Abstract 13033: Osteopontin and Neopterin Predict Stroke Risk in Patients with Prior Stroke or Transient Ischemic Attack. Results of the Analysis of 13 Biomarkers from the SPARCL Study
Background: Currently recognized risk factor profiles do not completely identify persons who will or will not have a recurrent stroke. The placebo-controlled Stroke Prevention by Aggressive Reduction in Cholesterol Levels (SPARCL) trial evaluated the effect of atorvastatin 80 mg/d on the risk of stroke in patients with a recent stroke or transient ischemic attack (TIA) and no known coronary heart disease. This nested case-control analysis explored the relationship between 13 candidate biomarkers assessed from samples obtained at trial enrolment and the occurrence of stroke over a median follow-up of 4.9 yrs.
Methods: Biomarkers (Table) were measured in 2,639 of 4,731 SPARCL subjects, including 562 of 576 subjects with recurrent strokes. Baseline characteristics of the sub-study and total SPARCL populations were similar. Time to stroke was evaluated by Cox proportional hazard models for quartiles of biomarkers without and with adjustment for age, sex, smoking, diabetes, entry event, time since entry event and geographic region.
Results: With quartile 4 (Q4) compared to Q1 as the reference quartile for all biomarkers, osteopontin (HR unadjusted = 2.058, adjusted = 1.695), neopterin (HR unadjusted = 1.652, adjusted = 1.404) and lipoprotein associated phospholipase A2 (LpPLA2) (HR unadjusted = 1.244, adjusted = 1.306) were each associated with stroke risk (no adjustment for multiple testing). Treatment with atorvastatin did not alter the risk associated with any of the biomarkers.
Conclusions: Inflammatory biomarkers commonly used to assess cardiovascular risk, including the risk of a first stroke, were of borderline significance (LpPLA2) or not predictive (hsCRP) of stroke risk in patients with prior stroke or TIA. In contrast, osteopontin and neopterin, novel biomarkers of inflammatory and immune activation, were more strongly predictive of stroke risk in these patients.
- © 2010 by American Heart Association, Inc.