Lipoprotein-associated phospholipase A2, high-sensitivity C-reactive protein, and risk for incident ischemic stroke in middle-aged men and women in the Atherosclerosis Risk in Communities (ARIC) study

被引:209
作者
Ballantyne, CM
Hoogeveen, RC
Bang, H
Coresh, P
Folsom, AR
Chambless, LE
Myerson, M
Wu, KK
Sharrett, AR
Boerwinkle, E
机构
[1] Baylor Coll Med, Dept Med, Sect Atherosclerosis & Lipoprot Res, Houston, TX 77030 USA
[2] Methodist DeBakey Heart Ctr, Ctr Cardiovasc Dis Prevent, Houston, TX USA
[3] Univ N Carolina, Sch Publ Hlth, Dept Biostat, Chapel Hill, NC USA
[4] Johns Hopkins Univ, John Hopkins Bloomberg Sch Publ Hlth, Dept Epidemiol, Baltimore, MD 21201 USA
[5] Univ Minnesota, Sch Publ Hlth, Div Epidemiol, Minneapolis, MN USA
[6] NHLBI, NIH, Bethesda, MD 20892 USA
[7] Univ Texas, Hlth Sci Ctr, Vasc Biol Res Ctr, Dept Internal Med, Houston, TX USA
[8] Univ Texas, Hlth Sci Ctr, Sch Publ Hlth, Ctr Human Genet, Houston, TX USA
关键词
D O I
10.1001/archinte.165.21.2479
中图分类号
R5 [内科学];
学科分类号
1002 ; 100201 ;
摘要
Background: Measurement of inflammatory markers has been reported to identify individuals at increased risk for ischemic stroke. Lipoprotein-associated phospholipase A(2) (Lp-PLA(2)) is a proinflammatory enzyme secreted by macrophages. We assessed Lp-PLA(2) and C-reactive protein (CRP) levels along with traditional risk factors to examine their relation to ischemic stroke. Methods: A proportional hazards model was used in a prospective case-cohort study of 12 762 apparently healthy middle-aged men and women in the Atherosclerosis Risk in Communities (ARIC) study who were observed for about 6 years. Results: Mean Lp-PLA2 and CRP levels adjusted for sex, race, and age were higher in the 194 stroke cases than the 766 noncases, whereas low-density lipoprotein cholesterol (LDL-C) level was not significantly different. Both Lp-PLA2 and CRP levels were associated with ischemic stroke after adjustment for age, sex, and race: hazard ratios were 2.23 for the highest vs the lowest tertile of Lp-PLA(2) and 2.70 for CRP level higher than 3 vs lower than 1 mg/L. In a model that included smoking, systolic hypertension, lipid levels, and diabetes, Lp-PLA(2) and CRP levels in the highest category were associated with hazard ratios of 1.91 (95% confidence interval, 1.15-3.18; P=.01) and 1.87 (95% confidence interval, 1.13-3. 10; P=.02), respectively. Individuals with high levels of both CRP and Lp-PLA(2) were at the highest risk after adjusting for traditional risk factors compared with individuals with low levels of both, whereas others were at intermediate risk. Conclusion: Levels of Lp-PLA(2) and CRP may be complementary beyond traditional risk factors in identifying middle-aged individuals at increased risk for ischemic stroke.
引用
收藏
页码:2479 / 2484
页数:6
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