Soluble vascular cell adhesion molecule 1 and N-terminal pro-B-type natriuretic peptide in predicting ischemic stroke in patients with cerebrovascular disease.

Abstract

BACKGROUND:

Patients with stroke or transient ischemic attack are at high risk of another stroke, and there is need for improved strategies to predict recurrent stroke.

OBJECTIVE:

To assess the prognostic value of levels of soluble vascular cell adhesion molecule 1 (sVCAM-1), N-terminal pro-B-type natriuretic peptide (NT-proBNP), C-reactive protein, homocysteine, renin, and lipids and lipoprotein particle concentration and size in patients with previous stroke or transient ischemic attack.

DESIGN, SETTING, AND PARTICIPANTS:

A nested case-control study of participants of the Perindopril Protection Against Recurrent Stroke Study was performed. The Perindopril Protection Against Recurrent Stroke Study was a placebo-controlled trial of a perindopril erbumine-based, blood pressure-lowering regimen that reduced ischemic stroke risk by 24% among individuals with previous stroke or transient ischemic attack. Each of 252 patients who experienced ischemic stroke during a mean follow-up of 3.9 years was matched to 1 to 3 control patients. Matching variables were age, sex, treatment allocated, region, and most recent qualifying event at randomization.

MAIN OUTCOME MEASURES:

Risk of ischemic stroke predicted by baseline levels of sVCAM-1, NT-proBNP, C-reactive protein, homocysteine, renin, and lipids and lipoprotein particle concentration and size.

RESULTS:

Levels of sVCAM-1 and NT-proBNP predicted recurrent ischemic stroke. The odds ratio for patients in the highest, as compared with the lowest, quarter was 2.24 (95% confidence interval, 1.35-3.73) for sVCAM-1 level and 1.62 (95% confidence interval, 0.98-2.69) for NT-proBNP level, after adjustment for matching and other risk factors. Patients in the highest quarters for both sVCAM-1 and NT-proBNP levels had 3.6 times the risk of recurrent ischemic stroke compared with patients in the lowest quarters for both biologic markers. Level of sVCAM-1 was similarly predictive of ischemic stroke in patients allocated to placebo and perindopril-based therapy. Baseline plasma levels of C-reactive protein, homocysteine, renin, and lipids and lipoprotein particle concentration and size did not predict recurrent ischemic stroke risk.

CONCLUSION:

Measurement of sVCAM-1 and NT-proBNP levels provides prognostic information for recurrent ischemic stroke beyond traditional risk factors.

• Authors: Duncan J Campbell, Mark Woodward, John P Chalmers, Samuel A Colman, Alicia J Jenkins, Bruce E Kemp, Bruce C Neal, Anushka Patel, Stephen W MacMahon
• Journal: Archives of neurology (Arch Neurol) Vol. 63 Issue 1 Pg. 60-5 (Jan 2006) ISSN: 0003-9942 [Print] United States
• PMID: 16286536 (Publication Type: Comparative Study, Journal Article, Multicenter Study, Research Support, N.I.H., Extramural, Research Support, Non-U.S. Gov't)

Chemical References

• Peptide Fragments
• Vascular Cell Adhesion Molecule-1
• pro-brain natriuretic peptide (1-76)
• Natriuretic Peptide, Brain
• C-Reactive Protein

Topics

• Aged
• C-Reactive Protein (metabolism)
• Case-Control Studies
• Cerebrovascular Disorders (complications, metabolism)
• Chromatography, High Pressure Liquid (methods)
• Female
• Follow-Up Studies
• Humans
• International Cooperation
• Male
• Middle Aged
• Natriuretic Peptide, Brain (blood)
• Odds Ratio
• Outcome Assessment, Health Care (methods)
• Peptide Fragments (blood)
• Predictive Value of Tests
• Stroke (blood, diagnosis, etiology)
• Vascular Cell Adhesion Molecule-1 (blood)