This Article Full Text Full Text (PDF) All Versions of this Article: 40/2/376    most recent STROKEAHA.107.513259v1 Alert me when this article is cited Alert me if a correction is posted Citation Map Services Email this article to a friend Similar articles in this journal Similar articles in PubMed Alert me to new issues of the journal Download to citation manager Request Permissions Citing Articles Citing Articles via HighWire Citing Articles via Google Scholar Google Scholar Articles by Nambi, V. Articles by Ballantyne, C. M. Search for Related Content PubMed PubMed Citation Articles by Nambi, V. Articles by Ballantyne, C. M. Related Collections Risk Factors Risk Factors for Stroke

(Stroke. 2009;40:376.)
© 2009 American Heart Association, Inc.

Original Contributions

Lipoprotein-Associated Phospholipase A₂ and High-Sensitivity C-Reactive Protein Improve the Stratification of Ischemic Stroke Risk in the Atherosclerosis Risk in Communities (ARIC) Study

Vijay Nambi, MD; Ron C. Hoogeveen, PhD; Lloyd Chambless, PhD; Yijuan Hu; Heejung Bang, PhD; Josef Coresh, MD, PhD; Hanyu Ni, PhD; Eric Boerwinkle, PhD; Thomas Mosley, PhD; Richey Sharrett, MD; Aaron R. Folsom, MD Christie M. Ballantyne, MD

From the Section of Atherosclerosis and Vascular Medicine, Department of Medicine (V.N., R.C.H., C.M.B.), Baylor College of Medicine, Houston, Texas; the Center for Cardiovascular Disease Prevention (V.N., R.C.H., C.M.B.), Methodist DeBakey Heart Center, Houston, Texas; the Department of Biostatistics (L.C., Y.H.), University of North Carolina, Chapel Hill, NC; the Division of Biostatistics and Epidemiology, Department of Public Health (H.B.), Weill Medical College of Cornell University, New York, NY; the Department of Epidemiology (J.C., R.S.), Johns Hopkins Bloomberg School of Public Health, Baltimore, Md; the National Institute of Health (H.N.), Bethesda, Md; the Human Genetics Center and Institute of Molecular Medicine (E.B.), University of Texas-Houston Health Science Center, Houston, Texas; the Department of Medicine (T.M.), University of Mississippi, Jackson, Miss; and the Division of Epidemiology and Community Health (A.R.F.), University of Minnesota School of Public Health, Minneapolis, Minn.

Correspondence to Christie M. Ballantyne, MD, Baylor College of Medicine, 6565 Fannin, MS STE-B-160 A-601, Houston, TX 77030. E-mail cmb{at}bcm.tmc.edu

Background and Purpose— Inflammation plays a critical role in the development of vascular disease, and increased levels of the inflammatory biomarkers, lipoprotein-associated phospholipase A₂ (Lp-PLA₂), and high-sensitivity C-reactive protein (hs-CRP) have been shown to be associated with an increased risk for ischemic stroke.

Methods— In a prospective case-cohort (n=949) study in 12 762 apparently healthy, middle-aged men and women in the Atherosclerosis Risk in Communities (ARIC) study, we first examined whether Lp-PLA₂ and hs-CRP levels improved the area under the receiver operator characteristic curve (AUC) for 5-year ischemic stroke risk. We then examined how Lp-PLA₂ and hs-CRP levels altered classification of individuals into low-, intermediate-, or high-risk categories compared with traditional risk factors.

Results— In a model using traditional risk factors alone, the AUC adjusted for optimism was 0.732, whereas adding hs-CRP improved the AUC to 0.743, and adding Lp-PLA₂ significantly improved the AUC to 0.752. Addition of hs-CRP and Lp-PLA₂ together in the model improved the AUC to 0.761, and the addition of the interaction between Lp-PLA₂ and hs-CRP further significantly improved the AUC to 0.774. With the use of traditional risk factors to assess 5-year risk for ischemic stroke, 86% of participants were categorized as low risk (<2%); 11%, intermediate risk (2% to 5%); and 3%, high risk (>5%). The addition of hs-CRP, Lp-PLA₂, and their interaction to the model reclassified 4%, 39%, and 34% of the low-, intermediate- and high-risk categories, respectively.

Conclusion— Lp-PLA₂ and hs-CRP may be useful in individuals classified as intermediate risk for ischemic stroke by traditional risk factors.

Key Words: CRP • Lp-PLA₂ • risk • stroke

This article has been cited by other articles:

				K. McGeechan, G. Liew, P. Macaskill, L. Irwig, R. Klein, B. E. K. Klein, J. J. Wang, P. Mitchell, J. R. Vingerling, P. T. V. M. de Jong, et al. Prediction of Incident Stroke Events Based on Retinal Vessel Caliber: A Systematic Review and Individual-Participant Meta-Analysis Am. J. Epidemiol., December 1, 2009; 170(11): 1323 - 1332. [Abstract] [Full Text] [PDF]