Lipoprotein-associated phospholipase A 2 and High-sensitivity C-reactive protein improve the stratification of ischemic stroke risk in the atherosclerosis risk in communities (ARIC) study

Vijay Nambi, Ron C. Hoogeveen, Lloyd Chambless, Yijuan Hu, Heejung Bang, Josef Coresh, Hanyu Ni, Eric Boerwinkle, Thomas Mosley, Richey Sharrett, Aaron R. Folsom, Christie M. Ballantyne

Research output: Contribution to journalArticle

64 Citations (Scopus)

Abstract

Background and Purpose-Inflammation plays a critical role in the development of vascular disease, and increased levels of the inflammatory biomarkers, lipoprotein-associated phospholipase A 2 (Lp-PLA 2), and high-sensitivity C-reactive protein (hs-CRP) have been shown to be associated with an increased risk for ischemic stroke. Methods-In a prospective case-cohort (n = 949) study in 12 762 apparently healthy, middle-aged men and women in the Atherosclerosis Risk in Communities (ARIC) study, we first examined whether Lp-PLA 2 and hs-CRP levels improved the area under the receiver operator characteristic curve (AUC) for 5-year ischemic stroke risk. We then examined how Lp-PLA 2 and hs-CRP levels altered classification of individuals into low-, intermediate-, or high-risk categories compared with traditional risk factors. Results-In a model using traditional risk factors alone, the AUC adjusted for optimism was 0.732, whereas adding hs-CRP improved the AUC to 0.743, and adding Lp-PLA 2 significantly improved the AUC to 0.752. Addition of hs-CRP and Lp-PLA 2 together in the model improved the AUC to 0.761, and the addition of the interaction between Lp-PLA 2 and hs-CRP further significantly improved the AUC to 0.774. With the use of traditional risk factors to assess 5-year risk for ischemic stroke, 86% of participants were categorized as low risk (<2%);11%, intermediate risk (2% to 5%);and 3%, high risk (>5%). The addition of hs-CRP, Lp-PLA 2, and their interaction to the model reclassified 4%, 39%, and 34% of the low-, intermediate-and high-risk categories, respectively. Conclusion-Lp-PLA 2 and hs-CRP may be useful in individuals classified as intermediate risk for ischemic stroke by traditional risk factors.

Original languageEnglish (US)
Pages (from-to)376-381
Number of pages6
JournalStroke
Volume40
Issue number2
DOIs
StatePublished - Feb 2009
Externally publishedYes

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1-Alkyl-2-acetylglycerophosphocholine Esterase
C-Reactive Protein
Atherosclerosis
Stroke
Area Under Curve
Vascular Diseases
Biomarkers
Inflammation

Keywords

  • CRP
  • Lp-PLA
  • Risk
  • Stroke

ASJC Scopus subject areas

  • Cardiology and Cardiovascular Medicine
  • Clinical Neurology
  • Advanced and Specialized Nursing
  • Medicine(all)

Cite this

Lipoprotein-associated phospholipase A 2 and High-sensitivity C-reactive protein improve the stratification of ischemic stroke risk in the atherosclerosis risk in communities (ARIC) study. / Nambi, Vijay; Hoogeveen, Ron C.; Chambless, Lloyd; Hu, Yijuan; Bang, Heejung; Coresh, Josef; Ni, Hanyu; Boerwinkle, Eric; Mosley, Thomas; Sharrett, Richey; Folsom, Aaron R.; Ballantyne, Christie M.

In: Stroke, Vol. 40, No. 2, 02.2009, p. 376-381.

Research output: Contribution to journalArticle

Nambi, V, Hoogeveen, RC, Chambless, L, Hu, Y, Bang, H, Coresh, J, Ni, H, Boerwinkle, E, Mosley, T, Sharrett, R, Folsom, AR & Ballantyne, CM 2009, 'Lipoprotein-associated phospholipase A 2 and High-sensitivity C-reactive protein improve the stratification of ischemic stroke risk in the atherosclerosis risk in communities (ARIC) study', Stroke, vol. 40, no. 2, pp. 376-381. https://doi.org/10.1161/STROKEAHA.107.513259
Nambi, Vijay ; Hoogeveen, Ron C. ; Chambless, Lloyd ; Hu, Yijuan ; Bang, Heejung ; Coresh, Josef ; Ni, Hanyu ; Boerwinkle, Eric ; Mosley, Thomas ; Sharrett, Richey ; Folsom, Aaron R. ; Ballantyne, Christie M. / Lipoprotein-associated phospholipase A 2 and High-sensitivity C-reactive protein improve the stratification of ischemic stroke risk in the atherosclerosis risk in communities (ARIC) study. In: Stroke. 2009 ; Vol. 40, No. 2. pp. 376-381.
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abstract = "Background and Purpose-Inflammation plays a critical role in the development of vascular disease, and increased levels of the inflammatory biomarkers, lipoprotein-associated phospholipase A 2 (Lp-PLA 2), and high-sensitivity C-reactive protein (hs-CRP) have been shown to be associated with an increased risk for ischemic stroke. Methods-In a prospective case-cohort (n = 949) study in 12 762 apparently healthy, middle-aged men and women in the Atherosclerosis Risk in Communities (ARIC) study, we first examined whether Lp-PLA 2 and hs-CRP levels improved the area under the receiver operator characteristic curve (AUC) for 5-year ischemic stroke risk. We then examined how Lp-PLA 2 and hs-CRP levels altered classification of individuals into low-, intermediate-, or high-risk categories compared with traditional risk factors. Results-In a model using traditional risk factors alone, the AUC adjusted for optimism was 0.732, whereas adding hs-CRP improved the AUC to 0.743, and adding Lp-PLA 2 significantly improved the AUC to 0.752. Addition of hs-CRP and Lp-PLA 2 together in the model improved the AUC to 0.761, and the addition of the interaction between Lp-PLA 2 and hs-CRP further significantly improved the AUC to 0.774. With the use of traditional risk factors to assess 5-year risk for ischemic stroke, 86{\%} of participants were categorized as low risk (<2{\%});11{\%}, intermediate risk (2{\%} to 5{\%});and 3{\%}, high risk (>5{\%}). The addition of hs-CRP, Lp-PLA 2, and their interaction to the model reclassified 4{\%}, 39{\%}, and 34{\%} of the low-, intermediate-and high-risk categories, respectively. Conclusion-Lp-PLA 2 and hs-CRP may be useful in individuals classified as intermediate risk for ischemic stroke by traditional risk factors.",
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AU - Hoogeveen, Ron C.

AU - Chambless, Lloyd

AU - Hu, Yijuan

AU - Bang, Heejung

AU - Coresh, Josef

AU - Ni, Hanyu

AU - Boerwinkle, Eric

AU - Mosley, Thomas

AU - Sharrett, Richey

AU - Folsom, Aaron R.

AU - Ballantyne, Christie M.

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