title: CD40 ligand and MCP-1 as predictors of cardiovascular events in diabetic patients with stroke.
abstract: OBJECTIVE
  Up-regulation of soluble CD40 ligand (sCD40L) and of monocyte chemoattractant protein-1 (MCP-1) has been found in diabetes and in patients with acute cerebral ischemia. We asked whether (i) the two molecules are similarly upregulated among non-lacunar and lacunar diabetic strokes and (ii) sCD40L and/or MCP-1 predict the risk of cardiovascular events in this setting.
  
  
  METHODS
  Ninety patients with type 2 diabetes mellitus presenting with an acute ischemic stroke (compared with 45 control subjects) were evaluated on admission and up to 36 months (median 24 months) after the event.
  
  
  RESULTS
  Diabetic patients with acute stroke had higher plasma CD40L and MCP-1 than controls (p<0.0001), with no significant differences among lacunar and non-lacunar strokes. On multiple regression analysis, only higher sCD40L quartiles and older age were associated with higher MCP-1 quartiles. Forty-eight percent of patients experienced vascular events. Cox regression analysis showed that only the presence of higher sCD40L values independently predicted the recurrence of vascular events.
  
  
  CONCLUSIONS
  Up-regulation of inflammatory molecules, such as CD40L and MCP-1, is involved in the advanced stage of atherosclerotic cerebro-vascular disease and is associated with increased risk of recurrence of cardiovascular events.
authors.affiliation: Department of Medicine and Aging, "G. d'Annunzio" University School of Medicine, Chieti, Italy. gdavi@unich.it
authors.forename: Giovanni
authors.initials: G
authors.lastname: Davì
authors.forename: Antonino
authors.initials: A
authors.lastname: Tuttolomondo
authors.forename: Francesca
authors.initials: F
authors.lastname: Santilli
authors.forename: Stefania
authors.initials: S
authors.lastname: Basili
authors.forename: Elisabetta
authors.initials: E
authors.lastname: Ferrante
authors.forename: Domenico
authors.initials: D
authors.lastname: Di Raimondo
authors.forename: Antonio
authors.initials: A
authors.lastname: Pinto
authors.forename: Giuseppe
authors.initials: G
authors.lastname: Licata
mesh_terms: D000368:Aged; D023201:CD40 Ligand / Q000096:biosynthesis*; D018932:Chemokine CCL2 / Q000096:biosynthesis*; D015331:Cohort Studies; D048909:Diabetes Complications / Q000097:blood*; D003920:Diabetes Mellitus / Q000097:blood*; D005260:Female; D005786:Gene Expression Regulation; D006801:Humans; D008297:Male; D008875:Middle Aged; D012044:Regression Analysis; D012306:Risk; D020521:Stroke / Q000097:blood* / Q000150:complications*; D016896:Treatment Outcome
chemical_list: C111835:CCL2 protein, human; D018932:Chemokine CCL2; D023201:CD40 Ligand