Inflammation and hemostasis biomarkers for predicting stroke in postmenopausal women: the Women's Health Initiative Observational Study.

Abstract

BACKGROUND:

Inflammatory and hemostasis-related biomarkers may identify women at risk of stroke.

METHODS:

Hormones and Biomarkers Predicting Stroke is a study of ischemic stroke among postmenopausal women participating in the Women's Health Initiative observational study (n = 972 case-control pairs). A Biomarker Risk Score (BRS) was derived from levels of 7 inflammatory and hemostasis-related biomarkers that appeared individually to predict risk of ischemic stroke: C-reactive protein (CRP), interleukin-6, tissue plasminogen activator, D-dimer, white blood cell count, neopterin, and homocysteine. The c index was used to evaluate discrimination.

RESULTS:

Of all the individual biomarkers examined, CRP emerged as the only independent single predictor of ischemic stroke (adjusted odds ratio comparing Quartile(4)v Quartile(1) = 1.64, 95% confidence interval: 1.15-2.32, P = .01) after adjustment for other biomarkers and standard stroke risk factors. The BRS identified a gradient of increasing stroke risk with a greater number of elevated inflammatory/hemostasis biomarkers, and improved the c index significantly compared with standard stroke risk factors (P = .02). Among the subset of individuals who met current criteria for high-risk levels of CRP (>3.0 mg/L), the BRS defined an approximately 2-fold gradient of risk. We found no evidence for a relationship between stroke and levels of E-selectin, fibrinogen, tumor necrosis factor-alpha, vascular cell adhesion molecule-1, prothrombin fragment 1+2, Factor VIIC, or plasminogen activator inhibitor-1 antigen (P > .15).

DISCUSSION:

The findings support the further exploration of multiple biomarker panels to develop approaches for stratifying an individual's risk of stroke.

• Authors: Robert C Kaplan, Aileen P McGinn, Alison E Baird, Susan L Hendrix, Charles Kooperberg, John Lynch, Daniel M Rosenbaum, Karen C Johnson, Howard D Strickler, Sylvia Wassertheil-Smoller
• Journal: Journal of stroke and cerebrovascular diseases : the official journal of National Stroke Association (J Stroke Cerebrovasc Dis) 2008 Nov-Dec Vol. 17 Issue 6 Pg. 344-55 ISSN: 1532-8511 [Electronic] United States
• PMID: 18984425 (Publication Type: Journal Article, Research Support, N.I.H., Extramural, Research Support, U.S. Gov't, Non-P.H.S.)

Chemical References

• Biomarkers
• Interleukin-6
• Homocysteine
• Neopterin
• C-Reactive Protein
• Tissue Plasminogen Activator

Topics

• Aged
• Biomarkers
• C-Reactive Protein (analysis, metabolism)
• Case-Control Studies
• Comorbidity
• Data Interpretation, Statistical
• Female
• Hemostatic Disorders (diagnosis, epidemiology)
• Homocysteine (analysis, blood)
• Humans
• Incidence
• Inflammation (diagnosis, epidemiology)
• Interleukin-6 (analysis, blood)
• Leukocyte Count
• Middle Aged
• Neopterin (analysis, blood)
• Postmenopause (blood)
• Predictive Value of Tests
• Risk Factors
• Stroke (diagnosis, epidemiology)
• Tissue Plasminogen Activator (analysis, blood)