High-sensitivity C-reactive protein, lipoprotein-associated phospholipase A2, and outcome after ischemic stroke

Mitchell S.V. Elkind, Wanling Tai, Kristen Coates, Myunghee C. Paik, Ralph L. Sacco

Research output: Contribution to journalArticlepeer-review

193 Scopus citations


Background: Inflammatory markers have been associated with ischemic stroke risk and prognosis after cardiac events. Their relationship to prognosis after stroke is unsettled. Methods: A population-based study of stroke risk factors in 467 patients with first ischemic stroke was undertaken to determine whether levels of high-sensitivity C-reactive protein (hs-CRP) and lipoprotein- associated phospholipase A2 (Lp-PLA2) predict risk of stroke recurrence, other vascular events, and death. Results: Levels of Lp-PLA2 and hs-CRP were weakly correlated (r = 0.09; P = .045). High-sensitivity CRP, but not Lp-PLA2, was associated with stroke severity. After adjusting for age, sex, race and ethnicity, history of coronary artery disease, diabetes mellitus, hypertension, hyperlipidemia, atrial fibrillation, smoking, and hs-CRP level, compared with the lowest quartile of Lp-PLA2, those in the highest quartile had an increased risk of recurrent stroke (adjusted hazard ratio, 2.08; 95% confidence interval, 1.04-4.18) and of the combined outcome of recurrent stroke, MI, or vascular death (adjusted hazard ratio, 1.86; 95% confidence interval, 1.01-3.42). After adjusting for confounders, hs-CRP was not associated with risk of recurrent stroke or recurrent stroke, myocardial infarction, or vascular death but was associated with risk of death (adjusted hazard ratio, 2.11; 95% confidence interval, 1.18-3.75). Conclusions: Inflammatory markers are associated with prognosis after first ischemic stroke and may offer complementary information. Lipoprotein-associated phospholipase A2 may be a stronger predictor of recurrent stroke risk. Levels of hs-CRP, an acute-phase reactant, increase with stroke severity and may be associated with mortality to a greater degree than recurrence.

Original languageEnglish (US)
Pages (from-to)2073-2080
Number of pages8
JournalArchives of internal medicine
Issue number19
StatePublished - Oct 23 2006
Externally publishedYes

ASJC Scopus subject areas

  • Internal Medicine


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