Stroke with polyvascular atherothrombotic disease.
OBJECTIVE
To study the influence of polyvascular atherothrombotic disease on stroke patient prognosis, its relation with inflammatory markers, and to analyze the progression of atherothrombotic disease.


METHODS
MITICO is a multi-centered prospective observational study recruiting non-anticoagulated ischemic stroke patients. Blood samples were obtained at baseline and at one year follow-up for determination of high sensitivity C reactive protein (hs-CRP), interleukin 6 (IL-6), intercellular adhesion molecule 1 (ICAM-1), vascular cell adhesion molecule 1 (VCAM-1), matrix metalloproteinase 9 (MMP-9), and cellular fibronectin (c-Fn). Patients with polyvascular atherothrombotic disease were considered when presented a history of angina-myocardial infarction, intermittent claudication or ischemic limbs-amputation at inclusion.


RESULTS
The sample consisted of 863 patients, 121 of them considered as polyvascular atherothrombotic disease (14.02%). Recurrence and vascular death were higher in patients with polyvascular atherothrombotic disease, as compared to patients with monovascular atherothrombotic disease (19.8% vs. 12.4%, p=0.022). Baseline plasma levels of IL-6 and VCAM-1 were higher in patients with polyvascular atherothrombotic disease. IL-6 and VCAM-1 levels were independently associated with a new vascular episode/vascular death. This association was stronger in the group of patients with polyvascular atherothrombotic disease. Baseline levels of IL-6, VCAM-1 and c-Fn were significantly higher in patients who developed progression of atherothrombotic disease. The increase from baseline in MMP-9 and c-Fn levels after one year follow-up was associated to progression of atherothrombotic disease.


CONCLUSIONS
Stroke patients with polyvascular atherothrombotic disease showed higher rates of vascular recurrence and a stronger association with inflammatory markers. Progression of atherothrombotic disease was associated with inflammatory markers.
Blanco
Miguel
M
Department of Neurology, Clinical Neuroscience Research Laboratory, Hospital Clínico Universitario, Universidad de Santiago de Compostela, Travesa da Choupana s/n, 15706 Santiago de Compostela, Spain.
Sobrino
Tomás
T
Montaner
Joan
J
Medrano
Vicente
V
Jiménez
Carmen
C
Masjuán
Jaime
J
Gómez-Escalonilla
Carlos
C
de Luis
Pilar
P
Arboix
Adriá
A
Castillo
José
J
D000368:Aged; D000787:Angina Pectoris / Q000473:pathology; D000925:Anticoagulants / Q000494:pharmacology; D001158:Arteries / Q000473:pathology*; D002545:Brain Ischemia / Q000473:pathology; D002318:Cardiovascular Diseases / Q000473:pathology*; D018450:Disease Progression; D005260:Female; D006801:Humans; D007249:Inflammation; D008297:Male; D008875:Middle Aged; D009203:Myocardial Infarction / Q000473:pathology; D011379:Prognosis; D011446:Prospective Studies; D020521:Stroke / Q000150:complications*; D013927:Thrombosis / Q000150:complications*
D000925:Anticoagulants