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Recurrent stroke and vascular events in elderly patients with anticardiolipin antibodies: a prospective study
1Department of Neurology, Vasculaire Saint Antoine Hospital, Paris, France.
Insights
In elderly patients, anticardiolipin antibodies (aCL) do not appear to increase the risk of recurrent vascular events, unlike in younger individuals. This study found no significant difference in stroke recurrence between elderly patients with and without elevated aCL levels.
Area of Science:
- Neurology
- Immunology
- Cardiology
Background:
- Anticardiolipin antibodies (aCL) are known stroke risk factors in young patients.
- The role of aCL in vascular event risk among the elderly is unclear.
Purpose of the Study:
- To assess the frequency of aCL in elderly stroke patients.
- To determine if aCL positivity predicts recurrent stroke or vascular events in patients over 60.
Main Methods:
- Evaluated 242 patients over 60 years old admitted for brain infarction.
- Measured aCL immunoreactivity (ELISA, IgG antiphospholipid units) and performed transoesophageal echocardiography.
- Followed patients for a mean of 2.33 years to track recurrent vascular events.
Main Results:
- 21% of patients had at least 10 GPL units of aCL.
- No significant differences in echocardiographic findings between aCL-positive and negative groups.
- Recurrent stroke incidence was 4.5/100 person-years (aCL >10 GPL) vs. 2.7/100 person-years (aCL <10 GPL).
- Kaplan-Meier analysis showed no difference in overall vascular events between groups.
Conclusions:
- Elderly patients with 10 or more GPL units of aCL and negative for anti-beta2 glycoprotein I do not exhibit an increased risk of vascular events.
- Findings contrast with the established risk associated with aCL in younger populations.
Abstract:
The presence of anticardiolipin antibodies (aCL) is a recognized risk factor for ischaemic stroke and a predictor of recurrent ischaemic events in young patients, but the significance of positive aCL tests is uncertain in the elderly. We evaluated the frequency of aCL and the risk of recurrence of stroke and other vascular events in a series of 242 consecutive patients aged over 60 years, admitted for brain infarction. All underwent aCL immunoreactivity (ELISA; measured by IgG antiphospholipid, GPL, units) and transoesophageal echocardiography and were later examined or contacted by telephone (mean 2.33 +/- 1.25 years, max. 4). Fifty patients (21 %) had at least l0 GPL units aCL. There were no differences between these and the other patients in the results of transoesophageal echocardiography, including mitral or aortic valvular thickening, atrial thrombus, atrial spontaneous contrast, strands, and aortic plaques thickness. None had IgG higher than 80 GPL units or was positive for anti-beta2 glycoprotein I. Patients with at least 10 GPL units more often had a past history of cerebral infarction than patients lower aCL level. However, the incidence of recurrent stroke was 4.5 per 100 person-year in patients with more than 10 GPL units, and 2.7 per 100 person-year in those with more than 10 GPL units. Kaplan-Meier analysis for any vascular events showed no differences between the two groups. In contrast to young patients, elderly patients with 10 or more GPL units aCL and negative for anti-beta2 glycoprotein I do not seem to have a higher risk of vascular events.