Elevated C-reactive protein levels predict worsening prognosis in Chinese patients with first-onset stroke
Elevated C-reactive protein levels predict worsening prognosis in Chinese patients with first-onset stroke
Jiangtao YAN1, Rutai HUI2, Daowen WANG1()
1. The Institute of Hypertension and Department of Internal Medicine, Tongji Hospital, Tongji Medical College, Huazhong University of Science & Technology, Wuhan 430030, China; 2. Fuwai Hospital, Peking Union Medical College and Chinese Academy of Medical Sciences, Beijing 100037, China
The role of high sensitivity C-reactive protein (hsCRP) in predicting prognosis after stroke in the Asian population has not been investigated. We hypothesized that elevated levels of hsCRP were associated with worsening prognosis after stroke in Chinese patients. Two hundred and ninety consecutive patients with first-onset stroke and 290 age- and gender-matched control subjects without any cerebrovascular disease were enrolled for study. Plasma hsCRP level was detected and subsequent vascular events and death were recorded in both groups over a 5-year period. Compared to control group, patients presenting with stroke had higher plasma hsCRP level (3.3 ± 3.8 vs 1.3 ± 2.2 mg/L, P< 0.01). Furthermore, in the group of patients with stroke, the mean plasma hsCRP level was higher in patients who developed subsequent vascular diseases or died as compared with the patients without further complications (4.4 ± 4.3 vs 2.7 ± 3.3 mg/L, P< 0.01). Compared to the lowest tertile of hsCRP level, the relative risk for vascular events or death in stroke patients was 2.91 in the highest tertile of hsCRP (95% CI, 1.54–5.50, P = 0.001). This increase in relative risk for vascular events or death in stroke patients continued after adjustment for age, sex and other cardiovascular risk factors such as hypertension and diabetes (OR: 2.771, 95% CI: 1.367–5.617, P = 0.005). These findings indicate that increased hsCRP level is associated with worsening prognosis after stroke in Chinese patients and suggests that inflammation is correlated with stroke outcome.
Corresponding Author(s):
WANG Daowen,Email:dwwang@tjh.tjmu.edu.cn
引用本文:
. Elevated C-reactive protein levels predict worsening prognosis in Chinese patients with first-onset stroke[J]. Frontiers of Medicine in China, 2009, 3(1): 30-35.
Jiangtao YAN, Rutai HUI, Daowen WANG. Elevated C-reactive protein levels predict worsening prognosis in Chinese patients with first-onset stroke. Front Med Chin, 2009, 3(1): 30-35.
Libby P. Inflammation in atherosclerosis. Nature , 2002, 420(6917): 868-874 doi: 10.1038/nature01323
2
Blake G J, Ridker P M. Inflammatory bio-markers and cardiovascular risk prediction. J Intern Med , 2002, 252(2): 283-294 doi: 10.1046/j.1365-2796.2002.01019.x
3
Engstrom G, Hedblad B, Stavenow L, Tyden P, Lind P, Janzon L, Lindgarde F. Fatality of future coronary events is related to inflammation-sensitive plasma proteins: A population-based prospective cohort study. Circulation , 2004, 110(1): 27-31 doi: 10.1161/01.CIR.0000133277.88655.00
4
Ridker P M, Hennekens C H, Buring J E, Rifai N. C-reactive protein and other markers of inflammation in the prediction of cardiovascular disease in women. N Engl J Med , 2000, 342(12): 836-843 doi: 10.1056/NEJM200003233421202
5
Danesh J, Wheeler J G, Hirschfield G M, Eda S, Eiriksdottir G, Rumley A, Lowe G D O, Pepys M B, Gudnason V. C-reactive protein and other circulating markers of inflammation in the prediction of coronary heart disease. N Engl J Med , 2004, 350(14): 1387-1397 doi: 10.1056/NEJMoa032804
6
Koenig W, Sund M, Frohlich M, Fischer H G, Lowel H, Doring A, Hutchinson W L, Pepys M B. C-reactive protein, a sensitive marker of inflammation, predicts future risk of coronary heart disease in initially healthy middle-aged men: Results from the monica (monitoring trends and determinants in cardiovascular disease) augsburg cohort study, 1984 to 1992. Circulation , 1999, 99(2): 237-242
7
Ridker P M, Cushman M, Stampfer M J, Tracy R P, Hennekens C H. Plasma concentration of c-reactive protein and risk of developing peripheral vascular disease. Circulation , 1998, 97(5): 425-428
8
Rost N S, Wolf P A, Kase C S, Kelly-Hayes M, Silbershatz H, Massaro J M, D'Agostino R B, Franzblau C, Wilson P W. Plasma concentration of C-reactive protein and risk of ischemic stroke and transient ischemic attack: the Framingham study. Stroke , 2001, 32(11): 2575-2579 doi: 10.1161/hs1101.098151
9
Thompson S G, Kienast J, Pyke S D, Haverkate F, van de Loo J C. Hemostatic factors and the risk of myocardial infarction or sudden death in patients with angina pectoris. European Concerted Action on Thrombosis and Disabilities Angina Pectoris Study Group. N Engl J Med , 1995, 332(10): 635-641 doi: 10.1056/NEJM199503093321003
10
Haverkate F T S, Pyke S D, Gallimore J R, Pepys M B. Production of c-reactive protein and risk of coronary events in stable and unstable angina. European concerted action on thrombosis and disabilities angina pectoris study group. Lancet , 1997, 349(9050): 462-466 doi: 10.1016/S0140-6736(96)07591-5
11
Liuzzo G, Biasucci L M, Gallimore J R, Grillo R L, Rebuzzi A G, Pepys M B, Maseri A. The prognostic value of c-reactive protein and serum amyloid a protein in severe unstable angina. N Engl J Med , 1994, 331(7): 417-424 doi: 10.1056/NEJM199408183310701
12
Hansson G K. Inflammation, atherosclerosis, and coronary artery disease. N Engl J Med , 2005, 352(16): 1685-1695 doi: 10.1056/NEJMra043430
13
Ridker P M, Cushman M, Stampfer M J, Tracy R P, Hennekens C H. Inflammation, aspirin, and the risk of cardiovascular disease in apparently healthy men. N Engl J Med , 1997, 336(14): 973-979 doi: 10.1056/NEJM199704033361401
14
Mega J L, Morrow D A, Cannon C P, Murphy S, Cairns R, Ridker P M, Braunwald E. Cholesterol, c-reactive protein, and cerebrovascular events following intensive and moderate statin therapy. J Thromb Thrombolysis . 2006, 22(1): 71-76 doi: 10.1007/s11239-006-8081-0
15
Ridker P M, Cannon C P, Morrow D, Rifai N, Rose L M, McCabe C H, Pfeffer M A, Braunwald E. the Pravastatin or Atorvastatin Evaluation and Infection Therapy Thrombolysis in Myocardial Infarction 22 (PROVE IT-TIMI 22) Investigators. C-reactive protein levels and outcomes after statin therapy. N Engl J Med , 2005, 352(1): 20-28 doi: 10.1056/NEJMoa042378
16
Di Napoli M, Papa F, Bocola V. C-reactive protein in ischemic stroke: An independent prognostic factor. Stroke , 2001, 32(4): 917-924
17
Muir K W, Weir C J, Alwan W, Squire I B, Lees K R. C-reactive protein and outcome after ischemic stroke. Stroke , 1999, 30(5): 981-985
18
Elkind M S, Tai W, Coates K, Paik M C, Sacco R L. High-sensitivity c-reactive protein, lipoprotein-associated phospholipase a2, and outcome after ischemic stroke. Arch Intern Med , 2006, 166(19): 2073-2080 doi: 10.1001/archinte.166.19.2073
19
Torzewski J T M, Bowyer D E, Frohlich M, Koenig W, Waltenberger J, Fitzsimmons C, Hombach V. C-reactive protein frequently colocalizes with the terminal complement complex in the intima of early atherosclerotic lesions of human coronary arteries. Arterioscler Thromb Vasc Biol , 1998, 18(9): 1386-1392
20
Zhang Y X, Cliff W J, Schoefl G I, Higgins G. Coronary c-reactive protein distribution: Its relation to development of atherosclerosis. Atherosclerosis , 1999, 145(2): 375-379 doi: 10.1016/S0021-9150(99)00105-7
21
Chang M K, Binder C J, Torzewski M, Witztum J L. From the cover: C-reactive protein binds to both oxidized ldl and apoptotic cells through recognition of a common ligand: Phosphorylcholine of oxidized phospholipids. PNAS , 2002, 99(20): 13043-13048 doi: 10.1073/pnas.192399699
22
Pasceri V, Willerson J T, Yeh E T. Direct proinflammatory effect of C-reactive protein on human endothelial cells. Circulation , 2000, 102(18): 2165-2168
23
Devaraj S, Xu D Y, Jialal I. C-reactive protein increases plasminogen activator inhibitor-1 expression and activity in human aortic endothelial cells: Implications for the metabolic syndrome and atherothrombosis. Circulation , 2003, 107(3): 398-404 doi: 10.1161/01.CIR.0000052617.91920.FD
24
Zwaka T P, Hombach V, Torzewski J. C-reactive protein-mediated low density lipoprotein uptake by macrophages: Implications for atherosclerosis. Circulation , 2001, 103(9): 1194-1197
25
Venugopal S K, Devaraj S, Yuhanna I, Shaul P, Jialal I. Demonstration that c-reactive protein decreases enos expression and bioactivity in human aortic endothelial cells. Circulation , 2002, 106(12): 1439-1441 doi: 10.1161/01.CIR.0000033116.22237.F9
26
Aronowski J, Hall C E. New horizons for primary intracerebral hemorrhage treatment: Experience from preclinical studies. Neurol Res , 2005, 27(3): 268-279 doi: 10.1179/016164105X25225
27
Xue M, Del Bigio M R. Immune pre-activation exacerbates hemorrhagic brain injury in immature mouse brain. J Neuroimmunol , 2005, 165(1-2): 75-82 doi: 10.1016/j.jneuroim.2005.04.016
28
Zhang X F, Attia J, D'Este C, Yu X H. Prevalence and magnitude of classical risk factors for stroke in a cohort of 5092 Chinese steelworkers over 13.5 years of follow-up. Stroke , 2004, 35(5): 1052-1056 doi: 10.1161/01.STR.0000125305.12859.ff
29
Leppala J M, Virtamo J, Fogelholm R, Albanes D, Heinonen O P. Different risk factors for different stroke subtypes: Association of blood pressure, cholesterol, and antioxidants. Stroke , 1999, 30(12): 2535-2540
30
Manabe S, Okura T, Watanabe S, Higaki J. Association between carotid haemodynamics and inflammation in patients with essential hypertension. J Hum Hypertens , 2005, 19(10): 787-791 doi: 10.1038/sj.jhh.1001898
31
Garanty-Bogacka B, Syrenicz M, Syrenicz A, Gebala A, Lulka D, Walczak M. Serum markers of inflammation and endothelial activation in children with obesity-related hypertension. Neuro Endocrinol Lett , 2005, 26(3): 242-246
