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 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.
| Original language | English (US) |
|---|---|
| Pages (from-to) | 344-355 |
| Number of pages | 12 |
| Journal | Journal of Stroke and Cerebrovascular Diseases |
| Volume | 17 |
| Issue number | 6 |
| DOIs | |
| State | Published - Nov 2008 |
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Keywords
- epidemiology
- Stroke
- women
ASJC Scopus subject areas
- Clinical Neurology
- Surgery
- Rehabilitation
- Cardiology and Cardiovascular Medicine
Cite this
Inflammation and Hemostasis Biomarkers for Predicting Stroke in Postmenopausal Women : The Women's Health Initiative Observational Study. / Kaplan, Robert C.; McGinn, Aileen P.; Baird, Alison E.; Hendrix, Susan L.; Kooperberg, Charles; Lynch, John; Rosenbaum, Daniel M.; Johnson, Karen C.; Strickler, Howard; Wassertheil-Smoller, Sylvia.
In: Journal of Stroke and Cerebrovascular Diseases, Vol. 17, No. 6, 11.2008, p. 344-355.Research output: Contribution to journal › Article
}
TY - JOUR
T1 - Inflammation and Hemostasis Biomarkers for Predicting Stroke in Postmenopausal Women
T2 - The Women's Health Initiative Observational Study
AU - Kaplan, Robert C.
AU - McGinn, Aileen P.
AU - Baird, Alison E.
AU - Hendrix, Susan L.
AU - Kooperberg, Charles
AU - Lynch, John
AU - Rosenbaum, Daniel M.
AU - Johnson, Karen C.
AU - Strickler, Howard
AU - Wassertheil-Smoller, Sylvia
PY - 2008/11
Y1 - 2008/11
N2 - 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.
AB - 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.
KW - epidemiology
KW - Stroke
KW - women
UR - http://www.scopus.com/inward/record.url?scp=54849433571&partnerID=8YFLogxK
UR - http://www.scopus.com/inward/citedby.url?scp=54849433571&partnerID=8YFLogxK
U2 - 10.1016/j.jstrokecerebrovasdis.2008.04.006
DO - 10.1016/j.jstrokecerebrovasdis.2008.04.006
M3 - Article
C2 - 18984425
AN - SCOPUS:54849433571
VL - 17
SP - 344
EP - 355
JO - Journal of Stroke and Cerebrovascular Diseases
JF - Journal of Stroke and Cerebrovascular Diseases
SN - 1052-3057
IS - 6
ER -