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 Quartile4 v Quartile1 = 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-α, 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.
Key Words
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Article info
Publication history
Accepted:
April 21,
2008
Received in revised form:
April 4,
2008
Received:
November 26,
2007
Footnotes
The Women's Health Initiative program is funded by the National Heart, Lung, and Blood Institute, US Department of Health and Human Services. The Hormones and Biomarkers Predicting Stroke (HaBPS) Study is funded by the National Institute of Neurological Disorders and Stroke, Bethesda, Md, US Department of Health and Human Services. The funders had no role in the design, conduct, or manuscript preparation for the HaBPS Study.
Identification
DOI: https://doi.org/10.1016/j.jstrokecerebrovasdis.2008.04.006
Copyright
© 2008 National Stroke Association. Published by Elsevier Inc. All rights reserved.
