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Anticardiolipin antibodies and their associations with cerebrovascular risk factors
D Tanne1, L D'Olhaberriague, L R Schultz
1Department of Neurology, Henry Ford Hospital & Health Sciences Center, Detroit, MI, USA.
Insights
Multiple cerebrovascular risk factors are linked to higher levels of immunoglobulin G anticardiolipin (aCL) antibodies. This association suggests caution in diagnosing antiphospholipid syndrome in patients with existing vascular conditions.
Area of Science:
- Immunology
- Neurology
- Cardiology
Background:
- High titers of anticardiolipin (aCL) immunoreactivity, particularly IgG isotype, are known predictors of thrombo-occlusive complications.
- Understanding the interplay between vascular risk factors and aCL is crucial for accurate diagnosis and management.
Purpose of the Study:
- To investigate the association between common cerebrovascular risk factors and anticardiolipin (aCL) immunoreactivity.
- To determine if the presence and number of risk factors correlate with aCL antibody levels, specifically IgG and IgM isotypes.
Main Methods:
- Measured anticardiolipin (aCL) antibodies, including IgG and IgM isotypes, using a validated assay.
- Analyzed data from 749 individuals, including 300 with first ischemic stroke and others with CNS disease.
- Assessed correlations between aCL levels and patient history of conditions like atrial fibrillation, heart failure, and valvular heart disease.
Main Results:
- Age was associated with higher aCL categories, with older patients showing increased immunoreactivity.
- History of atrial fibrillation, congestive heart failure, or valvular heart disease correlated with higher rates of positive IgG aCL.
- A significant dose-response relationship was observed between the number of cerebrovascular risk factors and IgG aCL immunoreactivity.
Conclusions:
- Multiple cerebrovascular risk factors are associated with significantly higher rates and levels of IgG isotype aCL.
- Findings suggest a need for caution to avoid overdiagnosis of antiphospholipid syndrome in patients with multiple vascular risk factors.
- These results may influence clinical management strategies for patients presenting with both vascular risk factors and aCL antibodies.
Objective:
To investigate associations between cerebrovascular risk factors and anticardiolipin (aCL) immunoreactivity.
Background:
High titers of aCL immunoreactivity, mainly the immunoglobulin (Ig) G isotype, were shown to predict aCL-related thrombo-occlusive complications.
Methods:
aCL antibodies, and IgG and IgM isotypes were measured by a validated assay in a single laboratory, run in duplicate, in 749 individuals with first ischemic stroke (n = 300) and patients with other CNS disease or undergoing diagnostic procedures.
Results:
Age varied according to aCL categories, with a mean of 61.8 years among patients with negative aCL (< 10 IgG phospholipid units [GPL]) to 62.3, 64.9, and 69.9 years in patients with immunoreactivity 10 to 20, 20 to 40, and >40 GPL respectively (p = 0.02). History of atrial fibrillation, congestive heart failure, or valvular heart disease was associated with significantly higher rates of positive IgG aCL (>10 GPL) and with higher immunoreactivity. IgG aCL immunoreactivity increased significantly, in a dose-response manner, as a function of the number of cerebrovascular risk factors present. In patients with first ischemic stroke, rates of 10 to 20, 20 to 40, and >40 GPL were 14%, 7%, and 0% among those with no risk factors versus 20%, 12%, and 12% respectively among patients with four or more risk factors (p = 0.007). No significant associations were identified, however, between IgM isotype aCL and any of the risk factors or increasing number of risk factors.
Conclusion:
The presence of multiple cerebrovascular risk factors is associated with substantially higher rates of positive IgG isotype aCL, and with higher immunoreactivity. These findings should caution against overdiagnosis of the antiphospholipid syndrome, and consequent changes in management among patients with multiple cerebrovascular risk factors.