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High-Sensitivity C-Reactive Protein and Risk of Recurrent Vascular Events in Patients With Stroke Associated With

Takao Hoshino¹, Kentaro Ishizuka¹, Takafumi Mizuno¹

¹Department of Neurology, Tokyo Women's Medical University Hospital Tokyo Japan.

Circulation Reports

|February 11, 2026

Insights

High-sensitivity C-reactive protein (hsCRP) elevation predicts major adverse cardiovascular events (MACE) in patients with complex aortic atheroma (CAA) stroke. This finding aids risk stratification for recurrent vascular events in this high-risk group.

Area of Science:

Cardiology
Neurology
Vascular Medicine

Background:

Complex aortic atheroma (CAA) is a significant risk factor for ischemic stroke.
Predictors of recurrent vascular events in CAA-related stroke are not well-defined.
Systemic inflammation may play a role in stroke recurrence.

Purpose of the Study:

To evaluate the prognostic value of high-sensitivity C-reactive protein (hsCRP) in patients with CAA-related stroke.
To determine if hsCRP levels can predict major adverse cardiovascular events (MACE).
To assess the association between hsCRP and recurrent vascular events.

Main Methods:

Prospective, observational registry of consecutive stroke patients within 1 week of onset.
Transesophageal echocardiography (TEE) used for embolic-source evaluation and CAA definition (plaque ≥4 mm, ulceration, or mobile components).
Patients dichotomized by hsCRP level (≥3.0 mg/L vs. <3.0 mg/L); primary outcome was 1-year MACE.

Main Results:

Out of 1,214 patients, 335 underwent TEE, identifying CAA in 83 (24.8%).
Among 76 patients with hsCRP data and 1-year follow-up, 17 experienced MACE (23.2% event rate).
MACE incidence was significantly higher in patients with hsCRP ≥3.0 mg/L (42.2%) compared to hsCRP <3.0 mg/L (15.3%; P=0.010).
Elevated hsCRP (≥3.0 mg/L) independently predicted MACE (HR 4.68; 95% CI 1.43-15.32).

Conclusions:

Elevated hsCRP is an independent predictor of MACE in CAA-related stroke.
hsCRP can aid in risk stratification for patients with CAA and stroke.
These findings highlight the role of systemic inflammation in the vascular events of this high-risk subgroup.

Read full analysis

Abstract

Background:

Complex aortic atheroma (CAA) is a high-risk source of ischemic stroke, yet predictors of recurrent vascular events in CAA-related stroke remain poorly defined. We evaluated the prognostic value of high-sensitivity C-reactive protein (hsCRP).

Methods And Results:

This single-center, prospective, observational registry enrolled consecutive patients with stroke within 1 week of onset. Transesophageal echocardiography (TEE) was not protocol-mandated but used at physician discretion, mainly for embolic-source evaluation. CAA was defined as any plaque ≥4 mm in thickness or a plaque with ulceration or mobile components on TEE. Patients were dichotomized by hsCRP at 3.0 mg/L. The primary outcome was 1-year major adverse cardiovascular events (MACE), including stroke, acute coronary syndrome, and vascular death. Among 1,214 patients, TEE was performed in 335; CAA was identified in 83 (24.8%). Seventy-six with hsCRP data were analyzed, with 1-year follow up obtained in 73 (96.1%). Over 1 year, 17 patients had at least 1 vascular event, yielding an event rate of 23.2%. The incidence of MACE was significantly higher in patients with hsCRP ≥3.0 mg/L than in those with hsCRP <3.0 mg/L (42.2% vs. 15.3%; log-rank P=0.010). In multivariable Cox analysis, hsCRP ≥3.0 mg/L independently predicted MACE (hazard ratio 4.68; 95% confidence interval 1.43-15.32).

Conclusions:

Elevated hsCRP is independently associated with an increased risk of MACE in CAA-related stroke. hsCRP may aid risk stratification and underscores the role of systemic inflammation in this high-risk subgroup.

Keywords:

Aortic stenosis Atherosclerosis C-reactive protein Ischemic stroke

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