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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
Main Authors: Naess, Halvor, MD, PhD, Nyland, Harald, MD, PhD, Idicula, Titto, MD, PhD, Waje-Andreassen, Ulrike, MD, PhD
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container_title Journal of stroke and cerebrovascular diseases
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creator Naess, Halvor, MD, PhD
Nyland, Harald, MD, PhD
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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 &gt;1 mg/L) showed increasing separation between the survival curves, and likewise for dichotomized homocysteine (≤9  v &gt;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 &gt;1 mg/L) showed increasing separation between the survival curves, and likewise for dichotomized homocysteine (≤9  v &gt;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. 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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 &gt;1 mg/L) showed increasing separation between the survival curves, and likewise for dichotomized homocysteine (≤9  v &gt;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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