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Anticardiolipin antibodies and mortality in patients with ischemic stroke: a prospective follow-up study
David Tanne1, Luis D'Olhaberriague, Ashish M Trivedi
1Detroit Medical Center Stroke Center, Wayne State University School of Medicine, Detroit, Mich., USA. tanne@post.tau.ac.il
Insights
Anticardiolipin antibodies (aCL) in first ischemic stroke patients indicate higher mortality. However, this increased risk is explained by older age, cardiovascular factors, and detected malignancies during follow-up.
Area of Science:
- Neurology
- Immunology
- Cardiology
Background:
- Anticardiolipin antibodies (aCL) are associated with thrombotic events.
- Their role in outcomes for first-time ischemic stroke patients requires further investigation.
Purpose of the Study:
- To determine if anticardiolipin antibodies (aCL) presence in first ischemic stroke patients is linked to adverse outcomes.
- To assess the association between aCL levels and mortality, thrombo-occlusive events, and malignancy.
Main Methods:
- Prospective observational study of 300 first ischemic stroke patients.
- Evaluation of IgG aCL levels and systematic follow-up for a median of 21 months.
- Statistical analysis of mortality, combined vascular endpoints, and malignancy rates.
Main Results:
- Mortality rates were significantly higher in patients with aCL >20 GPL (33%) and >40 GPL (40%) compared to those without.
- Elevated aCL was associated with a higher incidence of malignancy (19% and 27% respectively).
- The excess mortality linked to aCL was mitigated after adjusting for age, cardiovascular risk factors, and malignancy.
Conclusions:
- Elevated aCL levels (>20-40 GPL) in ischemic stroke patients serve as a marker for increased mortality.
- Older age, cardiovascular risk factors, and malignancy are key contributors to the observed higher mortality in aCL-positive patients.
- aCL itself may not be the direct cause of increased mortality but rather an indicator of underlying conditions.
Abstract:
The purpose of the present prospective observational study was to assess whether or not the presence of anticardiolipin antibodies (aCL) in unselected first ischemic stroke patients is associated with adverse outcome. Consecutive patients (n = 300; mean age 64 years; 48% males) presenting with a first acute ischemic stroke were evaluated for IgG aCL and were systematically followed up. During a median follow-up of 21 months, 58 patients (19%) died. Mortality rates were higher in patients with aCL >20 IgG phospholipid units (GPL) [33 vs. 18%; relative risk (RR) 1.94, 95% confidence interval (CI) 1.02-3.67; p = 0.042] or >40 GPL (40 vs. 19%; RR 2.46, 95% CI 1.05-5.75; p = 0.037). Elevated aCL did not confer an increased risk during follow-up of a combined end point of stroke, myocardial infarction and vascular death or of nonfatal thrombo-occlusive events. Rates of malignancy detected during follow-up were higher among patients with aCL >20 GPL (19 vs. 5%, p = 0.007) and >40 GPL (27 vs. 6%, p = 0.01). The excess mortality associated with elevated aCL was eliminated after adjustment for age, cardiovascular risk factors and malignancy. These results demonstrate that aCL above 20-40 GPL among consecutive ischemic stroke patients is a marker of increased mortality during follow-up, but older age and higher rates of cardiovascular risk factors and malignancy detected during follow-up account for the higher mortality.