Glycated albumin predicts the effect of dual and single antiplatelet therapy on recurrent stroke.
OBJECTIVE
To determine the relationship of glycated albumin (GA) and the recurrence of stroke in patients on either dual or single antiplatelet therapy.


METHODS
The Clopidogrel in High-Risk Patients with Acute Nondisabling Cerebrovascular Events trial randomized minor ischemic stroke or TIA patients to antiplatelet therapy of clopidogrel plus aspirin or aspirin alone. A subgroup of 3,044 consecutive patients with baseline GA levels from 73 (64%) prespecified clinical sites was analyzed. Patients were categorized into 2 groups based on GA level of 15.5%, the cut point for development of diabetes. The primary outcome was stroke recurrence during 90-day follow-up. Cox proportional hazards models were used to assess the interaction of GA with randomized antiplatelet therapy on their risk of recurrent stroke.


RESULTS
Significant interaction of GA levels with the 2 antiplatelet therapy groups was found after adjustment for age, sex, and other conventional confounding factors (p = 0.009). The interaction remained consistent after further adjustment for history of diabetes (p = 0.010). In patients with lower GA level, stroke occurred in 5.5% of patients in the clopidogrel-aspirin group, and 12.7% in the aspirin group (adjusted hazard ratio [HR] 0.40; 95% confidence interval [CI] 0.26-0.61; p < 0.001). Furthermore, in patients with elevated GA level, stroke occurred in 9.2% of patients in the clopidogrel-aspirin group, and 11.4% in the aspirin group (adjusted HR 0.79; 95% CI 0.60-1.05; p = 0.103).


CONCLUSIONS
GA could be a potential biomarker to predict the effects of dual and single antiplatelet therapy in patients with minor stroke or TIA.
From the Department of Neurology (J.L., Y.W., J.L., A.W., X.Z., L.L., C.W., Y.W.), Beijing Tiantan Hospital, Capital Medical University; China National Clinical Research Center for Neurological Diseases (Y.W.), Beijing; Center of Stroke (Y.W.), Beijing Institute for Brain Disorders, China; and the Illinois Neurological Institute Stroke Network (D.W.), Sisters of the Third Order of St. Francis Healthcare System, University of Illinois College of Medicine, Peoria.
Jiejie
J
Li
From the Department of Neurology (J.L., Y.W., J.L., A.W., X.Z., L.L., C.W., Y.W.), Beijing Tiantan Hospital, Capital Medical University; China National Clinical Research Center for Neurological Diseases (Y.W.), Beijing; Center of Stroke (Y.W.), Beijing Institute for Brain Disorders, China; and the Illinois Neurological Institute Stroke Network (D.W.), Sisters of the Third Order of St. Francis Healthcare System, University of Illinois College of Medicine, Peoria.
Yilong
Y
Wang
From the Department of Neurology (J.L., Y.W., J.L., A.W., X.Z., L.L., C.W., Y.W.), Beijing Tiantan Hospital, Capital Medical University; China National Clinical Research Center for Neurological Diseases (Y.W.), Beijing; Center of Stroke (Y.W.), Beijing Institute for Brain Disorders, China; and the Illinois Neurological Institute Stroke Network (D.W.), Sisters of the Third Order of St. Francis Healthcare System, University of Illinois College of Medicine, Peoria.
David
D
Wang
From the Department of Neurology (J.L., Y.W., J.L., A.W., X.Z., L.L., C.W., Y.W.), Beijing Tiantan Hospital, Capital Medical University; China National Clinical Research Center for Neurological Diseases (Y.W.), Beijing; Center of Stroke (Y.W.), Beijing Institute for Brain Disorders, China; and the Illinois Neurological Institute Stroke Network (D.W.), Sisters of the Third Order of St. Francis Healthcare System, University of Illinois College of Medicine, Peoria.
Jinxi
J
Lin
From the Department of Neurology (J.L., Y.W., J.L., A.W., X.Z., L.L., C.W., Y.W.), Beijing Tiantan Hospital, Capital Medical University; China National Clinical Research Center for Neurological Diseases (Y.W.), Beijing; Center of Stroke (Y.W.), Beijing Institute for Brain Disorders, China; and the Illinois Neurological Institute Stroke Network (D.W.), Sisters of the Third Order of St. Francis Healthcare System, University of Illinois College of Medicine, Peoria.
Anxin
A
Wang
From the Department of Neurology (J.L., Y.W., J.L., A.W., X.Z., L.L., C.W., Y.W.), Beijing Tiantan Hospital, Capital Medical University; China National Clinical Research Center for Neurological Diseases (Y.W.), Beijing; Center of Stroke (Y.W.), Beijing Institute for Brain Disorders, China; and the Illinois Neurological Institute Stroke Network (D.W.), Sisters of the Third Order of St. Francis Healthcare System, University of Illinois College of Medicine, Peoria.
Xingquan
X
Zhao
From the Department of Neurology (J.L., Y.W., J.L., A.W., X.Z., L.L., C.W., Y.W.), Beijing Tiantan Hospital, Capital Medical University; China National Clinical Research Center for Neurological Diseases (Y.W.), Beijing; Center of Stroke (Y.W.), Beijing Institute for Brain Disorders, China; and the Illinois Neurological Institute Stroke Network (D.W.), Sisters of the Third Order of St. Francis Healthcare System, University of Illinois College of Medicine, Peoria.
Liping
L
Liu
From the Department of Neurology (J.L., Y.W., J.L., A.W., X.Z., L.L., C.W., Y.W.), Beijing Tiantan Hospital, Capital Medical University; China National Clinical Research Center for Neurological Diseases (Y.W.), Beijing; Center of Stroke (Y.W.), Beijing Institute for Brain Disorders, China; and the Illinois Neurological Institute Stroke Network (D.W.), Sisters of the Third Order of St. Francis Healthcare System, University of Illinois College of Medicine, Peoria.
Chunxue
C
Wang
From the Department of Neurology (J.L., Y.W., J.L., A.W., X.Z., L.L., C.W., Y.W.), Beijing Tiantan Hospital, Capital Medical University; China National Clinical Research Center for Neurological Diseases (Y.W.), Beijing; Center of Stroke (Y.W.), Beijing Institute for Brain Disorders, China; and the Illinois Neurological Institute Stroke Network (D.W.), Sisters of the Third Order of St. Francis Healthcare System, University of Illinois College of Medicine, Peoria. yongjunwang1962@gmail.com.
Yongjun
Y
Wang
D000368:Aged; D001241:Aspirin / Q000008:administration & dosage / Q000009:adverse effects / Q000627:therapeutic use*; D015415:Biomarkers / Q000097:blood; D000077144:Clopidogrel; D004311:Double-Blind Method; D004359:Drug Therapy, Combination / Q000009:adverse effects; D005260:Female; D017127:Glycation End Products, Advanced; D006801:Humans; D002546:Ischemic Attack, Transient / Q000097:blood / Q000188:drug therapy*; D008297:Male; D008875:Middle Aged; D010975:Platelet Aggregation Inhibitors / Q000008:administration & dosage / Q000009:adverse effects / Q000627:therapeutic use*; D012008:Recurrence; D012709:Serum Albumin / Q000378:metabolism*; D020521:Stroke / Q000097:blood / Q000188:drug therapy*; D013988:Ticlopidine / Q000008:administration & dosage / Q000009:adverse effects / Q000031:analogs & derivatives* / Q000627:therapeutic use; D000093423:Glycated Serum Albumin
D015415:Biomarkers; D017127:Glycation End Products, Advanced; D010975:Platelet Aggregation Inhibitors; D012709:Serum Albumin; D000077144:Clopidogrel; D013988:Ticlopidine; D001241:Aspirin; D000093423:Glycated Serum Albumin