (i.e., elevated serum hsCRP levels) was associated with DWMLs independent of common vascular risk factors, while DWMLs were associated with apathy. The present analysis with SEM revealed the more realistic scheme that low-grade inflammation was associated with apathy indirectly via DWMLs in community-dwelling older adults.
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Affiliation(s)
- Hiroshi Yao
- Division of Clinical Research, National Hospital Organization Hizen Psychiatric Center, Saga 842-0192, Japan.
| | - Yoshito Mizoguchi
- Department of Psychiatry, Faculty of Medicine, Saga University, Saga 849-8501, Japan.
| | - Akira Monji
- Department of Psychiatry, Faculty of Medicine, Saga University, Saga 849-8501, Japan.
| | - Yusuke Yakushiji
- Division of Neurology, Department of Internal Medicine, Faculty of Medicine, Saga University, Saga 849-8501, Japan.
| | - Yuki Takashima
- Division of Clinical Research, National Hospital Organization Hizen Psychiatric Center, Saga 842-0192, Japan.
| | - Akira Uchino
- Department of Diagnostic Radiology, Saitama Medical University International Medical Center, Saitama 350-1298, Japan.
| | - Takefumi Yuzuriha
- Division of Clinical Research, National Hospital Organization Hizen Psychiatric Center, Saga 842-0192, Japan.
| | - Manabu Hashimoto
- Division of Clinical Research, National Hospital Organization Hizen Psychiatric Center, Saga 842-0192, Japan.
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Shen Y, Zhang Y, Xiong S, Zhu X, Ke C. High-sensitivity C-reactive protein and cystatin C independently and jointly predict all-cause mortality among the middle-aged and elderly Chinese population. Clin Biochem 2019; 65:7-14. [DOI: 10.1016/j.clinbiochem.2018.12.012] [Citation(s) in RCA: 16] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/01/2018] [Revised: 12/22/2018] [Accepted: 12/24/2018] [Indexed: 02/05/2023]
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Staszewski J, Pogoda A, Data K, Walczak K, Nowocień M, Frankowska E, Stępień A. The mean platelet volume on admission predicts unfavorable stroke outcomes in patients treated with IV thrombolysis. Clin Interv Aging 2019; 14:493-503. [PMID: 30880930 PMCID: PMC6398411 DOI: 10.2147/cia.s195451] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022] Open
Abstract
Purpose The role of biomarkers in the prediction of acute ischemic stroke (AIS) outcome or response to thrombolytic therapy (with recombinant tissue plasminogen activator [rt-PA]) remains limited. The aim of this study was to evaluate whether mean platelet volume (MPV) could predict short-term functional outcome in patients with AIS following rt-PA treatment. Patients and methods This was a retrospective analysis of 237 AIS patients (mean age 71.04±0.8 years, 50.6% women) consecutively admitted to a tertiary care center between 2011 and 2015. Results The mean MPV in the cohort was 9.8±0.35 fL (lowest tertile <7.29 fL, median 7.29–8.8 fL, and highest tertile >8.8 fL). Patients in the lowest tertile compared to median and highest tertiles were less often dependent (modified Rankin scale [mRS] ≥3) at admission (87.2% vs 96.1% and 96.1%, respectively, P=0.04) and less often had a poor stroke outcome (mRS 4–6) at discharge (28.2% vs 55.3% and 44.7%, P<0.01). However, there was no significant difference between tertiles with regard to AIS etiology, CT (Alberta Stroke Program Early CT) score, frequency of stroke due to large artery occlusion, risk of secondary hemorrhage, and early neurologic deterioration. Multivariable analysis after adjustment for confounders showed that patients in the second and third tertiles had a significantly higher risk of poor stroke outcome (OR =1.9, 95% CI =1.01–4), lack of early improvement (OR =1.91, 95% CI =1.05–3.47), lower chance of good outcome (mRS 0–2; OR =0.38, 95% CI =0.18–0.78), or minor stroke at discharge (OR =0.47, 95% CI =0.26–0.84). Receiver operating characteristic analysis for prediction of poor stroke outcome showed that the optimal cut-off point of MPV was 8.8 fL (area under the curve 0.586 [0.512–0.659], P=0.03) with a sensitivity of 82.7% and a specificity of 43.9%. Conclusion Disabling or fatal ischemic stroke in thrombolyzed patients was observed more often in patients with high admission MPV. The prognostic value of MPV was independent of other well-defined individual risk factors.
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Affiliation(s)
- Jacek Staszewski
- Clinic of Neurology, Military Institute of Medicine, Warsaw, Poland,
| | - Aleksandra Pogoda
- Clinic of Neurology, Military Institute of Medicine, Warsaw, Poland,
| | - Kamila Data
- Clinic of Neurology, Military Institute of Medicine, Warsaw, Poland,
| | - Klaudia Walczak
- Clinic of Neurology, Military Institute of Medicine, Warsaw, Poland,
| | - Maciej Nowocień
- Department of Radiology, Military Institute of Medicine, Warsaw, Poland
| | - Emilia Frankowska
- Department of Radiology, Military Institute of Medicine, Warsaw, Poland
| | - Adam Stępień
- Clinic of Neurology, Military Institute of Medicine, Warsaw, Poland,
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Fan Y, Yan G, Liu F, Rong J, Ma W, Yang D, Yu Y. Potential role of poly (ADP-ribose) polymerase in delayed cerebral vasospasm following subarachnoid hemorrhage in rats. Exp Ther Med 2019; 17:1290-1299. [PMID: 30680005 PMCID: PMC6327579 DOI: 10.3892/etm.2018.7073] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/06/2018] [Accepted: 11/14/2018] [Indexed: 01/13/2023] Open
Abstract
Poly (ADP-ribose) polymerase (PARP) serves a key role in several neurological disorders, however, the specific role of PARP in delayed cerebral vasospasm (DCVS) following subarachnoid hemorrhage (SAH) remains unclear. The present study was conducted to clarify the possible mechanism of PARP in DCVS with the treatment of 3-aminobenzamide (3-AB), a PARP inhibitor. In the preliminary experiment, an internal carotid artery puncture SAH model, a cisterna magna double injection SAH model and prechiasmatic cistern single injection SAH model were compared with respect to mortality and neurobehavioral test results. The prechiasmatic cistern single injection SAH model was chosen to induce DCVS in the formal experiment. In the formal experiment, a total of 96 Sprague Dawley rats were randomly allocated into the sham group, the SAH group and the SAH+3-AB group and then each group was further subdivided into days 3, 5, 7 and 14 post-SAH subgroups (n=8 for each subgroup). The prechiasmatic cistern single injection SAH model was established to induce DCVS. Neurobehavioral testing and HE staining were conducted to evaluate the degree of cerebral vasospasm. PARP activity was assessed by ELISA and immunohistochemistry. An electrophoretic mobility shift assay was used to detect nuclear factor (NF)-κB DNA-binding activity. The expression of monocyte chemotactic protein 1 (MCP-1) and C-reactive protein (CRP) were measured by western blotting. Cerebral vasospasm occurred following SAH and became most severe on around day 7 post-SAH. NF-κB activity, PARP activity, the expression of MCP-1 and CRP exhibited a similar time course to cerebral vasospasm. Treatment with 3-AB alleviated the degree of cerebral vasospasm. NF-κB activity, PARP activity and the expression of MCP-1 and CRP were also suppressed by 3-AB treatment. In conclusion, PARP may serve an important role in regulating the inflammatory response and ultimately contribute to DCVS. Therefore 3-AB may be a potential therapeutic agent for DCVS.
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Affiliation(s)
- Yameng Fan
- Department of Public Health, Medical College of Xi'an Jiaotong University, Xi'an, Shaanxi 710061, P.R. China
| | - Ge Yan
- Department of Medical Image, The First Affiliated Hospital of Xi'an Jiaotong University, Xi'an, Shaanxi 710061, P.R. China
| | - Furong Liu
- Department of Public Health, Medical College of Xi'an Jiaotong University, Xi'an, Shaanxi 710061, P.R. China
| | - Jie Rong
- Department of Public Health, Medical College of Xi'an Jiaotong University, Xi'an, Shaanxi 710061, P.R. China
| | - Wenxia Ma
- Department of Public Health, Medical College of Xi'an Jiaotong University, Xi'an, Shaanxi 710061, P.R. China
| | - Danrong Yang
- Department of Public Health, Medical College of Xi'an Jiaotong University, Xi'an, Shaanxi 710061, P.R. China
| | - Yan Yu
- Department of Public Health, Medical College of Xi'an Jiaotong University, Xi'an, Shaanxi 710061, P.R. China
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Cao YX, Li S, Liu HH, Li JJ. Impact of PCSK9 monoclonal antibodies on circulating hs-CRP levels: a systematic review and meta-analysis of randomised controlled trials. BMJ Open 2018; 8:e022348. [PMID: 30287608 PMCID: PMC6173233 DOI: 10.1136/bmjopen-2018-022348] [Citation(s) in RCA: 47] [Impact Index Per Article: 7.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/22/2022] Open
Abstract
OBJECTIVE To evaluate the potential effects of proprotein convertase subtilisin/kexin type 9 monoclonal antibody (PCSK9-mAb) on high-sensitivity C reactive protein (hs-CRP) concentrations. DESIGN A systematic review and meta-analysis of randomised controlled trials. DATA SOURCES PubMed, MEDLINE, the Cochrane Library databases, ClinicalTrials.gov and recent conferences were searched from inception to May 2018. ELIGIBILITY CRITERIA FOR SELECTING STUDIES All randomised controlled trials that reported changes of hs-CRP were included. RESULTS Ten studies involving 4198 participants were identified. PCSK9-mAbs showed a slight efficacy in reducing hs-CRP (-0.04 mg/L, 95% CI: -0.17 to 0.01) which was not statistically different. The results did not altered when subgroup analyses were performed including PCSK9-mAb types (alirocumab: 0.12 mg/L, 95% CI: -0.18 to 0.43; evolocumab: 0.00 mg/L, 95% CI: -0.07 to 0.07; LY3015014: -0.48 mg/L, 95% CI: -1.28 to 0.32; RG7652: 0.35 mg/L, 95% CI: -0.26 to 0.96), treatment duration (≤12w: 0.00 mg/L, 95% CI: -0.07 to 0.07; >12w: -0.11 mg/L, 95% CI: -0.45 to -0.23), participant characteristics (familial hypercholesterolaemia: 0.00 mg/L, 95% CI: -0.07 to 0.07; non-familial hypercholesterolaemia: 0.07 mg/L, 95% CI: -0.12 to 0.26; mix: -0.48 mg/L, 95% CI: -1.28 to 0.32) and treatment methods (monotherapy: 0.00 mg/L, -0.08 to 0.07; combination therapy: -0.08 mg/L, -0.37 to 0.21). Meta-regression analyses suggested no significant linear correlation between baseline age (p=0.673), sex (p=0.645) and low-density lipoprotein cholesterol reduction (p=0.339). CONCLUSIONS Our updated meta-analysis suggested that PCSK9-mAbs had no significant impact on circulating hs-CRP levels irrespective of PCSK9-mAb types, participant characteristics and treatment duration or methods.
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Affiliation(s)
- Ye-Xuan Cao
- Division of Dyslipidemia, State Key Laboratory of Cardiovascular Disease, Fu Wai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences, Peking Union Medical College, Beijing, China
| | - Sha Li
- Division of Dyslipidemia, State Key Laboratory of Cardiovascular Disease, Fu Wai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences, Peking Union Medical College, Beijing, China
| | - Hui-Hui Liu
- Division of Dyslipidemia, State Key Laboratory of Cardiovascular Disease, Fu Wai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences, Peking Union Medical College, Beijing, China
| | - Jian-Jun Li
- Division of Dyslipidemia, State Key Laboratory of Cardiovascular Disease, Fu Wai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences, Peking Union Medical College, Beijing, China
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Shin WC, Do MU, Woo SH, Choi SH, Moon NH, Suh KT. C-reactive protein for early detection of postoperative systemic infections in intertrochanteric femoral fractures. Injury 2018; 49:1859-1864. [PMID: 30082110 DOI: 10.1016/j.injury.2018.07.029] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/11/2018] [Revised: 07/10/2018] [Accepted: 07/26/2018] [Indexed: 02/02/2023]
Abstract
BACKGROUND This retrospective cohort study investigated perioperative C-reactive protein (CRP) value for early detection of postoperative systemic infective complications in elderly patients with intertrochanteric femoral fracture. METHODS A total of 250 patients aged ≥65 years, with intertrochanteric femoral fractures that were surgically treated between January 2011 and December 2015 were included. CRP value was measured preoperatively and on postoperative day (POD) 3, 5, and 10, and analyzed with regard to postoperative systemic infections, delirium, and death within 1 year. The patients were divided into two groups according to postoperative systemic infection, and perioperative CRP responses between the two groups were comparedusing t-test (or Man-Whitney test where appropriate). The receiver operator characteristic (ROC) curves of CRP value were used to determine the best-supported cut-off values for identifying postoperative systemic infections. Systemic infections were reclassified as pulmonary and extra-pulmonary infections. RESULTS The mean CRP values preoperatively and on POD 3, 5, and 10 were 2.82, 10.10, 3.74, and 1.89 mg/dL, respectively. Postoperative systemic infections, delirium, and death within 1 year were noted in 35 (14.0%), 30 (12.0%), and 45 (18.0%) patients, respectively. The CRP value in patients with postoperative systemic infections significantly elevated on POD 5 and 10 (p < 0.001, p < 0.001), and cut-off values were 4.71 and 1.59 mg/dL on POD 5 and 10, respectively. Postoperative delirium and death within 1 year were observed more often in the group with postoperative systemic infections (p = 0.003, p = 0.014). Although preoperatively elevated CRP values did not influence the postoperative CRP responses, they were significantly associated with delirium (p = 0.015). CONCLUSIONS The CRP value on POD 5 is the earliest predictor of postoperative systemic infections in elderly patients with intertrochanteric femoral fractures that are managed surgically. Moreover, when the CRP value on POD 5 is >4.71 mg/dL, the possibility of postoperative systemic infections should be considered. LEVEL OF EVIDENCE III, Retrospective cohort study.
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Affiliation(s)
- Won Chul Shin
- Department of Orthopaedic Surgery, Research Institute for Convergence of Biomedical Science and Technology, Pusan National University Yangsan Hospital, Pusan National University School of Medicine, Yangsan, Republic of Korea.
| | - Min Uk Do
- Department of Orthopaedic Surgery, Research Institute for Convergence of Biomedical Science and Technology, Pusan National University Yangsan Hospital, Pusan National University School of Medicine, Yangsan, Republic of Korea.
| | - Seung Hun Woo
- Department of Orthopaedic Surgery, Research Institute for Convergence of Biomedical Science and Technology, Pusan National University Yangsan Hospital, Pusan National University School of Medicine, Yangsan, Republic of Korea.
| | - Sung Hoon Choi
- Department of Orthopaedic Surgery, Research Institute for Convergence of Biomedical Science and Technology, Pusan National University Yangsan Hospital, Pusan National University School of Medicine, Yangsan, Republic of Korea.
| | - Nam Hoon Moon
- Department of Orthopaedic Surgery, Pusan National University Hospital, Busan, Republic of Korea.
| | - Kuen Tak Suh
- Department of Orthopaedic Surgery, Research Institute for Convergence of Biomedical Science and Technology, Pusan National University Yangsan Hospital, Pusan National University School of Medicine, Yangsan, Republic of Korea.
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Pajek M, Jerman A, Osredkar J, Ponikvar JB, Pajek J. Association of Uremic Toxins and Inflammatory Markers with Physical Performance in Dialysis Patients. Toxins (Basel) 2018; 10:toxins10100403. [PMID: 30275410 PMCID: PMC6215151 DOI: 10.3390/toxins10100403] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/26/2018] [Revised: 09/16/2018] [Accepted: 09/29/2018] [Indexed: 02/06/2023] Open
Abstract
Association of higher serum levels of uremic toxins and inflammatory markers with poorer physical performance is understudied. We measured the six-minute walk test (6MWT), 10 repetition sit-to-stand test (STS-10), handgrip strength (HGS), and Human Activity Profile (HAP) questionnaire score in 90 prevalent hemodialysis patents, with low comorbidity to reduce the potential confounding of concomitant disease. Midweek pre-dialysis serum levels of asymmetric dimethyl-arginine (ADMA), β2-microglobulin (B2M), high-sensitivity C-reactive protein (hs-CRP), indoxyl sulfate (IS), insulin-like growth factor 1 (IGF-1), interleukin 6 (IL-6), myostatin, and urea were analyzed as predictor parameters of physical performance measures in adjusted models. Serum levels of most measured toxins were not significantly related to performance, except for ADMA, which was significantly related to poorer performance in the STS-10 test (B = 0.11 ± 0.03 s, p < 0.01). Higher hs-CRP was associated with poorer results in the 6MWT (B = −2.6 ± 0.97 m, p < 0.01) and a lower HAP score (B = −0.36 ± 0.14, p = 0.01). There were no other significant associations found. We conclude that inflammation may be a more important pathway to physical impediment than uremic toxemia. This suggests that there is a large physical rehabilitation potential in non-inflamed uremic patients.
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Affiliation(s)
- Maja Pajek
- Faculty of Sport, University of Ljubljana, Gortanova 22, 1000 Ljubljana, Slovenia.
| | - Alexander Jerman
- Department of Nephrology, University Medical Centre Ljubljana, Zaloška 2, 1525 Ljubljana, Slovenia.
| | - Joško Osredkar
- Clinical Institute for Clinical Chemistry and Biochemistry, University Medical Centre Ljubljana, Zaloška 2, 1525 Ljubljana, Slovenia.
| | | | - Jernej Pajek
- Department of Nephrology, University Medical Centre Ljubljana, Zaloška 2, 1525 Ljubljana, Slovenia.
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Vasudevan A, Tecson KM, Bennett-Firmin J, Bottiglieri T, Lopez LR, Peterson M, Sathyamoorthy M, Schiffmann R, Schussler JM, Swift C, Velasco CE, McCullough PA. Prognostic value of urinary 11-dehydro-thromboxane B 2 for mortality: A cohort study of stable coronary artery disease patients treated with aspirin. Catheter Cardiovasc Interv 2018; 92:653-658. [PMID: 29193683 DOI: 10.1002/ccd.27437] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/27/2017] [Revised: 10/17/2017] [Accepted: 11/04/2017] [Indexed: 11/07/2022]
Abstract
AIM There is a variable cardiovascular risk reduction attributable to aspirin because of individual differences in the suppression of thromboxane A2 and its downstream metabolite 11-dehydro-thromboxane B2 (11dhTxB2 ). The aim of this study is to evaluate the optimal cut point of urinary 11dhTxB2 for the risk of mortality in aspirin-treated coronary artery disease (CAD) patients. METHODS AND RESULTS This was a prospective cohort study including stable CAD patients who visited the Baylor Heart and Vascular Hospital in Dallas or the Texas Heart Hospital Baylor Plano, TX between 2010 and 2013. The outcome of all-cause mortality was ascertained from chart review and automated sources. The 449 patients included in this analysis had a mean age of 66.1 ± 10.1 years. 67 (14.9%) patients died within 5 years; 56 (87.5%) of the 64 patients with known cause of death suffered a cardiovascular related mortality. Baseline ln(urinary 11dhTxB2 /creatinine) ranged between 5.8 and 11.1 (median = 7.2) with the higher concentrations among those who died (median: 7.6) than those who survived (median = 7.2, P < 0.001). Using baseline ln(11dhTxB2 ) to predict all-cause mortality, the area under the curve was 0.70 (95% CI: 0.64-0.76). The optimal cut point was found to be ln(7.38) = 1597.8 pg/mg, which had the following decision statistics: sensitivity = 0.67, specificity = 0.62, positive predictive value = 0.24, negative predictive value = 0.92, and accuracy = 0.63. CONCLUSION Our data indicate the optimal cut point for urine 11dhTxB2 is 1597.8 (pg/mg) for the risk prediction of mortality over five years in stable patients with CAD patients treated with aspirin.
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Affiliation(s)
- Anupama Vasudevan
- Baylor Heart and Vascular Institute, Baylor Research Institute, Dallas, Texas.,Department of Medicine, Texas A&M Health Science Center College of Medicine, Dallas Campus, Texas
| | - Kristen M Tecson
- Baylor Heart and Vascular Institute, Baylor Research Institute, Dallas, Texas.,Department of Medicine, Texas A&M Health Science Center College of Medicine, Dallas Campus, Texas
| | | | | | | | - Margarita Peterson
- Institute of Metabolic Disease, Baylor Research Institute, Dallas, Texas
| | - Mohanakrishnan Sathyamoorthy
- Baylor Jack and Jane Hamilton Heart and Vascular Hospital, Baylor University Medical Center, Dallas, Texas.,Division of Cardiology, Baylor All Saints Medical Center, Fort Worth, Texas
| | - Raphael Schiffmann
- Institute of Metabolic Disease, Baylor Research Institute, Dallas, Texas
| | - Jeffrey M Schussler
- Department of Medicine, Texas A&M Health Science Center College of Medicine, Dallas Campus, Texas.,Baylor Jack and Jane Hamilton Heart and Vascular Hospital, Baylor University Medical Center, Dallas, Texas
| | - Caren Swift
- Institute of Metabolic Disease, Baylor Research Institute, Dallas, Texas
| | - Carlos E Velasco
- Department of Medicine, Texas A&M Health Science Center College of Medicine, Dallas Campus, Texas.,Baylor Jack and Jane Hamilton Heart and Vascular Hospital, Baylor University Medical Center, Dallas, Texas
| | - Peter A McCullough
- Department of Medicine, Texas A&M Health Science Center College of Medicine, Dallas Campus, Texas.,Baylor Jack and Jane Hamilton Heart and Vascular Hospital, Baylor University Medical Center, Dallas, Texas.,Division of Cardiology, The Heart Hospital Baylor Plano, Texas
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24
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Katan M, Elkind MSV. The potential role of blood biomarkers in patients with ischemic stroke. CLINICAL AND TRANSLATIONAL NEUROSCIENCE 2018. [DOI: 10.1177/2514183x18768050] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Affiliation(s)
- Mira Katan
- Department of Neurology, Universitiy Hospital of Zurich, Zürich, Switzerland
| | - Mitchell SV Elkind
- Department of Neurology, Division of Stroke, Columbia University, New York, NY, USA
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25
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Ganz P, Amarenco P, Goldstein LB, Sillesen H, Bao W, Preston GM, Welch KMA. Association of Osteopontin, Neopterin, and Myeloperoxidase With Stroke Risk in Patients With Prior Stroke or Transient Ischemic Attacks: Results of an Analysis of 13 Biomarkers From the Stroke Prevention by Aggressive Reduction in Cholesterol Levels Trial. Stroke 2017; 48:3223-3231. [PMID: 29114094 DOI: 10.1161/strokeaha.117.017965] [Citation(s) in RCA: 25] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/11/2017] [Revised: 09/07/2017] [Accepted: 10/02/2017] [Indexed: 11/16/2022]
Abstract
BACKGROUND AND PURPOSE Established risk factors do not fully identify patients at risk for recurrent stroke. The SPARCL trial (Stroke Prevention by Aggressive Reduction in Cholesterol Levels) evaluated the effect of atorvastatin on stroke risk in patients with a recent stroke or transient ischemic attack and no known coronary heart disease. This analysis explored the relationships between 13 plasma biomarkers assessed at trial enrollment and the occurrence of outcome strokes. METHODS We conducted a case-cohort study of 2176 participants; 562 had outcome strokes and 1614 were selected randomly from those without outcome strokes. Time to stroke was evaluated by Cox proportional hazards models. RESULTS There was no association between time to stroke and lipoprotein-associated phospholipase A2, monocyte chemoattractant protein-1, resistin, matrix metalloproteinase-9, N-terminal fragment of pro-B-type natriuretic peptide, soluble vascular cell adhesion molecule-1, soluble intercellular adhesion molecule-1, or soluble CD40 ligand. In adjusted analyses, osteopontin (hazard ratio per SD change, 1.362; P<0.0001), neopterin (hazard ratio, 1.137; P=0.0107), myeloperoxidase (hazard ratio, 1.177; P=0.0022), and adiponectin (hazard ratio, 1.207; P=0.0013) were independently associated with outcome strokes. After adjustment for the Stroke Prognostic Instrument-II and treatment, osteopontin, neopterin, and myeloperoxidase remained independently associated with outcome strokes. The addition of these 3 biomarkers to Stroke Prognostic Instrument-II increased the area under the receiver operating characteristic curve by 0.023 (P=0.015) and yielded a continuous net reclassification improvement (29.1%; P<0.0001) and an integrated discrimination improvement (42.3%; P<0.0001). CONCLUSIONS Osteopontin, neopterin, and myeloperoxidase were independently associated with the risk of recurrent stroke and improved risk classification when added to a clinical risk algorithm. CLINICAL TRIAL REGISTRATION URL: http://www.clinicaltrials.gov. Unique Identifier: NCT00147602.
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Affiliation(s)
- Peter Ganz
- From Division of Cardiology, San Francisco General Hospital and University of California (P.G.); Paris-Diderot, Sorbonne University, France (P.A.); Department of Neurology and Stroke Center, Bichat University Hospital, Paris, France (P.A.); Department of Neurology, University of Kentucky, Lexington (L.B.G.); Department of Vascular Surgery, University of Copenhagen, Denmark (H.S.); Pfizer Inc, New York, NY (W.B., G.M.P.); and Rosalind Franklin University of Medicine and Science, North Chicago, IL (K.M.A.W.).
| | - Pierre Amarenco
- From Division of Cardiology, San Francisco General Hospital and University of California (P.G.); Paris-Diderot, Sorbonne University, France (P.A.); Department of Neurology and Stroke Center, Bichat University Hospital, Paris, France (P.A.); Department of Neurology, University of Kentucky, Lexington (L.B.G.); Department of Vascular Surgery, University of Copenhagen, Denmark (H.S.); Pfizer Inc, New York, NY (W.B., G.M.P.); and Rosalind Franklin University of Medicine and Science, North Chicago, IL (K.M.A.W.)
| | - Larry B Goldstein
- From Division of Cardiology, San Francisco General Hospital and University of California (P.G.); Paris-Diderot, Sorbonne University, France (P.A.); Department of Neurology and Stroke Center, Bichat University Hospital, Paris, France (P.A.); Department of Neurology, University of Kentucky, Lexington (L.B.G.); Department of Vascular Surgery, University of Copenhagen, Denmark (H.S.); Pfizer Inc, New York, NY (W.B., G.M.P.); and Rosalind Franklin University of Medicine and Science, North Chicago, IL (K.M.A.W.)
| | - Henrik Sillesen
- From Division of Cardiology, San Francisco General Hospital and University of California (P.G.); Paris-Diderot, Sorbonne University, France (P.A.); Department of Neurology and Stroke Center, Bichat University Hospital, Paris, France (P.A.); Department of Neurology, University of Kentucky, Lexington (L.B.G.); Department of Vascular Surgery, University of Copenhagen, Denmark (H.S.); Pfizer Inc, New York, NY (W.B., G.M.P.); and Rosalind Franklin University of Medicine and Science, North Chicago, IL (K.M.A.W.)
| | - Weihang Bao
- From Division of Cardiology, San Francisco General Hospital and University of California (P.G.); Paris-Diderot, Sorbonne University, France (P.A.); Department of Neurology and Stroke Center, Bichat University Hospital, Paris, France (P.A.); Department of Neurology, University of Kentucky, Lexington (L.B.G.); Department of Vascular Surgery, University of Copenhagen, Denmark (H.S.); Pfizer Inc, New York, NY (W.B., G.M.P.); and Rosalind Franklin University of Medicine and Science, North Chicago, IL (K.M.A.W.)
| | - Gregory M Preston
- From Division of Cardiology, San Francisco General Hospital and University of California (P.G.); Paris-Diderot, Sorbonne University, France (P.A.); Department of Neurology and Stroke Center, Bichat University Hospital, Paris, France (P.A.); Department of Neurology, University of Kentucky, Lexington (L.B.G.); Department of Vascular Surgery, University of Copenhagen, Denmark (H.S.); Pfizer Inc, New York, NY (W.B., G.M.P.); and Rosalind Franklin University of Medicine and Science, North Chicago, IL (K.M.A.W.)
| | - K Michael A Welch
- From Division of Cardiology, San Francisco General Hospital and University of California (P.G.); Paris-Diderot, Sorbonne University, France (P.A.); Department of Neurology and Stroke Center, Bichat University Hospital, Paris, France (P.A.); Department of Neurology, University of Kentucky, Lexington (L.B.G.); Department of Vascular Surgery, University of Copenhagen, Denmark (H.S.); Pfizer Inc, New York, NY (W.B., G.M.P.); and Rosalind Franklin University of Medicine and Science, North Chicago, IL (K.M.A.W.)
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26
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Li Y, Zhong X, Cheng G, Zhao C, Zhang L, Hong Y, Wan Q, He R, Wang Z. Hs-CRP and all-cause, cardiovascular, and cancer mortality risk: A meta-analysis. Atherosclerosis 2017; 259:75-82. [PMID: 28327451 DOI: 10.1016/j.atherosclerosis.2017.02.003] [Citation(s) in RCA: 247] [Impact Index Per Article: 35.3] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/02/2016] [Revised: 01/11/2017] [Accepted: 02/07/2017] [Indexed: 01/20/2023]
Abstract
BACKGROUND AND AIMS Inconsistent findings have been reported on the association between high-sensitivity C-reactive protein (hs-CRP) and mortality risk. The objective of this meta-analysis was to investigate the association of elevated baseline hs-CRP levels with all-cause, cardiovascular, and cancer mortality risk in the general population. METHODS PubMed and Embase were systematically searched for studies published from inception to October 2016. Prospective observational studies were eligible if they reported the effects of elevated baseline hs-CRP levels on cancer-related, cardiovascular or all-cause mortality in the general population. The pooled adjusted risk ratio (RR) with 95% confidence interval (CI) comparing the highest to the lowest category of hs-CRP levels was used as association measures. RESULTS A total of 83,995 participants from 14 studies were identified. When comparing the highest to the lowest category of hs-CRP levels, the pooled RR was 1.25 (95% CI 1.13-1.38) for cancer-related mortality, 2.03 (95% CI 1.65-2.50) for cardiovascular mortality, and 1.75 (1.55-1.98) for all-cause mortality, respectively. Subgroup analysis showed that the effect of elevated hs-CRP levels on cancer-related mortality was observed in men (RR 1.26; 95% CI 1.11-1.43) but not in women (RR 1.03; 95% CI 0.83-1.27). CONCLUSIONS Elevated hs-CRP levels can independently predict risk of all-cause, cardiovascular mortality in the general population. However, the gender differences in the predictive role of hs-CRP on cancer mortality should to be further investigated.
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Affiliation(s)
- Yunwei Li
- Department of Cardiology, Huaihe Hospital of Henan University, Kaifeng, 475000, China
| | - Xiaoming Zhong
- Department of Cardiology, Huaihe Hospital of Henan University, Kaifeng, 475000, China
| | - Guanchang Cheng
- Department of Cardiology, Huaihe Hospital of Henan University, Kaifeng, 475000, China.
| | - Cuihua Zhao
- Department of Cardiology, Huaihe Hospital of Henan University, Kaifeng, 475000, China
| | - Lei Zhang
- Department of Cardiology, Huaihe Hospital of Henan University, Kaifeng, 475000, China
| | - Yan Hong
- Department of Cardiology, Huaihe Hospital of Henan University, Kaifeng, 475000, China
| | - Qilin Wan
- Department of Cardiology, Huaihe Hospital of Henan University, Kaifeng, 475000, China
| | - Ruili He
- Department of Cardiology, Huaihe Hospital of Henan University, Kaifeng, 475000, China
| | - Zhizhong Wang
- Department of Cardiology, Huaihe Hospital of Henan University, Kaifeng, 475000, China
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27
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Katan M, Moon Y, von Eckardstein A, Spanaus K, DeRosa J, Gutierrez J, DeCarli C, Wright C, Sacco R, Elkind M. Procalcitonin and Midregional Proatrial Natriuretic Peptide as Biomarkers of Subclinical Cerebrovascular Damage: The Northern Manhattan Study. Stroke 2017; 48:604-610. [PMID: 28123058 DOI: 10.1161/strokeaha.116.014945] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/29/2016] [Revised: 10/25/2016] [Accepted: 11/18/2016] [Indexed: 01/26/2023]
Abstract
BACKGROUND AND PURPOSE Chronic infections and cardiac dysfunction are risk factors for stroke. We hypothesized that blood biomarkers of infection (procalcitonin) and cardiac dysfunction (midregional proatrial natriuretic peptide [MR-proANP]), previously associated with small vessel stroke and cardioembolic stroke are also associated with subclinical cerebrovascular damage, including silent brain infarcts and white matter hyperintensity volume. METHODS The NOMAS (Northern Manhattan Study) was designed to assess risk factors for incident vascular disease in a multiethnic cohort. A subsample underwent brain magnetic resonance imaging and had blood samples available for biomarker measurement (n=1178). We used logistic regression models to estimate the odds ratios and 95% confidence intervals (95% CIs) for the association of these biomarkers with silent brain infarcts after adjusting for demographic, behavioral, and medical risk factors. We used linear regression to assess associations with log-white matter hyperintensity volume. RESULTS Mean age was 70±9 years; 60% were women, 66% Hispanic, 17% black, and 15% were white. After adjusting for risk factors, subjects with procalcitonin or MR-proANP in the top quartile, compared with the lowest quartile were more likely to have silent brain infarcts (adjusted odds ratio for procalcitonin, 2.2; 95% CI, 1.3-3.7 and for MR-proANP, 3.3; 95% CI, 1.7-6.3) and increased white matter hyperintensity volume (adjusted mean change in log-white matter hyperintensity volume for procalcitonin, 0.29; 95% CI, 0.13-0.44 and for MR-proANP, 0.18; 95% CI, 0.004-0.36). CONCLUSIONS Higher concentrations of procalcitonin, a marker of infection, and MR-proANP, a marker of cardiac dysfunction, are independently associated with subclinical cerebrovascular damage. If further studies demonstrate an incremental value for risk stratification, biomarker-guided primary prevention studies may lead to new approaches to prevent cerebrovascular disease.
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Affiliation(s)
- Mira Katan
- From the Departments of Neurology (M.K., Y.M., J.D.R., J.G., M.E.) and Epidemiology (M.E.), Columbia University, New York, NY; Departments of Neurology (M.K.) and Clinical Chemistry (A.v.E., K.S.), University Hospital of Zurich, Switzerland; Department of Neurology, University of California at Davis, Sacramento (C.D.C.); and Departments of Neurology (C.W., R.S.), Public Health Sciences (R.S.), and Human Genetics (R.S.), University of Miami, FL.
| | - Yeseon Moon
- From the Departments of Neurology (M.K., Y.M., J.D.R., J.G., M.E.) and Epidemiology (M.E.), Columbia University, New York, NY; Departments of Neurology (M.K.) and Clinical Chemistry (A.v.E., K.S.), University Hospital of Zurich, Switzerland; Department of Neurology, University of California at Davis, Sacramento (C.D.C.); and Departments of Neurology (C.W., R.S.), Public Health Sciences (R.S.), and Human Genetics (R.S.), University of Miami, FL
| | - Arnold von Eckardstein
- From the Departments of Neurology (M.K., Y.M., J.D.R., J.G., M.E.) and Epidemiology (M.E.), Columbia University, New York, NY; Departments of Neurology (M.K.) and Clinical Chemistry (A.v.E., K.S.), University Hospital of Zurich, Switzerland; Department of Neurology, University of California at Davis, Sacramento (C.D.C.); and Departments of Neurology (C.W., R.S.), Public Health Sciences (R.S.), and Human Genetics (R.S.), University of Miami, FL
| | - Kathartina Spanaus
- From the Departments of Neurology (M.K., Y.M., J.D.R., J.G., M.E.) and Epidemiology (M.E.), Columbia University, New York, NY; Departments of Neurology (M.K.) and Clinical Chemistry (A.v.E., K.S.), University Hospital of Zurich, Switzerland; Department of Neurology, University of California at Davis, Sacramento (C.D.C.); and Departments of Neurology (C.W., R.S.), Public Health Sciences (R.S.), and Human Genetics (R.S.), University of Miami, FL
| | - Janet DeRosa
- From the Departments of Neurology (M.K., Y.M., J.D.R., J.G., M.E.) and Epidemiology (M.E.), Columbia University, New York, NY; Departments of Neurology (M.K.) and Clinical Chemistry (A.v.E., K.S.), University Hospital of Zurich, Switzerland; Department of Neurology, University of California at Davis, Sacramento (C.D.C.); and Departments of Neurology (C.W., R.S.), Public Health Sciences (R.S.), and Human Genetics (R.S.), University of Miami, FL
| | - Jose Gutierrez
- From the Departments of Neurology (M.K., Y.M., J.D.R., J.G., M.E.) and Epidemiology (M.E.), Columbia University, New York, NY; Departments of Neurology (M.K.) and Clinical Chemistry (A.v.E., K.S.), University Hospital of Zurich, Switzerland; Department of Neurology, University of California at Davis, Sacramento (C.D.C.); and Departments of Neurology (C.W., R.S.), Public Health Sciences (R.S.), and Human Genetics (R.S.), University of Miami, FL
| | - Charles DeCarli
- From the Departments of Neurology (M.K., Y.M., J.D.R., J.G., M.E.) and Epidemiology (M.E.), Columbia University, New York, NY; Departments of Neurology (M.K.) and Clinical Chemistry (A.v.E., K.S.), University Hospital of Zurich, Switzerland; Department of Neurology, University of California at Davis, Sacramento (C.D.C.); and Departments of Neurology (C.W., R.S.), Public Health Sciences (R.S.), and Human Genetics (R.S.), University of Miami, FL
| | - Clinton Wright
- From the Departments of Neurology (M.K., Y.M., J.D.R., J.G., M.E.) and Epidemiology (M.E.), Columbia University, New York, NY; Departments of Neurology (M.K.) and Clinical Chemistry (A.v.E., K.S.), University Hospital of Zurich, Switzerland; Department of Neurology, University of California at Davis, Sacramento (C.D.C.); and Departments of Neurology (C.W., R.S.), Public Health Sciences (R.S.), and Human Genetics (R.S.), University of Miami, FL
| | - Ralph Sacco
- From the Departments of Neurology (M.K., Y.M., J.D.R., J.G., M.E.) and Epidemiology (M.E.), Columbia University, New York, NY; Departments of Neurology (M.K.) and Clinical Chemistry (A.v.E., K.S.), University Hospital of Zurich, Switzerland; Department of Neurology, University of California at Davis, Sacramento (C.D.C.); and Departments of Neurology (C.W., R.S.), Public Health Sciences (R.S.), and Human Genetics (R.S.), University of Miami, FL
| | - Mitchell Elkind
- From the Departments of Neurology (M.K., Y.M., J.D.R., J.G., M.E.) and Epidemiology (M.E.), Columbia University, New York, NY; Departments of Neurology (M.K.) and Clinical Chemistry (A.v.E., K.S.), University Hospital of Zurich, Switzerland; Department of Neurology, University of California at Davis, Sacramento (C.D.C.); and Departments of Neurology (C.W., R.S.), Public Health Sciences (R.S.), and Human Genetics (R.S.), University of Miami, FL
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28
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Dhamoon MS, Cheung YK, Moon YP, Wright CB, Willey JZ, Sacco R, Elkind MS. C-reactive protein is associated with disability independently of vascular events: the Northern Manhattan Study. Age Ageing 2017; 46:77-83. [PMID: 28181636 DOI: 10.1093/ageing/afw179] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/04/2016] [Accepted: 09/14/2016] [Indexed: 12/26/2022] Open
Abstract
Background High-sensitivity C-reactive protein (CRP) has been associated with cardiovascular events and mortality, but the association of CRP with functional status is not well defined. We hypothesised that serum levels of high-sensitivity CRP are associated with long-term trajectories of functional status independently of vascular risk factors and stroke and myocardial infarction (MI) occurring during follow-up. Design Prospective, population-based. Setting Northern Manhattan Study. Participants Stroke-free participants aged ≥40 years. Measurements Annual assessments of disability with the Barthel index (BI) for a median of 13 years. BI was analysed as a continuous variable (range 0–100). Baseline demographics, risk factors and laboratory studies were collected, including CRP (n = 2,240). Separate generalised estimating equation models estimated standardised associations between CRP and (i) baseline functional status and (ii) change in function over time, adjusting for demographics, vascular risk factors, social variables, cognition, and depression measured at baseline, and stroke and MI occurring during follow-up. Results Mean age was 69 (SD 10) years, 36% were male, 55% Hispanic, 75% hypertensive and 21% diabetic; 337 MIs and 369 first strokes occurred during follow-up. Mean CRP level was 5.24 mg/l (SD 8.86). logCRP was associated with baseline BI (−0.34 BI points per unit logCRP, 95% confidence interval −0.62, −0.06) but not with change over time. Conclusions In this large population-based study, higher serum CRP levels were associated with higher baseline disability, even when adjusting for baseline covariates and stroke and MI occurring during follow-up. Systemic inflammation may contribute to disability independently of clinical vascular events.
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Affiliation(s)
- Mandip S Dhamoon
- Neurology, Icahn School of Medicine at Mount Sinai, New York, NY 10029-6574, USA
| | | | - Yeseon P Moon
- Biostatistics, Columbia University, New York, NY, USA
| | | | | | - Ralph Sacco
- Medicine, University of Miami, Miami, FL, USA
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The role of very high high-sensitivity C-reactive protein levels on mortality after stroke. J Neurol Sci 2017; 372:1-5. [DOI: 10.1016/j.jns.2016.11.019] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/16/2016] [Revised: 11/04/2016] [Accepted: 11/10/2016] [Indexed: 11/17/2022]
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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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Kim BG, Lee YK, Park HP, Sohn HM, Oh AY, Jeon YT, Koo KH. C-reactive protein is an independent predictor for 1-year mortality in elderly patients undergoing hip fracture surgery: A retrospective analysis. Medicine (Baltimore) 2016; 95:e5152. [PMID: 27787371 PMCID: PMC5089100 DOI: 10.1097/md.0000000000005152] [Citation(s) in RCA: 24] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
Abstract
Numerous factors are associated with mortality after hip fracture surgery in elderly patients. The aim of this study was to investigate whether preoperative C-reactive protein (CRP) was an independent risk factor for 1-year mortality after hip fracture surgery in the elderly. The electronic medical records of 772 elderly patients (age ≥ 65 years) undergoing hip fracture surgery from May 2003 to November 2011 were reviewed retrospectively. The patients comprised a high CRP group (>10.0 mg/dL) and low CRP group (≤10.0 mg/dL), based upon preoperative CRP levels. The overall 1-year mortality was 14.1%; the value was significantly higher in the high CRP group than in the low CRP group (31.8% vs 12.5%; P < 0.001). On binary logistic regression, body mass index (odds ratio [OR], 0.93; 95% confidence interval [CI], 0.88-0.99; P = 0.025), history of malignancy (OR, 2.59; 95% CI, 1.47-4.57; P = 0.001), American Society of Anesthesiologists physical status (ASA PS) class 3-4 (OR, 1.96; 95% CI, 1.25-3.07; P = 0.003), preoperative albumin (OR, 0.39; 95% CI, 0.25-0.61; P < 0.001), preoperative CRP > 10.0 mg/dL (OR, 2.04; 95% CI, 1.09-3.80; P = 0.025), postoperative intensive care unit (ICU) admission (OR, 2.29; 95% CI, 1.15-4.59; P = 0.019), and creatinine on the second postoperative day (OR, 1.20; 95% CI, 1.00-1.45; P = 0.048) were independent predictors of 1-year mortality after hip surgery. Male gender and low preoperative hemoglobin were associated with in-hospital mortality, whereas delayed surgery and femoral neck fracture were related to the 6-month mortality. Low preoperative albumin and low body mass index predicted the 6-month and 1-year mortality. An increased preoperative CRP level, particularly >10.0 mg/dL, was associated with the 1-year mortality after hip fracture surgery in the elderly. In addition, a history of malignancy, high ASA PS score, and postoperative ICU admission were related to mortality after hip fracture.
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Affiliation(s)
- Byung-Gun Kim
- Department of Anesthesiology and Pain Medicine, College of Medicine, Inha University, Incheon
| | - Young-Kyun Lee
- Department of Orthopedics, Seoul National University Bundang Hospital, Seongnam
| | - Hee-Pyoung Park
- Department of Anesthesiology and Pain Medicine, Seoul National University Hospital, Seoul National University College of Medicine, Seoul
| | - Hye-Min Sohn
- Department of Anesthesiology and Pain Medicine, Seoul National University Bundang Hospital, Seongnam, South Korea
| | - Ah-Young Oh
- Department of Anesthesiology and Pain Medicine, Seoul National University Bundang Hospital, Seongnam, South Korea
| | - Young-Tae Jeon
- Department of Anesthesiology and Pain Medicine, Seoul National University Bundang Hospital, Seongnam, South Korea
- Correspondence: Young-Tae Jeon, Department of Anesthesiology and Pain Medicine, Seoul National University Bundang Hospital, Bundang-gu, Seongnam-si, Kyonggi-do, South Korea (e-mail: )
| | - Kyung-Hoi Koo
- Department of Orthopedics, Seoul National University Bundang Hospital, Seongnam
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32
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Esenwa CC, Elkind MS. Inflammatory risk factors, biomarkers and associated therapy in ischaemic stroke. Nat Rev Neurol 2016; 12:594-604. [DOI: 10.1038/nrneurol.2016.125] [Citation(s) in RCA: 166] [Impact Index Per Article: 20.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
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Shi H, Leng S, Liang H, Zheng Y, Chen L. Association study of C-reactive protein associated gene HNF1A with ischemic stroke in Chinese population. BMC MEDICAL GENETICS 2016; 17:51. [PMID: 27460564 PMCID: PMC4962403 DOI: 10.1186/s12881-016-0313-3] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 01/09/2016] [Accepted: 07/19/2016] [Indexed: 11/17/2022]
Abstract
Background Ischemic stroke is a life-threatening condition due to obstructed blood supply of the brain. Elevation of plasma C-reactive protein, an important inflammatory marker, was known to associate with increased risk of ischemic stroke. Previous studies reported association between genetic variants of HNF1A and plasma level of C-reactive protein. The HNF1A gene encodes a hepatocyte transcription factor which might have regulatory effects on C-reactive protein synthesis in liver. Therefore, the C-reactive protein associated gene HNF1A seems to be a promising candidate gene for ischemic stroke. Results We used HNF1A as a candidate gene of ischemic stroke and evaluated seven common variants of HNF1A for their contribution to ischemic stroke. The association analysis of HNF1A variants with ischemic stroke was performed in a Chinese population with 918 cases and 979 controls. For total ischemic stroke and large vessel disease subtype, none of variants exceeded significant threshold. For small vessel disease subtype of ischemic stroke, the G allele of rs7953249 showed nominal association (OR = 0.82, p = 0.04) after data adjustment for conventional risk factors. However, our preliminary results did not survived bonferroni correction for multiple comparisons. Conclusions Common genetic variants of HNF1A showed nominal association with small vessel disease subtype of ischemic stroke though not survived bonferroni correction for multiple comparisons. The association between HNF1A and ischemic stroke is limited by small effects of individual SNPs. Our study provided additional genetic evidences to understand the role of HNF1A gene and C-reactive protein underlying ischemic stroke. Electronic supplementary material The online version of this article (doi:10.1186/s12881-016-0313-3) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Haibin Shi
- Fujian University of Traditional Chinese Medicine, No.1 Qiuyang Road, Shangjie, Minhou, Fuzhou, 350122, China.,Fujian University of Traditional Chinese Medicine Subsidiary Rehabilitation Hospital, Fuzhou, China.,Academy of Integrative Medicine, Fujian University of Traditional Chinese Medicine, Fuzhou, China
| | - Song Leng
- Health Management Center, The Second Hospital of Dalian Medical University, Dalian, China
| | - Hui Liang
- Department of Neurology, The People's Hospital of Fujian Province, Fuzhou, China
| | - Yan Zheng
- The Second People's Hospital Affiliated to Fujian University of Traditional Chinese Medicine, Fuzhou, China
| | - Lidian Chen
- Fujian University of Traditional Chinese Medicine, No.1 Qiuyang Road, Shangjie, Minhou, Fuzhou, 350122, China.
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Turner CL, Budohoski K, Smith C, Hutchinson PJ, Kirkpatrick PJ, Murray GD. Elevated Baseline C-Reactive Protein as a Predictor of Outcome After Aneurysmal Subarachnoid Hemorrhage: Data From the Simvastatin in Aneurysmal Subarachnoid Hemorrhage (STASH) Trial. Neurosurgery 2016; 77:786-92; discussion 792-3. [PMID: 26280117 PMCID: PMC4605277 DOI: 10.1227/neu.0000000000000963] [Citation(s) in RCA: 31] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022] Open
Abstract
There remains a proportion of patients with unfavorable outcomes after aneurysmal subarachnoid hemorrhage, of particular relevance in those who present with a good clinical grade. A forewarning of those at risk provides an opportunity towards more intensive monitoring, investigation, and prophylactic treatment prior to the clinical manifestation of advancing cerebral injury.
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Affiliation(s)
- Carole L Turner
- Academic Division of Neurosurgery, Cambridge University Hospitals NHS Foundation Trust, Cambridge, United Kingdom
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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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Zhang Q, Qiu DX, Fu RL, Xu TF, Jing MJ, Zhang HS, Geng HH, Zheng LC, Wang PX. H-Type Hypertension and C Reactive Protein in Recurrence of Ischemic Stroke. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2016; 13:ijerph13050477. [PMID: 27164124 PMCID: PMC4881102 DOI: 10.3390/ijerph13050477] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 03/07/2016] [Revised: 04/27/2016] [Accepted: 05/04/2016] [Indexed: 01/04/2023]
Abstract
Hypertension with high homocysteine (HHcy) (H-type hypertension) and C reactive protein (CRP) can increase the incidence of ischemic stroke. However, it is not clear whether recurrent ischemic stroke (RIS) is related to H-type hypertension and CRP. The present study investigated the correlation of H-type hypertension and CRP level with RIS. Totally, 987 consecutive patients with acute ischemic stroke were recruited in a teaching hospital in Henan province, China during March 2014 to March 2015. The demographic and clinical characteristics and blood biochemical parameters of patients were analyzed. Elevated levels of CRP and homocysteine (Hcy) were defined as >8.2 mg/L and 10 μmol/L, respectively. Among the 987 patients, 234 were RIS. Thirty-eight percent of RIS patients had elevated CRP level and 91.5% of RIS patients had HHcy. In multivariate analysis, adjusted odds ratio (OR) of RIS in patients aged ≥60 years was 1.576 (95% CI: 1.125–2.207), in male patients 1.935 (95% CI: 1.385–2.704), in patients with diabetes 1.463 (95% CI: 1.037–2.064), CRP levels 1.013 (95% CI: 1.006–1.019), simple hypertension 3.370 (95% CI: 1.15–10.183), and H-type hypertension 2.990 (95% CI: 1.176–7.600). RIS was associated with older age, male, diabetes, H-type hypertension and CRP. Controlling H-type hypertension and CRP level may reduce the risk of RIS.
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Affiliation(s)
- Qing Zhang
- Institute of Public Health, School of Nursing, Henan University, Kaifeng 475004, China.
| | - De-Xing Qiu
- Guangming New District People's Hospital & Community Health Service Management Center of Guangming Area, Shenzhen 518000, China.
| | - Rong-Li Fu
- Internal Medicine-Neurology, Huaihe Hospital, Henan University, Kaifeng 475000, China.
| | - Tian-Fen Xu
- Basical School, Guangzhou Medical University, Guangzhou 510180, China.
| | - Meng-Juan Jing
- Institute of Public Health, School of Nursing, Henan University, Kaifeng 475004, China.
| | - Hui-Shan Zhang
- Department of Preventive Medicine, School of Public Health, Guangzhou Medical University, Guangzhou 510180, China.
| | - He-Hong Geng
- Institute of Public Health, School of Nursing, Henan University, Kaifeng 475004, China.
| | - Long-Chao Zheng
- Department of Public Health, School of Public Health, Graduate School of Guizhou Medical University, Guiyang 550025, China.
| | - Pei-Xi Wang
- Institute of Public Health, School of Nursing, Henan University, Kaifeng 475004, China.
- Department of Preventive Medicine, School of Public Health, Guangzhou Medical University, Guangzhou 510180, China.
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Zhou Y, Han W, Gong D, Man C, Fan Y. Hs-CRP in stroke: A meta-analysis. Clin Chim Acta 2015; 453:21-7. [PMID: 26633855 DOI: 10.1016/j.cca.2015.11.027] [Citation(s) in RCA: 76] [Impact Index Per Article: 8.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/30/2015] [Revised: 11/18/2015] [Accepted: 11/25/2015] [Indexed: 12/17/2022]
Abstract
BACKGROUND Studies on high-sensitivity C-reactive protein (hs-CRP) and stroke risk have yielded conflicting results. OBJECTIVE To determine whether elevated baseline hs-CRP presents an independent risk for different kinds of strokes by conducting a meta-analysis. METHODS The PubMed, Embase, Cochrane Library, China National Knowledge Infrastructure and Wanfang databases were systematically searched for prospective observational studies published until January 2015. Studies reporting hs-CRP levels and adjusted risk estimates of different stroke subtypes by hs-CRP were selected. Pooled results were expressed as adjusted risk ratios (RRs), with corresponding 95% confidence intervals (CI) for the highest versus the lowest hs-CRP category. RESULTS Twelve studies involving 2269 strokes, of which 2436 were ischemic and 655 were hemorrhagic, were identified from 66,560 participants. When comparing the highest with the lowest hs-CRP category, the pooled RR of ischemic strokes was 1.46 (95% CI 1.27-1.67) in a fixed-effect model. The pooled RRs of all strokes and hemorrhagic stroke were 1.23 (95% CI: 0.997-1.51) and 0.82 (95% CI 0.59-1.13), respectively. The risk of ischemic strokes seemed higher in men (RR 1.66; 95% CI 1.23-2.24). CONCLUSIONS Elevated baseline hs-CRP levels are independently associated with excessive ischemic stroke risk but exhibit no clear effect on hemorrhagic stroke.
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Affiliation(s)
- Yongjing Zhou
- Institute of Molecular Biology & Translational Medicine, the Affiliated People's Hospital, Jiangsu University, Zhenjiang, Jiangsu 212002, PR China
| | - Wei Han
- Department of Pharmacy, Shenyang Children's Hospital, Shenyang 110032, PR China
| | - Dandan Gong
- Institute of Molecular Biology & Translational Medicine, the Affiliated People's Hospital, Jiangsu University, Zhenjiang, Jiangsu 212002, PR China
| | - Changfeng Man
- Institute of Molecular Biology & Translational Medicine, the Affiliated People's Hospital, Jiangsu University, Zhenjiang, Jiangsu 212002, PR China
| | - Yu Fan
- Institute of Molecular Biology & Translational Medicine, the Affiliated People's Hospital, Jiangsu University, Zhenjiang, Jiangsu 212002, PR China.
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Abstract
Stroke remains to be a leading cause of disability. However, optimal strategies can prevent up to 80% of strokes. A large body of evidence supports many strategies for primary and secondary prevention of stroke. The purpose of this paper is to highlight recent major advances for management of modifiable medical and behavioral risk factors of stroke. Specific studies are highlighted, including those related to atrial fibrillation (AF), hypertension, revascularization, hyperlipidemia, antiplatelets, smoking, diet, and physical activity. Effective strategies include the use of novel oral anticoagulants for AF, antiplatelet therapy, and intensive lowering of atherosclerosis risk factors.
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Affiliation(s)
- Ayesha Z Sherzai
- Departments of Neurology and Epidemiology, Columbia University Medical Center, New York, New York
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Brito V, Alcaraz A, Augustovski F, Pichón-Riviere A, García-Martí S, Bardach A, Ciapponi A, Lopez A, Comandé D. [High sensitivity C protein as an independent risk factor in people with and without history of cardiovascular disease]. ARCHIVOS DE CARDIOLOGIA DE MEXICO 2015; 85:124-35. [PMID: 25700576 DOI: 10.1016/j.acmx.2014.11.005] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/14/2014] [Revised: 11/02/2014] [Accepted: 11/03/2014] [Indexed: 10/24/2022] Open
Abstract
Among the new cardiovascular event (CVE) risk biomarkers, C-reactive protein detected using high sensitive techniques (hs-CRP) has been one of the most commonly evaluated. In this review, the available evidence on the usefulness of hs-CRP was explored as an independent risk event factor in subjects with no cardiovascular history and as prognosis in case of chronic or acute cardiovascular condition. An overview (revision of revisions) was carried out searching in the main bibliographic databases and in other general Internet search engines. During the first stage, systematic reviews, clinical practice guidelines, health technology assessments and coverage policies were found and, during the second stage primary studies published after the systematic review search dates were added. Seven hundred and seventy four quotes were found, including 36 papers assessing the role of hs-CRP in healthy populations or with cardiovascular history. High quality evidence was found pointing out hs-CRP, both as risk factor in the general population and as prognostic factor in those with CVE, in all the populations assessed. It was most useful in subjects with a history of CVE and intermediate risk of events at 10 years; where adding hs-CRP to the classical models for event risk estimation improves risk staging. There was no consensus on its clinical usefulness as a prognostic marker in subjects with chronic or acute disease.
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Affiliation(s)
- Viviana Brito
- Departamento de Evaluaciones de Tecnologías Sanitarias y Economía de la Salud, Instituto de Efectividad Clínica y Sanitaria, Buenos Aires, Argentina.
| | - Andrea Alcaraz
- Departamento de Evaluaciones de Tecnologías Sanitarias y Economía de la Salud, Instituto de Efectividad Clínica y Sanitaria, Buenos Aires, Argentina
| | - Federico Augustovski
- Departamento de Evaluaciones de Tecnologías Sanitarias y Economía de la Salud, Instituto de Efectividad Clínica y Sanitaria, Buenos Aires, Argentina
| | - Andrés Pichón-Riviere
- Departamento de Evaluaciones de Tecnologías Sanitarias y Economía de la Salud, Instituto de Efectividad Clínica y Sanitaria, Buenos Aires, Argentina
| | - Sebastián García-Martí
- Departamento de Evaluaciones de Tecnologías Sanitarias y Economía de la Salud, Instituto de Efectividad Clínica y Sanitaria, Buenos Aires, Argentina
| | - Ariel Bardach
- Departamento de Evaluaciones de Tecnologías Sanitarias y Economía de la Salud, Instituto de Efectividad Clínica y Sanitaria, Buenos Aires, Argentina
| | - Agustín Ciapponi
- Departamento de Evaluaciones de Tecnologías Sanitarias y Economía de la Salud, Instituto de Efectividad Clínica y Sanitaria, Buenos Aires, Argentina
| | - Analía Lopez
- Departamento de Evaluaciones de Tecnologías Sanitarias y Economía de la Salud, Instituto de Efectividad Clínica y Sanitaria, Buenos Aires, Argentina
| | - Daniel Comandé
- Departamento de Evaluaciones de Tecnologías Sanitarias y Economía de la Salud, Instituto de Efectividad Clínica y Sanitaria, Buenos Aires, Argentina
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Siegel G, Ermilov E, Knes O, Rodríguez M. Combined lowering of low grade systemic inflammation and insulin resistance in metabolic syndrome patients treated with Ginkgo biloba. Atherosclerosis 2014; 237:584-8. [PMID: 25463092 DOI: 10.1016/j.atherosclerosis.2014.10.023] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/18/2014] [Revised: 09/25/2014] [Accepted: 10/16/2014] [Indexed: 10/24/2022]
Abstract
In a clinical pilot study with eleven metabolic syndrome patients, a simultaneous decrease in hs-CRP from 8.85 ± 4.09 to 4.92 ± 2.51 mg/L (-44.4%) (p < 0.0436) and HOMA-IR from 3.07 ± 0.63 to 2.60 ± 0.51 mU/L × mg/dL (-15.3%) (p < 0.0120) as well as a beneficial change of arteriosclerotic, inflammatory and oxidative stress biomarkers were detected after 2-month treatment with Ginkgo biloba. Furthermore, both IL-6 (-12.9%, p < 0.0407) and nanoplaque formation (-14.3%, p < 0.0077) were additionally reduced. According to a large clinical trial elucidating the importance of insulin resistance and low-grade systemic inflammation for cardiovascular disease and overall mortality risk, these data might indicate a CVD/total mortality risk reduction.
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Affiliation(s)
- G Siegel
- Charité - University Clinic Berlin, 10117 Berlin, Germany; University of Uppsala Biomedical Center, 751 23 Uppsala, Sweden.
| | - E Ermilov
- Charité - University Clinic Berlin, 10117 Berlin, Germany
| | - O Knes
- Swiss Analysis AG, 8274 Tägerwilen, Switzerland
| | - M Rodríguez
- Charité - University Clinic Berlin, 10117 Berlin, Germany; Scienion AG, 12489 Berlin, Germany
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Löppönen P, Qian C, Tetri S, Juvela S, Huhtakangas J, Bode MK, Hillbom M. Predictive value of C-reactive protein for the outcome after primary intracerebral hemorrhage. J Neurosurg 2014; 121:1374-9. [PMID: 25170663 DOI: 10.3171/2014.7.jns132678] [Citation(s) in RCA: 30] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
OBJECT Primary intracerebral hemorrhage (ICH) carries high morbidity and mortality rates. Several factors have been suggested as predicting the outcome. The value of C-reactive protein (CRP) levels in predicting a poor outcome is unclear, and findings have been contradictory. In their population-based cohort, the authors tested whether, independent of confounding factors, elevated CRP levels on admission (< 24 hours after ictus) are associated with an unfavorable outcome. METHODS The authors identified all patients who suffered primary ICH between 1993 and 2008 among the population of Northern Ostrobothnia, Finland, and from the laboratory records they extracted the CRP values at admission. Independent predictors of an unfavorable outcome (moderate disability or worse according to the Glasgow Outcome Scale at 3 months) were tested by unconditional logistic regression in a model including all the well-established confounding factors and CRP on admission. RESULTS Of 961 patients, 807 (84%) had CRP values available within 24 hours of admission, and multivariable analysis showed elevated CRP at that point to be associated with an unfavorable outcome (OR 1.41 per 10 mg/L [95% CI 1.09-1.81], p < 0.01), together with diabetes mellitus (OR 1.99 [95% CI 1.09-3.64], p < 0.05), age (1.06 per year [95% CI 1.04-1.08], p < 0.001), low Glasgow Coma Scale score (0.75 per unit [95% CI 0.67-0.84], p < 0.001), hematoma size (1.05 per ml [95% CI 1.03-1.07], p < 0.001), and the presence of an intraventricular hemorrhage (2.70 [95% CI 1.66-4.38], p < 0.001). Subcortical location predicted a favorable outcome (0.33 [95% CI 0.20-0.54], p < 0.001). CONCLUSIONS Elevated CRP on admission is an independent predictor of an unfavorable outcome and is only slightly associated with the clinical and radiological severity of the bleeding.
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Zuliani G, Morieri ML, Volpato S, Maggio M, Cherubini A, Francesconi D, Bandinelli S, Paolisso G, Guralnik JM, Ferrucci L. Insulin resistance and systemic inflammation, but not metabolic syndrome phenotype, predict 9 years mortality in older adults. Atherosclerosis 2014; 235:538-45. [PMID: 24956526 PMCID: PMC4156965 DOI: 10.1016/j.atherosclerosis.2014.05.959] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/02/2014] [Revised: 05/28/2014] [Accepted: 05/29/2014] [Indexed: 11/15/2022]
Abstract
BACKGROUND Although metabolic syndrome (MS) is a typical condition of middle-aged/older person, the association between MS and mortality risk has not been confirmed in people over 65 years. We hypothesized that while in the elderly MS phenotype might lose its value in predicting mortality risk, the two core factors of MS, i.e. insulin resistance (IR) and low grade systemic inflammation (LGSI) would not. METHODS 1011 community-dwelling older individuals (InCHIANTI study) were included. MS phenotype was defined by NCEP-ATP-III criteria. IR was calculated by HOMA; high-sensitivity C reactive protein was measured by ELISA. Subjects were divided into four groups based on presence/absence of IR (HOMA ≥ 2.27) and LGSI (hs-CRP ≥ 3 g/L): Group 1: no IR/LGSI (reference); Group 2: LGSI only; Group 3: IR only; Group 4: IR + LGSI. Hazard Ratios (HR) for 9-years cardiovascular (CVD) and total mortality, according to IR/LGSI groups, were estimated in subjects with (n.311) and without MS by Cox model. RESULTS 31.8% of subjects with MS phenotype had no IR, 45.3% had no LGSI; moreover, 51% of subjects with both IR and LGSI didn't display the MS phenotype. MS phenotype was not associated with CVD (HR: 1.29; 95%C.I.:0.92-1.81) or total (HR: 1.07; 95%C.I.:0.86-1.34) mortality risk, whereas the presence of IR plus LGSI was associated with increased CVD (no MS: HR 2.07, 95%CI: 1.12-3.72; MS: HR 9.88, 95%CI: 2.18-4), and overall (no MS: HR 1.72, 95%CI: 1.001-3.17; MS: HR 1.51, 95%CI: 1.02-2.28) mortality risk. The presence of IR (HR: 6.90, 95%CI: 1.45-32) or LGSI (HR 7.56, 95%CI: 1.63-35) was associated with CVD mortality, only among individuals with MS phenotype. CONCLUSIONS Among community-dwelling older individuals, IR and LGSI, but not MS phenotype, was associated with 9-years overall and CVD mortality risk. Since a reduced "overlap" between MS phenotype and its physiopathological core (IR and LGSI) might be present with aging, we suggest that the definition of MS might be more holistic in advanced age, and probably comprise the measurement of IR and LGSI.
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Affiliation(s)
- Giovanni Zuliani
- Department of Medical Sciences, Section of Internal and CardioRespiratory Medicine, University of Ferrara, Italy.
| | - Mario Luca Morieri
- Department of Medical Sciences, Section of Internal and CardioRespiratory Medicine, University of Ferrara, Italy
| | - Stefano Volpato
- Department of Medical Sciences, Section of Internal and CardioRespiratory Medicine, University of Ferrara, Italy
| | - Marcello Maggio
- Department of Internal Medicine and Biomedical Sciences, Section of Geriatrics, University of Parma, Italy
| | | | - Daniela Francesconi
- Department of Medical Sciences, Section of Internal and CardioRespiratory Medicine, University of Ferrara, Italy
| | - Stefania Bandinelli
- ASF Geriatric Rehabilitation, Florence, Italy; Tuscany Regional Health Agency, I.O.T., Florence, Italy
| | - Giuseppe Paolisso
- Department of Gerontology, Geriatrics and Metabolic Diseases, Second University of Naples, Italy
| | - Jack M Guralnik
- Department of Epidemiology and Public Health, University of Maryland School of Medicine, Baltimore, MD, USA
| | - Luigi Ferrucci
- Longitudinal Studies Section, Clinical Research Branch, National Institute on Aging, NIH, Baltimore, MD, USA
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Luna JM, Moon YP, Liu KM, Spitalnik S, Paik MC, Cheung K, Sacco RL, Elkind MSV. High-sensitivity C-reactive protein and interleukin-6-dominant inflammation and ischemic stroke risk: the northern Manhattan study. Stroke 2014; 45:979-87. [PMID: 24627113 DOI: 10.1161/strokeaha.113.002289] [Citation(s) in RCA: 50] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
BACKGROUND AND PURPOSE Interleukin-6 (IL-6) is a proinflammatory cytokine with known autoregulatory feedback mechanisms. We hypothesized that elevated high-sensitivity C-reactive protein (hsCRP) relative to IL-6 confers an increased risk of ischemic stroke (IS), and low hsCRP relative to IL-6 a decreased risk, for individuals in the prospective, multiethnic, population-based Northern Manhattan Study (NOMAS). METHODS Serum hsCRP and IL-6 were measured in NOMAS participants at baseline. We created a trichotomized predictor based on the dominant biomarker in terms of quartiles: hsCRP-dominant, IL-6-dominant, and codominant groups. Cox proportional hazards models were used to calculate hazard ratios and 95% confidence intervals for the association between inflammatory biomarker group status and risk of incident IS. RESULTS Of 3298 participants, both hsCRP and IL-6 were available in 1656 participants (mean follow-up, 7.8 years; 113 incident IS). The hsCRP-dominant group had increased risk of IS (adjusted hazard ratio, 2.62; 95% confidence interval, 1.56-4.41) and the IL-6-dominant group had decreased risk (adjusted hazard ratio, 0.38; 95% confidence interval, 0.18-0.82) when compared with the referent group, after adjusting for potential confounders. Model fit was improved using the inflammation-dominant construct, over either biomarker alone. CONCLUSIONS In this multiethnic cohort, when hsCRP-quartile was higher than IL-6 quartile, IS risk was increased, and conversely when IL-6 quartiles were elevated relative to hsCRP, IS risk was decreased. Construct validity requires confirmation in other cohorts.
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Affiliation(s)
- Jorge M Luna
- From the Department of Epidemiology, Mailman School of Public Health, New York, NY (J.M.L., M.S.V.E.); Departments of Neurology (Y.P.M., M.S.V.E.) and Pathology (K.M.L., S.S.), Columbia University College of Physicians and Surgeons, New York, NY; Division of Biostatistics, Mailman School of Public Health, New York, NY (M.C.P., K.C.); Departments of Neurology, Epidemiology, and Human Genetics, Miller School of Medicine, University of Miami, FL (R.L.S.); and Gertrude H. Sergievsky Center, Columbia University, New York, NY (M.S.V.E.)
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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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Sen S, Sumner R, Hardin J, Barros S, Moss K, Beck J, Offenbacher S. Periodontal disease and recurrent vascular events in stroke/transient ischemic attack patients. J Stroke Cerebrovasc Dis 2013; 22:1420-7. [PMID: 23910516 PMCID: PMC5624802 DOI: 10.1016/j.jstrokecerebrovasdis.2013.06.024] [Citation(s) in RCA: 31] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/06/2013] [Revised: 06/11/2013] [Accepted: 06/13/2013] [Indexed: 01/02/2023] Open
Abstract
Periodontal disease (PD) has been shown to be associated with incident stroke. We investigated whether PD is independently associated with recurrent vascular events and certain inflammatory markers in stroke/transient ischemic attack (TIA) patients. In this prospective, longitudinal, hospital-based cohort study, PD was assessed in stroke/TIA patients. High periodontal disease (HPD) was defined as the highest tertile of extent (% of sites) with an attachment loss of 5 mm or more. Serum interleukin-6 (IL-6), high-sensitivity C-reactive protein, and soluble intracellular adhesion molecule 1 (s-ICAM) were measured. The patients were followed for recurrent vascular events-stroke, TIA, myocardial infarction, and vascular death. In the 106 patients who were evaluated, 40 (38%) showed HPD and 27 (26%) had recurrent vascular events over a median of 24 months (range, 12-24 months). HPD patients had higher levels of IL-6 (P=.01) and s-ICAM (P=.03). HPD was associated with recurrent vascular events before (log-rank P=.01; hazard ratio [HR], 2.6; 95% confidence interval [CI], 1.2-5.7) and after adjustment for significant confounders-age and stroke status (HR, 2.5; 95% CI, 1.1-5.5; P=.03); adjustment for possible confounders-age, male, years of education, and cardioembolic strokes (HR, 2.8; 95% CI, 1.2-6.5; P=.02); and adjustment for propensity score that accounted for all potential measured confounders (HR, 2.8; 95% CI, 1.2-6.5; P=.02). There is an independent association between HPD and recurrent vascular events in stroke/TIA patients. HPD is also associated with higher serum levels of IL-6 and s-ICAM.
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Affiliation(s)
- Souvik Sen
- Department of Neurology, University of North Carolina, Chapel Hill, North Carolina; Department of Neurology, University of South Carolina, Columbia, South Carolina.
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Hwang SH, Park YS, Kwon JT, Nam TK, Hwang SN, Kang H. Significance of C-reactive protein and transcranial Doppler in cerebral vasospasm following aneurysmal subarachnoid hemorrhage. J Korean Neurosurg Soc 2013; 54:289-95. [PMID: 24294451 PMCID: PMC3841270 DOI: 10.3340/jkns.2013.54.4.289] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/03/2013] [Revised: 09/17/2013] [Accepted: 09/30/2013] [Indexed: 11/27/2022] Open
Abstract
Objective Cerebral vasospasm is a common and potentially devastating complication of aneurysmal subarachnoid hemorrhage (aSAH). Inflammatory processes seem to play a major role in the pathogenesis of vasospasm. C-reactive protein (CRP) constitutes a highly sensitive inflammatory marker. Elevation of serum CRP levels has been demonstrated in patients with aSAH. The purpose of the current study was to evaluate the possible relationship between CRP levels in the serum and transcranial Doppler (TCD) and the development of vasospasm in patients with aSAH. Methods A total of 61 adult patients in whom aSAH was diagnosed were included in the study from November 2008 to May 2011. The patients' demographics, Hunt and Hess grade, Fisher grade, CT scans, digital subtraction angiography studies, and daily neurological examinations were recorded. Serial serum CRP measurements were obtained on days 1, 3, 5, 7, 9, 11 and 13 and TCD was measured on days 3, 5, 7, 9, 11 and 13. All patients underwent either surgical or endovascular treatment within 24 hours of their hemorrhagic attacks. Results Serum CRP levels peaked on the 3rd postoperative day. There were significant differences between the vasospasm group and the non-vasospasm group on the 1st, 3rd and 5th day. There were significant differences between the vasospasm group and the non-vasospasm group on the 3rd day in the mean middle cerebral artery velocities on TCD. Conclusion Patients with high levels of CRP on the 1st postoperative day and high velocity of mean TCD on the 3rd postoperative day may require closer observation to monitor for the development of vasospasm.
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Affiliation(s)
- Sung-Hwan Hwang
- Department of Neurosurgery, Chung-Ang University College of Medicine, Seoul, Korea
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Luna JM, Moon Y, Liu K, Spitalnik S, Paik M, Sacco R, Elkind MSV. Tumour necrosis factor receptor 1 and mortality in a multi-ethnic cohort: the Northern Manhattan Study. Age Ageing 2013; 42:385-90. [PMID: 23321203 DOI: 10.1093/ageing/afs175] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023] Open
Abstract
OBJECTIVE to study the association between soluble tumour necrosis factor receptor 1 (sTNFR1) levels and mortality in the population-based Northern Manhattan Study (NOMAS). METHODS NOMAS is a multi-ethnic, community-based cohort study with mean 8.4 years of follow-up. sTNFR1 was measured using ELISA. Cox proportional hazards models were used to calculate hazard ratios and 95% confidence intervals (HR, 95% CI) for the association of sTNFR1 with risk of all-cause mortality after adjusting for relevant confounders. RESULTS sTNFR1 measurements were available in 1,862 participants (mean age 69.2 ± 10.2 years) with 512 all-cause deaths. Median sTNFR1 was 2.28 ng/ml. Those with sTNFR1 levels in the highest quartile (Q4), compared with those with sTNFR1 in the lowest quartile (Q1), were at an increased risk of all-cause mortality (adjusted HR: 1.8, 95% CI: 1.4-2.4) and non-vascular mortality (adjusted HR: 2.5, 95% CI: 1.5-3.6), but not vascular mortality (adjusted HR: 1.3, 95% CI: 0.9-1.9). There were interactions between sTNFR1 quartiles and medical insurance-status [likelihood ratio test (LRT) with 3 degrees of freedom, Pinteraction = 0.02] and alcohol consumption (LRT with 3 degrees of freedom, Pinteraction < 0.01) for all-cause mortality. In participants with no insurance or Medicaid, those with sTNFR1 in the top quartile had nearly a threefold increased risk of total mortality than the lowest quartile (adjusted HR: 2.9, 95% CI: 1.9-4.4). CONCLUSION in this multi-ethnic cohort, sTNFR1 was associated with all-cause and non-vascular mortality, particularly among those of a lower socioeconomic status.
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Affiliation(s)
- Jorge M Luna
- Department of Neurology, Columbia University, New York, NY, USA.
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Economos A, Wright CB, Moon YP, Rundek T, Rabbani L, Paik MC, Sacco RL, Elkind MSV. Interleukin 6 plasma concentration associates with cognitive decline: the northern Manhattan study. Neuroepidemiology 2013; 40:253-9. [PMID: 23364322 DOI: 10.1159/000343276] [Citation(s) in RCA: 46] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/12/2011] [Accepted: 08/31/2012] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND Interleukin 6 (IL-6) is an inflammatory cytokine that has been associated with vascular disease and cognitive impairment, but few studies have examined these relationships in population-based studies that include Hispanic and Black people who often have a greater prevalence of vascular risk factors and are at an elevated risk of dementia than Whites. We examined relative elevations of plasma IL-6 concentrations in relation to cognitive decline in a stroke-free racially/ethnically diverse community-based sample from Northern Manhattan. METHODS We used mixed effects models to measure the effect of IL-6 on change in performance on the modified Telephone Interview for Cognitive Status (TICS-m) measured annually in our cohort, adjusting for sociodemographic and vascular risk factors. RESULTS There were 1,224 participants with IL-6 levels (median 1.5 pg/ml, interquartile range 0.83-2.57 pg/ml) and TICS-m data available (mean = 31.6 points, SD 6.5). The mean age was 71 (SD 9.3; 64% women, 59% Hispanic, 19% Black, 19% White) with 3,406 person-years and a median 3.0 years of follow-up (interquartile range 1.1-4.0 years). Participants with IL-6 levels above the median showed greater cognitive decline on the TICS-m compared to those with levels below the median, adjusting for sociodemographic and vascular factors (β = -0.17 points/year, p = 0.02). Decline on the TICS-m among participants with IL-6 above the median differed by age (p for interaction <0.001). There was no interaction by race/ethnicity, vascular risk factors, C-reactive protein, apolipoprotein ε4 allele status, or the metabolic syndrome among nondiabetics. CONCLUSIONS IL-6 associated with cognitive decline among older participants in this racially/ethnically diverse sample independent of other vascular risk factors and C-reactive protein.
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Miwa K, Tanaka M, Okazaki S, Furukado S, Sakaguchi M, Mochizuki H, Kitagawa K. Association between interleukin-6 levels and first-ever cerebrovascular events in patients with vascular risk factors. Arterioscler Thromb Vasc Biol 2012; 33:400-5. [PMID: 23175672 DOI: 10.1161/atvbaha.112.300350] [Citation(s) in RCA: 27] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/15/2023]
Abstract
OBJECTIVE The objective of this study was to examine the association of inflammatory markers with risk of first-ever cerebrovascular events (CVEs), while simultaneously evaluating subclinical vascular disease. METHODS AND RESULTS We enrolled 464 outpatients who had vascular risk factors without any preexisting cardiovascular disease. We examined the presence of silent lacunar infarction (SLI) by magnetic resonance imaging; carotid intima-media thickness by ultrasound; and measured high-sensitivity C-reactive protein, interleukin (IL)-6, and IL-18 at baseline, and assessed their associations with CVEs using Cox proportional hazards models of 4.8±2.6 years follow-up. We further calculated measures of reclassification and discrimination. In age- and sex-adjusted analysis, IL-6, but neither high-sensitivity C-reactive protein nor IL-18, was associated with CVEs. The association remained significant after adjustment for conventional risk factors, intima-media thickness, and SLI (hazard ratios: 1.80, per 1-SD increase in log IL-6, P=0.03). Compared with the patients with below median IL-6 without SLI, those with above median IL-6 and SLI had a higher risk of CVEs (hazard ratios: 4.14, P=0.0014). The combination of IL-6 and SLI resulted in the net reclassification improvement of 14.3% (P=0.04), and the integrated discrimination improvement gain of 2.1% (P=0.05). CONCLUSIONS IL-6 levels were independently associated with CVEs and could improve reclassification in those with SLI.
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Affiliation(s)
- Kaori Miwa
- Department of Neurology and Stroke Center, Osaka University Graduate School of Medicine, Osaka, Japan
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