C-reactive protein, carotid intima-media thickness, and incidence of ischemic stroke in the elderly: the Cardiovascular Health Study.
BACKGROUND
Increased carotid artery intima-media thickness (IMT) and elevated C-reactive protein (CRP) are both associated with the occurrence of stroke. We investigated whether elevated CRP is a risk factor for ischemic stroke independent of carotid IMT and studied the interaction between CRP and IMT.


RESULTS
We studied 5417 participants aged 65 years or older without preexisting stroke or chronic atrial fibrillation who were participants in the Cardiovascular Health Study. The hazard ratio of incident ischemic stroke was estimated by Cox proportional hazards regression. During 10.2 years of follow-up, 469 incident ischemic strokes occurred. The adjusted hazard ratios for ischemic stroke in the 2nd to 4th quartiles of baseline CRP, relative to the 1st quartile, were 1.19 (95% CI 0.92 to 1.53), 1.05 (95% CI 0.81 to 1.37), and 1.60 (95% CI 1.23 to 2.08), respectively. With additional adjustment for carotid IMT, there was little confounding. The association of CRP with stroke was significantly different depending on IMT (P<0.02), with no association of CRP with stroke among those in the lowest IMT tertile and a significant association among those with higher levels of IMT.


CONCLUSIONS
We conclude that elevated CRP is a risk factor for ischemic stroke, independent of atherosclerosis severity as measured by carotid IMT. The association of CRP with stroke is more apparent in the presence of a higher carotid IMT. CRP and carotid IMT may each be independent integrals in determining the risk of ischemic stroke.
Cao
Jie J
JJ
Henry Ford Heart and Vascular Institute, Detroit, Mich, USA.
Thach
Chau
C
Manolio
Teri A
TA
Psaty
Bruce M
BM
Kuller
Lewis H
LH
Chaves
Paulo H M
PH
Polak
Joseph F
JF
Sutton-Tyrrell
Kim
K
Herrington
David M
DM
Price
Thomas R
TR
Cushman
Mary
M
D000368:Aged; D002545:Brain Ischemia / Q000097:blood* / Q000453:epidemiology; D002097:C-Reactive Protein / Q000032:analysis*; D002140:California / Q000453:epidemiology; D002339:Carotid Arteries / Q000000981:diagnostic imaging*; D015331:Cohort Studies; D015897:Comorbidity; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D015994:Incidence; D008137:Longitudinal Studies; D008297:Male; D008396:Maryland / Q000453:epidemiology; D009657:North Carolina / Q000453:epidemiology; D016017:Odds Ratio; D010414:Pennsylvania / Q000453:epidemiology; D016016:Proportional Hazards Models; D018570:Risk Assessment; D012307:Risk Factors; D020521:Stroke / Q000097:blood* / Q000453:epidemiology; D017539:Tunica Intima / Q000000981:diagnostic imaging*; D017540:Tunica Media / Q000000981:diagnostic imaging*; D014463:Ultrasonography
D002097:C-Reactive Protein