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C-reactive Protein and Homocysteine Predict Long-term Mortality in Young Ischemic Stroke Patients
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 an...
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Published in: | Journal of stroke and cerebrovascular diseases 2013-11, Vol.22 (8), p.e435-e440 |
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description | 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. |
doi_str_mv | 10.1016/j.jstrokecerebrovasdis.2013.04.031 |
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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.</description><identifier>ISSN: 1052-3057</identifier><identifier>EISSN: 1532-8511</identifier><identifier>DOI: 10.1016/j.jstrokecerebrovasdis.2013.04.031</identifier><identifier>PMID: 23735372</identifier><language>eng</language><publisher>United States: Elsevier Inc</publisher><subject>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</subject><ispartof>Journal of stroke and cerebrovascular diseases, 2013-11, Vol.22 (8), p.e435-e440</ispartof><rights>National Stroke Association</rights><rights>2013 National Stroke Association</rights><rights>Copyright © 2013 National Stroke Association. Published by Elsevier Inc. All rights reserved.</rights><lds50>peer_reviewed</lds50><woscitedreferencessubscribed>false</woscitedreferencessubscribed><citedby>FETCH-LOGICAL-c459t-3be6b91bd7113a6add2c144ee1f411fe8049d23885938b86917b4dc2b0d2d7ba3</citedby><cites>FETCH-LOGICAL-c459t-3be6b91bd7113a6add2c144ee1f411fe8049d23885938b86917b4dc2b0d2d7ba3</cites></display><links><openurl>$$Topenurl_article</openurl><openurlfulltext>$$Topenurlfull_article</openurlfulltext><thumbnail>$$Tsyndetics_thumb_exl</thumbnail><link.rule.ids>314,778,782,27911,27912</link.rule.ids><backlink>$$Uhttps://www.ncbi.nlm.nih.gov/pubmed/23735372$$D View this record in MEDLINE/PubMed$$Hfree_for_read</backlink></links><search><creatorcontrib>Naess, Halvor, MD, PhD</creatorcontrib><creatorcontrib>Nyland, Harald, MD, PhD</creatorcontrib><creatorcontrib>Idicula, Titto, MD, PhD</creatorcontrib><creatorcontrib>Waje-Andreassen, Ulrike, MD, PhD</creatorcontrib><title>C-reactive Protein and Homocysteine Predict Long-term Mortality in Young Ischemic Stroke Patients</title><title>Journal of stroke and cerebrovascular diseases</title><addtitle>J Stroke Cerebrovasc Dis</addtitle><description>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.</description><subject>Adolescent</subject><subject>Adult</subject><subject>Age Factors</subject><subject>Biomarkers - blood</subject><subject>Brain Ischemia - blood</subject><subject>Brain Ischemia - diagnosis</subject><subject>Brain Ischemia - mortality</subject><subject>C-reactive protein</subject><subject>C-Reactive Protein - metabolism</subject><subject>Cardiovascular</subject><subject>Cause of Death</subject><subject>Cerebral infarction</subject><subject>Comorbidity</subject><subject>Disability Evaluation</subject><subject>Female</subject><subject>homocysteine</subject><subject>Homocysteine - blood</subject><subject>Humans</subject><subject>Kaplan-Meier Estimate</subject><subject>Linear Models</subject><subject>Male</subject><subject>Middle Aged</subject><subject>mortality</subject><subject>Neurology</subject><subject>Norway - epidemiology</subject><subject>Prognosis</subject><subject>Proportional Hazards Models</subject><subject>Registries</subject><subject>Retrospective Studies</subject><subject>Risk Factors</subject><subject>Stroke - blood</subject><subject>Stroke - diagnosis</subject><subject>Stroke - mortality</subject><subject>Time Factors</subject><subject>Young Adult</subject><subject>young adults</subject><issn>1052-3057</issn><issn>1532-8511</issn><fulltext>true</fulltext><rsrctype>article</rsrctype><creationdate>2013</creationdate><recordtype>article</recordtype><recordid>eNqVkU1v1DAQhiMEoqXwF5CPCCnB4498XJBgVWilRVQqHDhZjj1bnCZxsZ2V9t_jsKWHigsn25rX78w8b1G8BVoBhfrdUA0xBX-LBgP2we91tC5WjAKvqKgohyfFKUjOylYCPM13KlnJqWxOihcxDpQCyFY-L04Yb7jkDTst9KYMqE1yeyRXwSd0M9GzJRd-8uYQ1_daQOtMIls_35QJw0S--JD06NKBZP0Pv8w35DKanzg5Q67_zEiudHI4p_iyeLbTY8RX9-dZ8f3T-bfNRbn9-vly82FbGiG7VPIe676D3jYAXNfaWmZACETYCYAdtlR0lvG2lR1v-7buoOmFNaynltmm1_yseHP0vQv-14IxqclFg-OoZ_RLVCBqIbr8u8vSj0epCT7GgDt1F9ykw0EBVStqNah_oVYrakWFyqizyev7fks_oX2w-Ms2C7ZHAeat9w6DiiYTMZllQJOU9e7_-r1_ZGdGNzujx1s8YBz8EubMV4GKTFF1vYa_Zg885y67mv8GyE6z_A</recordid><startdate>20131101</startdate><enddate>20131101</enddate><creator>Naess, Halvor, MD, PhD</creator><creator>Nyland, Harald, MD, PhD</creator><creator>Idicula, Titto, MD, PhD</creator><creator>Waje-Andreassen, Ulrike, MD, PhD</creator><general>Elsevier Inc</general><scope>CGR</scope><scope>CUY</scope><scope>CVF</scope><scope>ECM</scope><scope>EIF</scope><scope>NPM</scope><scope>AAYXX</scope><scope>CITATION</scope><scope>7X8</scope></search><sort><creationdate>20131101</creationdate><title>C-reactive Protein and Homocysteine Predict Long-term Mortality in Young Ischemic Stroke Patients</title><author>Naess, Halvor, MD, PhD ; Nyland, Harald, MD, PhD ; Idicula, Titto, MD, PhD ; Waje-Andreassen, Ulrike, MD, PhD</author></sort><facets><frbrtype>5</frbrtype><frbrgroupid>cdi_FETCH-LOGICAL-c459t-3be6b91bd7113a6add2c144ee1f411fe8049d23885938b86917b4dc2b0d2d7ba3</frbrgroupid><rsrctype>articles</rsrctype><prefilter>articles</prefilter><language>eng</language><creationdate>2013</creationdate><topic>Adolescent</topic><topic>Adult</topic><topic>Age Factors</topic><topic>Biomarkers - blood</topic><topic>Brain Ischemia - blood</topic><topic>Brain Ischemia - diagnosis</topic><topic>Brain Ischemia - mortality</topic><topic>C-reactive protein</topic><topic>C-Reactive Protein - metabolism</topic><topic>Cardiovascular</topic><topic>Cause of Death</topic><topic>Cerebral infarction</topic><topic>Comorbidity</topic><topic>Disability Evaluation</topic><topic>Female</topic><topic>homocysteine</topic><topic>Homocysteine - blood</topic><topic>Humans</topic><topic>Kaplan-Meier Estimate</topic><topic>Linear Models</topic><topic>Male</topic><topic>Middle Aged</topic><topic>mortality</topic><topic>Neurology</topic><topic>Norway - epidemiology</topic><topic>Prognosis</topic><topic>Proportional Hazards Models</topic><topic>Registries</topic><topic>Retrospective Studies</topic><topic>Risk Factors</topic><topic>Stroke - blood</topic><topic>Stroke - diagnosis</topic><topic>Stroke - mortality</topic><topic>Time Factors</topic><topic>Young Adult</topic><topic>young adults</topic><toplevel>peer_reviewed</toplevel><toplevel>online_resources</toplevel><creatorcontrib>Naess, Halvor, MD, PhD</creatorcontrib><creatorcontrib>Nyland, Harald, MD, PhD</creatorcontrib><creatorcontrib>Idicula, Titto, MD, PhD</creatorcontrib><creatorcontrib>Waje-Andreassen, Ulrike, MD, PhD</creatorcontrib><collection>Medline</collection><collection>MEDLINE</collection><collection>MEDLINE (Ovid)</collection><collection>MEDLINE</collection><collection>MEDLINE</collection><collection>PubMed</collection><collection>CrossRef</collection><collection>MEDLINE - Academic</collection><jtitle>Journal of stroke and cerebrovascular diseases</jtitle></facets><delivery><delcategory>Remote Search Resource</delcategory><fulltext>fulltext</fulltext></delivery><addata><au>Naess, Halvor, MD, PhD</au><au>Nyland, Harald, MD, PhD</au><au>Idicula, Titto, MD, PhD</au><au>Waje-Andreassen, Ulrike, MD, PhD</au><format>journal</format><genre>article</genre><ristype>JOUR</ristype><atitle>C-reactive Protein and Homocysteine Predict Long-term Mortality in Young Ischemic Stroke Patients</atitle><jtitle>Journal of stroke and cerebrovascular diseases</jtitle><addtitle>J Stroke Cerebrovasc Dis</addtitle><date>2013-11-01</date><risdate>2013</risdate><volume>22</volume><issue>8</issue><spage>e435</spage><epage>e440</epage><pages>e435-e440</pages><issn>1052-3057</issn><eissn>1532-8511</eissn><abstract>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.</abstract><cop>United States</cop><pub>Elsevier Inc</pub><pmid>23735372</pmid><doi>10.1016/j.jstrokecerebrovasdis.2013.04.031</doi></addata></record> |
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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 |
title | C-reactive Protein and Homocysteine Predict Long-term Mortality in Young Ischemic Stroke Patients |
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