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C-reactive protein and homocysteine predict long-term mortality in young ischemic stroke patients
Halvor Naess1, Harald Nyland, Titto Idicula
1Department of Neurology, Haukeland University Hospital, Bergen, Norway.
Insights
In young ischemic stroke survivors, elevated C-reactive protein (CRP) and homocysteine levels predict long-term mortality. These inflammatory markers are independent predictors of death, even after accounting for traditional risk factors.
Area of Science:
- Neurology
- Cardiovascular Research
- Inflammation Studies
Background:
- Investigated the relationship between C-reactive protein (CRP) and homocysteine levels and subsequent mortality in young ischemic stroke patients.
- Utilized a population-based study design for comprehensive analysis.
Purpose of the Study:
- To determine the long-term prognostic value of CRP and homocysteine in young ischemic stroke survivors.
- To assess the independence of this association from traditional cardiovascular risk factors.
Main Methods:
- Followed-up young ischemic stroke patients for an average of 6 years post-stroke.
- Measured CRP and homocysteine levels, recorded risk factors (myocardial infarction, diabetes, hypertension, smoking, alcoholism, cancer), and assessed stroke outcome using the modified Rankin Scale.
- Analyzed subsequent survival data from the population registry using Cox regression.
Main Results:
- 198 young ischemic stroke patients (mean age 47.8 years) were included; 36 (18.2%) died during a mean follow-up of 12.4 years.
- Mortality was significantly associated with CRP (HR 1.05; P=.001) and homocysteine levels (HR 1.04; P=.02) in patients without dissection.
- Kaplan-Meier curves demonstrated increasing separation in survival rates based on dichotomized CRP and homocysteine levels.
Conclusions:
- CRP and homocysteine levels measured years after ischemic stroke in young adults are independently associated with subsequent mortality.
- This association persists for at least 12 years post-measurement, highlighting their long-term prognostic significance.
- Findings emphasize the role of inflammation and homocysteine in long-term outcomes for young stroke survivors.
Background:
We investigated the relationship between C-reactive protein (CRP) and homocysteine on follow-up and subsequent mortality in young ischemic stroke patients in a population-based study.
Methods:
Young ischemic stroke patients were followed-up on average 6 years after the index stroke. CRP and homocysteine levels were measured and risk factors were recorded, including myocardial infarction, diabetes mellitus, hypertension, smoking, alcoholism, and cancer. Stroke outcome was measured using the modified Rankin Scale score. Subsequent survival was obtained by examining the official population registry. Cox regression analyses were performed.
Results:
In total, 198 patients were included in this study (82 [41%] women and 116 [59%] men). The mean age on follow-up was 47.8 years. In total, 36 (18.2%) patients died during the subsequent mean follow-up of 12.4 years. Cox regression analysis revealed that mortality was associated with CRP (hazard ratio [HR] 1.05; P=.001) and homocysteine levels (HR 1.04; P=.02) in patients without dissection. Kaplan-Meier curves grouped by dichotomized CRP (CRP≤1 v >1 mg/L) showed increasing separation between the survival curves, and likewise for dichotomized homocysteine (≤9 v >9 μg/L).
Conclusions:
There is an independent association between CRP and homocysteine levels obtained several years after ischemic stroke in young adults and subsequent mortality, even when adjusting for traditional risk factors. This association seems to continue for at least 12 years after the measurements.
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