CD40 ligand and MCP-1 as predictors of cardiovascular events in diabetic patients with stroke.
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.
Davì
Giovanni
G
Department of Medicine and Aging, "G. d'Annunzio" University School of Medicine, Chieti, Italy. gdavi@unich.it
Tuttolomondo
Antonino
A
Santilli
Francesca
F
Basili
Stefania
S
Ferrante
Elisabetta
E
Di Raimondo
Domenico
D
Pinto
Antonio
A
Licata
Giuseppe
G
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
C111835:CCL2 protein, human; D018932:Chemokine CCL2; D023201:CD40 Ligand