Predicting a 2nd stroke

Measuring two key inflammatory markers in the blood may help clinicians determine patients’ post-stroke prognosis more accurately than using either marker alone, say investigators at Columbia University in New York City.

Levels of high-sensitivity C-reactive protein (hs-CRP) and lipoprotein-associated phospholipase A2 (Lp-PLA2) were measured in 467 patients (mean age 69) who were admitted with their first ischemic stroke to the university’s hospital. Blood samples were collected within a few days after admission. Lp-PLA2, an enzyme responsible for the metabolism of LDL, is associated with heightened risk of MI and stroke. The participants, 53% of whom were Hispanic, were followed for a median of four years after discharge.

At the end of the study, those in the highest quartile of serum Lp-PLA2 were 86% more likely to have experienced a recurrent stroke, an MI, or vascular death than those in the lowest quartile. Patients in the highest CRP quartile were 2.11 times more likely to die than those in the lowest quartile; there was no elevated risk of recurrent stroke or vascular events in the highest CRP quartile group.

The authors say their findings support an association between serum inflammatory markers and prognosis after stroke and that “the use of both markers together may provide more information than the use of either alone” (Arch Intern Med. 2006;166:2073-2080).

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