Open AccessImprovement in stroke risk prediction: role of C ‐reactive protein and lipoprotein‐associated phospholipase A 2 in the women's health initiative
Author(s) -
WassertheilSmoller Sylvia,
McGinn Aileen,
Allison Matthew,
Ca Tianxi,
Curb David,
Eaton Charles,
Hendrix Susan,
Kaplan Robert,
Ko Marcia,
Martin Lisa W.,
Xue Xiaonan
Publication year - 2014
Publication title -
international journal of stroke
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 2.375
H-Index - 74
eISSN - 1747-4949
pISSN - 1747-4930
DOI - 10.1111/j.1747-4949.2012.00860.x
Subject(s) - medicine , framingham risk score , confidence interval , lipoprotein associated phospholipase a2 , stroke (engine) , c reactive protein , framingham heart study , physical therapy , disease , lipoprotein , cholesterol , mechanical engineering , engineering , inflammation
Background Classification of risk of ischemic stroke is important for medical care and public health reasons. Whether addition of biomarkers adds to predictive power of the F ramingham S troke R isk or other traditional risk factors has not been studied in older women. Methods The H ormones and B iomarkers P redicting S troke Study is a case‐control study of blood biomarkers assayed in 972 ischemic stroke cases and 972 controls, nested in the W omen's H ealth I nitiative O bservational S tudy of 93 676 postmenopausal women followed for an average of eight‐years. We evaluated additive predictive value of two commercially available biomarkers: C ‐reactive protein and lipoprotein‐associated phospholipase A 2 to determine if they added to risk prediction by the F ramingham S troke R isk S core or by traditional risk factors, which included lipids and other variables not included in the F ramingham S troke R isk S core. As measures of additive predictive value, we used the C ‐statistic, net reclassification improvement, category‐less net reclassification improvement, and integrated discrimination improvement index. Results Addition of C ‐reactive protein to F ramingham risk models or additional traditional risk factors overall modestly improved prediction of ischemic stroke and resulted in overall net reclassification improvement of 6·3%, (case net reclassification improvement = 3·9%, control net reclassification improvement = 2·4%). In particular, high‐sensitivity C ‐reactive protein was useful in prediction of cardioembolic strokes (net reclassification improvement = 12·0%; 95% confidence interval 4·3–19·6%) and in strokes occurring in less than three‐years (net reclassification improvement = 7·9%, 95% confidence interval 0·8–14·9%). Lipoprotein‐associated phospholipase A 2 was useful in risk prediction of large artery strokes (net reclassification improvement = 19·8%, 95% confidence interval 7·4−32·1%) and in early strokes (net reclassification improvement = 5·8%, 95% confidence interval 0·4–11·2%). Conclusions C ‐reactive protein and lipoprotein‐associated phospholipase A 2 can improve prediction of certain subtypes of ischemic stroke in older women, over the Framingham stroke risk model and traditional risk factors, and may help to guide surveillance and treatment of women at risk.