title: Inflammation and hemostasis biomarkers for predicting stroke in postmenopausal women: the Women's Health Initiative Observational Study.
abstract: BACKGROUND
  Inflammatory and hemostasis-related biomarkers may identify women at risk of stroke.
  
  
  METHODS
  Hormones and Biomarkers Predicting Stroke is a study of ischemic stroke among postmenopausal women participating in the Women's Health Initiative observational study (n = 972 case-control pairs). A Biomarker Risk Score (BRS) was derived from levels of 7 inflammatory and hemostasis-related biomarkers that appeared individually to predict risk of ischemic stroke: C-reactive protein (CRP), interleukin-6, tissue plasminogen activator, D-dimer, white blood cell count, neopterin, and homocysteine. The c index was used to evaluate discrimination.
  
  
  RESULTS
  Of all the individual biomarkers examined, CRP emerged as the only independent single predictor of ischemic stroke (adjusted odds ratio comparing Quartile(4)v Quartile(1) = 1.64, 95% confidence interval: 1.15-2.32, P = .01) after adjustment for other biomarkers and standard stroke risk factors. The BRS identified a gradient of increasing stroke risk with a greater number of elevated inflammatory/hemostasis biomarkers, and improved the c index significantly compared with standard stroke risk factors (P = .02). Among the subset of individuals who met current criteria for high-risk levels of CRP (>3.0 mg/L), the BRS defined an approximately 2-fold gradient of risk. We found no evidence for a relationship between stroke and levels of E-selectin, fibrinogen, tumor necrosis factor-alpha, vascular cell adhesion molecule-1, prothrombin fragment 1+2, Factor VIIC, or plasminogen activator inhibitor-1 antigen (P > .15).
  
  
  CONCLUSIONS
  The findings support the further exploration of multiple biomarker panels to develop approaches for stratifying an individual's risk of stroke.
authors.affiliation: Department of Epidemiology and Population Health, Albert Einstein College of Medicine, Bronx, New York 10461, USA.
authors.forename: Robert C
authors.initials: RC
authors.lastname: Kaplan
authors.forename: Aileen P
authors.initials: AP
authors.lastname: McGinn
authors.forename: Alison E
authors.initials: AE
authors.lastname: Baird
authors.forename: Susan L
authors.initials: SL
authors.lastname: Hendrix
authors.forename: Charles
authors.initials: C
authors.lastname: Kooperberg
authors.forename: John
authors.initials: J
authors.lastname: Lynch
authors.forename: Daniel M
authors.initials: DM
authors.lastname: Rosenbaum
authors.forename: Karen C
authors.initials: KC
authors.lastname: Johnson
authors.forename: Howard D
authors.initials: HD
authors.lastname: Strickler
authors.forename: Sylvia
authors.initials: S
authors.lastname: Wassertheil-Smoller
mesh_terms: D000368:Aged; D015415:Biomarkers; D002097:C-Reactive Protein / Q000032:analysis / Q000378:metabolism; D016022:Case-Control Studies; D015897:Comorbidity; D003627:Data Interpretation, Statistical; D005260:Female; D020141:Hemostatic Disorders / Q000175:diagnosis* / Q000453:epidemiology; D006710:Homocysteine / Q000032:analysis / Q000097:blood; D006801:Humans; D015994:Incidence; D007249:Inflammation / Q000175:diagnosis* / Q000453:epidemiology; D015850:Interleukin-6 / Q000032:analysis / Q000097:blood; D007958:Leukocyte Count; D008875:Middle Aged; D019798:Neopterin / Q000032:analysis / Q000097:blood; D017698:Postmenopause / Q000097:blood*; D011237:Predictive Value of Tests; D012307:Risk Factors; D020521:Stroke / Q000175:diagnosis* / Q000453:epidemiology; D010959:Tissue Plasminogen Activator / Q000032:analysis / Q000097:blood
chemical_list: D015415:Biomarkers; D015850:Interleukin-6; D006710:Homocysteine; D019798:Neopterin; D002097:C-Reactive Protein; D010959:Tissue Plasminogen Activator