Abstract | BACKGROUND AND PURPOSE: METHODS: We conducted a case-control study of 173 hospital cases of first-ever ischemic stroke and 186 randomly selected community controls. Using established criteria, we classified cases of stroke by etiologic subtype. Protein Z concentrations were measured during the first 7 days and at 3 to 6 months after the acute stroke event. RESULTS: Blood levels of protein Z measured within 7 days of acute stroke were significantly higher in cases than in controls (geometric mean, 1.46 versus 1.16 microg/mL; P<0.0001). Compared with the lowest tertile, the upper 2 tertiles of protein Z were associated with an adjusted odds ratio (OR) of ischemic stroke of 1.75 (95% CI, 1.00 to 3.07) for the second tertile and 3.07 (95% CI, 1.73 to 5.45) for the upper tertile. The adjusted odds of ischemic stroke caused by large-artery atherothrombosis was nearly 8-fold greater for those with protein Z concentrations in the upper tertile compared with the lower tertile (OR, 7.91; 95% CI, 3.11 to 20.14). The adjusted odds of ischemic stroke due to small-artery disease (OR, 1.79; 95% CI, 0.83 to 3.87) and cardioembolism (OR, 1.80; 95% CI, 0.58 to 5.64) was also increased among individuals with protein Z concentrations in the upper tertile compared with the lower tertile, but not significantly so. There was no significant difference between mean protein Z concentrations among cases in the convalescent phase (3 months) after stroke and age- and sex-matched controls. CONCLUSIONS: There is a strong, independent relationship between elevated blood levels of protein Z and ischemic stroke during the acute phase, particularly ischemic stroke due to large-artery atherothromboembolism, which is no longer evident during the convalescent phase. These results are consistent with the notion that protein Z is either an important factor in the pathogenesis of ischemic stroke due to large-artery atherothromboembolism or an acute phase reactant. Further studies are required to elucidate whether protein Z has a causative or prognostic role in acute arterial thrombosis.
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Authors | Andrew M McQuillan, John W Eikelboom, Graeme J Hankey, Ross Baker, Jim Thom, Janelle Staton, Qilong Yi, Vanessa Cole |
Journal | Stroke
(Stroke)
Vol. 34
Issue 10
Pg. 2415-9
(Oct 2003)
ISSN: 1524-4628 [Electronic] United States |
PMID | 12970515
(Publication Type: Journal Article)
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Chemical References |
- Blood Proteins
- plasma protein Z
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Topics |
- Age Distribution
- Aged
- Blood Proteins
(analysis)
- Brain Ischemia
(blood, classification, epidemiology)
- Case-Control Studies
- Comorbidity
- Disease Progression
- Female
- Humans
- Male
- Odds Ratio
- Predictive Value of Tests
- Risk Factors
- Sex Distribution
- Stroke
(blood, classification, epidemiology)
- Western Australia
(epidemiology)
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