C-reactive protein is a determinant of first-ever stroke: prospective nested case-referent study

Area of Science:

• Neurology
• Cardiovascular Medicine
• Genetics

Background:

• C-reactive protein (CRP) is an established marker for stroke risk.
• Limited prospective data exist on CRP's association with specific etiologic subtypes of ischemic stroke.
• The role of CRP in intracerebral hemorrhage (ICH) risk is also under investigation.

Purpose of the Study:

• To prospectively evaluate C-reactive protein (CRP) as a determinant of first ischemic stroke, categorized by TOAST criteria.
• To assess the association between CRP and intracerebral hemorrhage (ICH).
• To investigate the relationship between the CRP 1444C>T polymorphism, plasma CRP levels, and stroke risk.

Main Methods:

• A prospective, population-based case-referent study nested within the Northern Sweden Cohorts.
• Inclusion of 308 ischemic stroke cases, 61 ICH cases, and 2 controls per case from the same cohort.
• Analysis of CRP levels and the CRP 1444C>T polymorphism in relation to stroke subtypes.

Main Results:

• Elevated CRP levels (>3 mg/l) were associated with a 2.58-fold increased risk of ischemic stroke (95% CI 1.74-3.84).
• After adjusting for traditional risk factors, CRP remained significantly associated with ischemic stroke (OR 2.06; 95% CI 1.29-3.29).
• Small-vessel disease showed a strong association with CRP (OR 3.88; 95% CI 1.10-13.7), while ICH risk was not significantly linked to CRP.
• The CRP 1444C>T polymorphism correlated with CRP plasma levels but not with stroke risk.

Conclusions:

• CRP is a significant independent predictor of first ischemic stroke, particularly the small-vessel disease subtype.
• No association was found between the CRP 1444C>T polymorphism and ischemic stroke or ICH.
• These findings highlight CRP's role in ischemic stroke pathogenesis and risk stratification.