on June 23, 2003
Circulation. 2003
Published online before print June 23, 2003, doi: 10.1161/01.CIR.0000079160.07364.6A
Published online before print June 23, 2003, doi: 10.1161/01.CIR.0000079160.07364.6A
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Submitted on September 25, 2002
From the Henry Ford Heart and Vascular Institute (J.J.C.), Detroit, Mich; Merck Research Laboratory (C.T.), Rahway, NJ; National Heart, Lung, and Blood Institute (T.A.M.), Bethesda, Md; University of Washington (B.M.P.), Seattle, Wash; University of Pittsburgh (L.H.K., K.S.-T.), Pittsburgh, Pa; Johns Hopkins University (P.H.M.C.), Baltimore, Md; Brigham and Women's Hospital (J.F.P.), Boston, Mass; Wake Forest University (D.M.H.), Winston-Salem, NC; University of Maryland (T.R.P.), Baltimore, Md; and University of Vermont (M.C.), Burlington, Vt. * To whom correspondence should be addressed. E-mail: mary.cushman{at}uvm.edu.
Background--Increased carotid artery intima-media thickness (IMT) and elevated C-reactive protein (CRP) are both associated with the occurrence of stroke. We investigated whether elevated CRP is a risk factor for ischemic stroke independent of carotid IMT and studied the interaction between CRP and IMT. Methods and Results--We studied 5417 participants aged 65 years or older without preexisting stroke or chronic atrial fibrillation who were participants in the Cardiovascular Health Study. The hazard ratio of incident ischemic stroke was estimated by Cox proportional hazards regression. During 10.2 years of follow-up, 469 incident ischemic strokes occurred. The adjusted hazard ratios for ischemic stroke in the 2nd to 4th quartiles of baseline CRP, relative to the 1st quartile, were 1.19 (95% CI 0.92 to 1.53), 1.05 (95% CI 0.81 to 1.37), and 1.60 (95% CI 1.23 to 2.08), respectively. With additional adjustment for carotid IMT, there was little confounding. The association of CRP with stroke was significantly different depending on IMT (P<0.02), with no association of CRP with stroke among those in the lowest IMT tertile and a significant association among those with higher levels of IMT. Conclusions--We conclude that elevated CRP is a risk factor for ischemic stroke, independent of atherosclerosis severity as measured by carotid IMT. The association of CRP with stroke is more apparent in the presence of a higher carotid IMT. CRP and carotid IMT may each be independent integrals in determining the risk of ischemic stroke.
Revised on April 17, 2003
Accepted on April 18, 2003
C-Reactive Protein, Carotid Intima-Media Thickness, and Incidence of Ischemic Stroke in the Elderly. The Cardiovascular Health Study
Jie J. Cao MD, MPH,
Key words: inflammation • atherosclerosis • carotid arteries • stroke • risk factors
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