Biomarkers For Patients At Risk For Recurrent Ischemic Stroke
Measurement of two biomarker levels in stroke survivors may provide predictive information for recurrent ischemic stroke beyond traditional risk factors, according to a study published online today by the Archives of Neurology, one of the JAMA/Archives journals. The study will be published in the January print edition of the journal.
The two biomarkers are soluble vascular cell adhesion molecule 1 (sVCAM-1) and N-terminal pro-B-type natruiretic peptide (NT-proBNP). These biomarkers along with C-reactive protein, homocysteine, renin (an enzyme from the kidneys that affects blood pressure) and lipids and lipoprotein particle concentration and size were measured in 252 participants with cerebrovascular disease, a sub-group, of the Perindopril Protection Against Recurrent Stroke Study (PROGRESS). These participants had experienced ischemic stroke during the follow-up period of the study and were matched to control patients who did not have a stroke. PROGRESS was a placebo-controlled trial of a perindopril erbumine-based, blood pressure-lowering regimen (a medication) that reduced ischemic stroke risk by 24 percent among individuals with previous stroke or transient ischemic attack. Ischemic stroke is the most common kind of stroke caused by an interruption of blood flowing to the brain.
In background information provided by the scientists they write "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." Stroke is a leading cause of death and disablement, with a risk of 21 percent for people 55 years of age or older.
Duncan J. Campbell, M.D., Ph.D., from St. Vincent's Institute of Medical Research, Fitzroy, Australia, and his colleagues analyzed the findings. "Patients in the highest quarters [highest 25 percent of values] 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," the scientists found. "Level of sVCAM-1 was similarly predictive of ischemic stroke in patients allocated to placebo and perindopril-based (blood pressure lowering) 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."
In conclusion the authors write, "Characterization of the mechanisms of ischemic stroke pathogenesis associated with increased sVCAM-1 level may lead to development of therapies that provide benefits additional to those provided by angiotensin-converting enzyme inhibitor-based (ACE-inhibitors), blood pressure lowering therapies."
(Arch Neurol. 2006;63:1-6. Available to the media pre-embargo at www.jamamedia.org).