C-Reactive Protein as a Prognostic Marker After Lacunar Stroke
2014; Lippincott Williams & Wilkins; Volume: 45; Issue: 3 Linguagem: Inglês
10.1161/strokeaha.113.004562
ISSN1524-4628
AutoresMitchell S.V. Elkind, Jorge M. Luna, Leslie A. McClure, Yu Zhang, Christopher S. Coffey, Ana Roldán, Óscar H. Del Brutto, E. Javier Pretell, L. Creed Pettigrew, Brett C. Meyer, Jorge Tapía, Carole L. White, Oscar Benavente, L. Creed Pettigrew, Anand Vaishnav, Peter Sawaya, Anna Fowler, Nedda Hughes, Johnya Rice, Kathy Vanderpool, Brett C. Meyer, Christy Jackson, Paul Gamble, N. C. Kelly, Janet Warner, Jo Bell, Irene Meissner, John W. Graves, Deb Herzig, Jody L. Covalt, Salvador Cruz‐Flores, Heath Walden, Eve Holzemer, Bruce M. Coull, Lien Howard, Mina Malekniazi, Melissa VanSkiver, Denise Bruck, Stacey Redman, Joseph Hanna, Thomas Zipp, S. M. Bailey, Dana P. Cook, Alice Liskay, Dana Simcox, Joan Kappler, Bart M. Demaerschalk, Michael Hogan, Daniel N. Wochos, Judith Wieser, Barbara S. Cleary, Lori Wood, Angelo Katramados, Brian Silver, Jerry Yee, Krisy Aiello, Kathleen Wilson, Sharon McCarthy, Carlos S. Kase, Haralambos Gavras, Helena Lau, Matt Ogrodnik, Nancy B. Allen, David C. Anderson, Richard H. Grimm, Donna J. Brauer, Dean K. Naritoku, Richard M. Zweifler, M. I. Culpepper, Mel Parnell, Robin Yunker, Kelly Boots, Renay Drinkard, Rachel Backlin, M.S.V. Elkind, Russell J. Crew, Jai Radhakrishan, Tania Corporan, Julisa Diaz, R Aragón, Oscar Benavente, Robert G. Hart, Pablo E. Pérgola, S. del Palacio, Irma Castro, Arlene Farias, Ana Roldán, Tom Mirsen, Susan McAllister, Arnaud Bastien, Patricia Niblack, Sophia Sundararajan, Mahboob Rahman, Tom Horvath, David Korosec, Chris M. Murphy, Helmi L. Lutsep, Don Girard, Kali Seisler, Megan Cingel, Megan E. Ross, Rachel Stone, Darren Larsen, Ann Doherty, Diane Book, Sunu Eapen, Clarence Grimm, Barbara Blaney, Stephanie Rozman, L Gaertner, Erin Bradenburg, Laura Spencer Loomis, Jolene Monarch-Cotton, Jean Ravavelli-Meyer, Anna Golembieski, José G. Romano, Gustavo Ortiz, Maria del Carmen Lichtenberger, Mark Johnson, Yinghui Liu, Robert Goldsteen, April Blair, Gregg F. Wright, Naomie Gathua, Michael Jacoby, David Jones, Jeffrey DeFrancisco, Theresa Hamm, Scott W. Burgin, Joshua Hollander, Walter Polashenski, Patricia Wallace, Cheryl Weber, Jason Greenberg, Laura Lennihan, Marjorie L. King, Laura Tenteromano, Lorainne Pereira, Marilou Ching, Robert G. Sawyer, Kathy Parkes, Cheryl A. Conover, Jesse Weinberger, Lewis Wright, Dorothy Burch, Curtis Benesch, John D. Bisognano, Ann M Leonhardt, Justine Zentner, Molly Hildreth, Percy N. Karanjia, Narayana S. Murali, Richard A. Dart, Kathleen Mancl, David M. Lefkowitz, Levy Pavel, Nancy Buchheimer, Sara J. Vaughn, Emily Smith, Jean Satterfield, Renee Van Stavern, Angela L. Brown, Jannie Serna, Jill Newgent, Julie Naylor, Laura A. Carpenter, Ashfaq Shuab, Khurshid Khan, Naeen Dean, Frederika Herbert, Karen Kastelic, Richard Atkinson, Roger Lieberman, Teresa Carter, Pat Zrelak, Nola Kenney, W. R. Logan, David Carpenter, Sally Schroer, Léo Berger, Sylvain Brunet, Johanne Pontbriand, Martine Mainville, Denise Racicot, Robert Côté, Laurence Green, Lisa Wadup, Anne Marie Fontaine, Jorge Tapía, Iván Godoy, M. Palma Gómez-Calero Valdés, Gonzalo Matamala, Helmut Goecke, Marcela Parra, Jessica Pozo, Oscar Del Brutto, Rocío Santibáñez, Joffre Lara, Mauricio Zambrano, José Luís Sandoval, Eduardo Salcido Vásquez, C. J. Gómez Ruiz, Antonio Araúz, Graciela Cervantes, Adolfo Leyva, Itzel Camacho, E. Javier Pretell, J. Valdivia, Marissa Pretell, Joaquín Serena Leal, Mar Castellanos, Verónica Cruz, Mercè Cepeda, Adrià Arboix, Antoni Pelegrí, Lorena Blanco, Francisco Rubio Borrego, Francisco Gudiol, Meritxell Gomis, Juan F. Arenillas, Antonio Dávalos, Ana Suñol, Sílvia Reverté‐Villarroya, Jaume Roquer, Ana Oliveras Serrano, Jordi Jiménez Conde, Ana Rodríguez, Gemma Romeral, José Castillo Sánchez, Miguel Blanco González, Manuel Rodríguez, Isabel Jiménez, Jaime Rodríguez, Leslie A. McClure, Christopher S. Coffey, Jeff M. Szychowski, George Howard, Charles R. Katholi, Yu Zhang, Kalyani Peri, Charles Allcorn, R. Mailhot, Lisa Irby, Fekisha Guyton, Mary Jo Sewell, Oscar Benavente, Robert G. Hart, Pablo E. Pérgola, Ana Roldán, Marie-France Benavente, Carole L. White, Camilla Robu, Che Kelly, Robert L. Talbert, Eduardo Camillo Martinez, Carlos Bazan, Gabriela Pergola, Lesly A. Pearce, Raymond M. Costello, Claudia Jacova, Luisa Camelia, Crystal Mendoza, Brandy Pratt, Steve Holliday, Mitchell S.V. Elkind, Jorge Luna,
Tópico(s)Adipokines, Inflammation, and Metabolic Diseases
ResumoBackground and Purpose— Inflammatory biomarkers predict incident and recurrent cardiac events, but their relationship to stroke prognosis is uncertain. We hypothesized that high-sensitivity C-reactive protein (hsCRP) predicts recurrent ischemic stroke after recent lacunar stroke. Methods— Levels of Inflammatory Markers in the Treatment of Stroke (LIMITS) was an international, multicenter, prospective ancillary biomarker study nested within Secondary Prevention of Small Subcortical Strokes (SPS3), a phase III trial in patients with recent lacunar stroke. Patients were assigned in factorial design to aspirin versus aspirin plus clopidogrel, and higher versus lower blood pressure targets. Patients had blood samples collected at enrollment and hsCRP measured using nephelometry at a central laboratory. Cox proportional hazard models were used to calculate hazard ratios (HRs) and 95% confidence intervals (95% CIs) for recurrence risks before and after adjusting for demographics, comorbidities, and statin use. Results— Among 1244 patients with lacunar stroke (mean age, 63.3±10.8 years), median hsCRP was 2.16 mg/L. There were 83 recurrent ischemic strokes (including 45 lacunes) and 115 major vascular events (stroke, myocardial infarction, and vascular death). Compared with the bottom quartile, those in the top quartile (hsCRP >4.86 mg/L) were at increased risk of recurrent ischemic stroke (unadjusted HR, 2.54; 95% CI, 1.30–4.96), even after adjusting for demographics and risk factors (adjusted HR, 2.32; 95% CI, 1.15–4.68). hsCRP predicted increased risk of major vascular events (top quartile adjusted HR, 2.04; 95% CI, 1.14–3.67). There was no interaction with randomized antiplatelet treatment. Conclusions— Among recent lacunar stroke patients, hsCRP levels predict the risk of recurrent strokes and other vascular events. hsCRP did not predict the response to dual antiplatelets. Clinical Trial Registration— URL: http://www.clinicaltrials.gov . Unique identifier: NCT00059306.
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