title: High-sensitivity C-reactive protein, lipoprotein-associated phospholipase A2, and outcome after ischemic stroke.
abstract: BACKGROUND
  Inflammatory markers have been associated with ischemic stroke risk and prognosis after cardiac events. Their relationship to prognosis after stroke is unsettled.
  
  
  METHODS
  A population-based study of stroke risk factors in 467 patients with first ischemic stroke was undertaken to determine whether levels of high-sensitivity C-reactive protein (hs-CRP) and lipoprotein-associated phospholipase A(2) (Lp-PLA2) predict risk of stroke recurrence, other vascular events, and death.
  
  
  RESULTS
  Levels of Lp-PLA2 and hs-CRP were weakly correlated (r = 0.09; P = .045). High-sensitivity CRP, but not Lp-PLA2, was associated with stroke severity. After adjusting for age, sex, race and ethnicity, history of coronary artery disease, diabetes mellitus, hypertension, hyperlipidemia, atrial fibrillation, smoking, and hs-CRP level, compared with the lowest quartile of Lp-PLA2, those in the highest quartile had an increased risk of recurrent stroke (adjusted hazard ratio, 2.08; 95% confidence interval, 1.04-4.18) and of the combined outcome of recurrent stroke, MI, or vascular death (adjusted hazard ratio, 1.86; 95% confidence interval, 1.01-3.42). After adjusting for confounders, hs-CRP was not associated with risk of recurrent stroke or recurrent stroke, myocardial infarction, or vascular death but was associated with risk of death (adjusted hazard ratio, 2.11; 95% confidence interval, 1.18-3.75).
  
  
  CONCLUSIONS
  Inflammatory markers are associated with prognosis after first ischemic stroke and may offer complementary information. Lipoprotein-associated phospholipase A(2) may be a stronger predictor of recurrent stroke risk. Levels of hs-CRP, an acute-phase reactant, increase with stroke severity and may be associated with mortality to a greater degree than recurrence.
authors.affiliation: Department of Neurology, College of Physicians and Surgeons, and Divisions of Biostatistics, Joseph P. Mailman School of Public Health, Columbia University, New York, New York, USA. mse13@columbia.edu
authors.forename: Mitchell S V
authors.initials: MS
authors.lastname: Elkind
authors.forename: Wanling
authors.initials: W
authors.lastname: Tai
authors.forename: Kristen
authors.initials: K
authors.lastname: Coates
authors.forename: Myunghee C
authors.initials: MC
authors.lastname: Paik
authors.forename: Ralph L
authors.initials: RL
authors.lastname: Sacco
mesh_terms: D043203:1-Alkyl-2-acetylglycerophosphocholine Esterase; D000368:Aged; D015415:Biomarkers / Q000097:blood; D020520:Brain Infarction / Q000097:blood / Q000201:enzymology* / Q000453:epidemiology; D002097:C-Reactive Protein / Q000032:analysis / Q000378:metabolism*; D005260:Female; D006801:Humans; D008297:Male; D010741:Phospholipases A / Q000097:blood / Q000378:metabolism*; D054467:Phospholipases A2; D011237:Predictive Value of Tests; D011379:Prognosis; D016016:Proportional Hazards Models; D012008:Recurrence; D012307:Risk Factors
chemical_list: D015415:Biomarkers; D002097:C-Reactive Protein; D010741:Phospholipases A; D054467:Phospholipases A2; D043203:1-Alkyl-2-acetylglycerophosphocholine Esterase