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Duncan J. Campbell, MD, PhD; Mark Woodward, PhD; John P. Chalmers, MD, PhD; Samuel A. Colman, MBios; Alicia J. Jenkins, MD; Bruce E. Kemp, PhD; Bruce C. Neal, MD, PhD; Anushka Patel, MD; Stephen W. MacMahon, PhD

Arch Neurol. 2006;63:60-65. Published online November 14, 2005 (doi:10.1001/archneur.63.1.noc50221).

Background  Patients with stroke or transient ischemic attack are at high risk of another stroke, and there is need for improved strategies to predict recurrent stroke.

Objective  To assess the prognostic value of levels of soluble vascular cell adhesion molecule 1 (sVCAM-1), N-terminal pro–B-type natriuretic peptide (NT-proBNP), C-reactive protein, homocysteine, renin, and lipids and lipoprotein particle concentration and size in patients with previous stroke or transient ischemic attack.

Design, Setting, and Participants  A nested case-control study of participants of the Perindopril Protection Against Recurrent Stroke Study was performed. The Perindopril Protection Against Recurrent Stroke Study was a placebo-controlled trial of a perindopril erbumine–based, blood pressure–lowering regimen that reduced ischemic stroke risk by 24% among individuals with previous stroke or transient ischemic attack. Each of 252 patients who experienced ischemic stroke during a mean follow-up of 3.9 years was matched to 1 to 3 control patients. Matching variables were age, sex, treatment allocated, region, and most recent qualifying event at randomization.

Main Outcome Measures  Risk of ischemic stroke predicted by baseline levels of sVCAM-1, NT-proBNP, C-reactive protein, homocysteine, renin, and lipids and lipoprotein particle concentration and size.

Results  Levels of sVCAM-1 and NT-proBNP predicted recurrent ischemic stroke. The odds ratio for patients in the highest, as compared with the lowest, quarter was 2.24 (95% confidence interval, 1.35-3.73) for sVCAM-1 level and 1.62 (95% confidence interval, 0.98-2.69) for NT-proBNP level, after adjustment for matching and other risk factors. Patients in the highest quarters for both sVCAM-1 and NT-proBNP levels had 3.6 times the risk of recurrent ischemic stroke compared with patients in the lowest quarters for both biologic markers. Level of sVCAM-1 was similarly predictive of ischemic stroke in patients allocated to placebo and perindopril-based therapy. Baseline plasma levels of C-reactive protein, homocysteine, renin, and lipids and lipoprotein particle concentration and size did not predict recurrent ischemic stroke risk.

Conclusion  Measurement of sVCAM-1 and NT-proBNP levels provides prognostic information for recurrent ischemic stroke beyond traditional risk factors.

Author Affiliations: St Vincent’s Institute of Medical Research, Fitzroy, Australia (Drs Campbell and Kemp); Department of Medicine, University of Melbourne, St Vincent’s Hospital, Fitzroy (Drs Campbell, Jenkins, and Kemp); CSIRO Health Sciences and Nutrition, Parkville, Australia (Dr Kemp); The George Institute for International Health, University of Sydney, Camperdown, Australia (Drs Woodward, Chalmers, Neal, Patel, and MacMahon, and Mr Colman).

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