C-reactive Protein and Homocysteine Predict Long-term Mortality in Young Ischemic Stroke Patients

• Published in: Journal of stroke and cerebrovascular diseases 2013-11, Vol.22 (8), p.e435-e440
• Main Authors: Naess, Halvor, MD, PhD, Nyland, Harald, MD, PhD, Idicula, Titto, MD, PhD, Waje-Andreassen, Ulrike, MD, PhD
• Format: Article
• Language: English
• Subjects: Adolescent; Adult; Age Factors; Biomarkers - blood; Brain Ischemia - blood; Brain Ischemia - diagnosis; Brain Ischemia - mortality; C-reactive protein; C-Reactive Protein - metabolism; Cardiovascular; Cause of Death; Cerebral infarction; Comorbidity; Disability Evaluation; Female; homocysteine; Homocysteine - blood; Humans; Kaplan-Meier Estimate; Linear Models; Male; Middle Aged; mortality; Neurology; Norway - epidemiology; Prognosis; Proportional Hazards Models; Registries; Retrospective Studies; Risk Factors; Stroke - blood; Stroke - diagnosis; Stroke - mortality; Time Factors; Young Adult; young adults
• ISSN: 1052-3057; 1532-8511
• DOI: 10.1016/j.jstrokecerebrovasdis.2013.04.031

Background We investigated the relationship between C-reactive protein (CRP) and homocysteine on follow-up and subsequent mortality in young ischemic stroke patients in a population-based study. Methods Young ischemic stroke patients were followed-up on average 6 years after the index stroke. CRP and homocysteine levels were measured and risk factors were recorded, including myocardial infarction, diabetes mellitus, hypertension, smoking, alcoholism, and cancer. Stroke outcome was measured using the modified Rankin Scale score. Subsequent survival was obtained by examining the official population registry. Cox regression analyses were performed. Results In total, 198 patients were included in this study (82 [41%] women and 116 [59%] men). The mean age on follow-up was 47.8 years. In total, 36 (18.2%) patients died during the subsequent mean follow-up of 12.4 years. Cox regression analysis revealed that mortality was associated with CRP (hazard ratio [HR] 1.05; P = .001) and homocysteine levels (HR 1.04; P = .02) in patients without dissection. Kaplan–Meier curves grouped by dichotomized CRP (CRP ≤1 v >1 mg/L) showed increasing separation between the survival curves, and likewise for dichotomized homocysteine (≤9  v >9 μg/L). Conclusions There is an independent association between CRP and homocysteine levels obtained several years after ischemic stroke in young adults and subsequent mortality, even when adjusting for traditional risk factors. This association seems to continue for at least 12 years after the measurements.