Biomarkers and functional outcomes from ischaemic cerebral events in women: a prospective cohort study

Authors

  • P. M. Rist,

    Corresponding author
    1. Department of Epidemiology, Harvard School of Public Health, Boston, MA, USA
    • Division of Preventive Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA
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  • J. E. Buring,

    1. Division of Preventive Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA
    2. Department of Epidemiology, Harvard School of Public Health, Boston, MA, USA
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  • C. S. Kase,

    1. Department of Neurology, Boston University School of Medicine, Boston, MA, USA
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  • P. M Ridker,

    1. Division of Preventive Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA
    2. Division Cardiovascular Medicine, Department of Medicine, and Center for Cardiovascular Disease and Prevention, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA
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  • T. Kurth

    1. Division of Preventive Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA
    2. Department of Epidemiology, Harvard School of Public Health, Boston, MA, USA
    3. INSERM Unit 708–Neuroepidemiology, Bordeaux, France
    4. University of Bordeaux, Bordeaux, France
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Correspondence: P. M. Rist, Division of Preventive Medicine, Brigham and Women's Hospital, 900 Commonwealth Avenue, 3rd fl, Boston, MA 02215, USA (tel.: +(617) 278 0878; fax: +(617) 731 3843; e-mail: prist@partners.org).

Abstract

Background and purpose

Several biomarkers have been associated with an increased risk of ischaemic stroke. However, the association between these biomarkers and functional outcome from cerebral ischaemic events is unclear. We aimed to assess the patterns of association between cardiovascular disease biomarkers and functional outcomes after incident ischaemic cerebral events in women.

Methods

Prospective cohort study of 27 728 women enrolled in the Women's Health Study who provided information on blood samples and were free of stroke or transient ischaemic attack (TIA) at baseline. Multinomial logistic regression was used to determine the association between elevated biomarker levels and functional outcomes from ischaemic cerebral events. Possible functional outcomes included TIA and ischaemic stroke with modified Rankin Scale (mRS) score of 0–1, 2–3, or 4–6.

Results

After a mean follow-up of 15.1 years, 461 TIAs and 380 ischaemic strokes occurred. Elevated levels of total cholesterol were associated with the highest risk of poor functional outcome (mRS 4–6) after incident cerebral ischaemic events (relative risk = 2.02, 95% CI = 1.18–3.46). We observed significant associations between elevated levels of total cholesterol, Lp(a), C-reactive protein, and triglycerides, and mild or moderate functional outcomes after ischaemic cerebral events. Elevations in all other biomarkers were not significantly associated with functional outcomes.

Conclusions

Whilst total cholesterol level was associated with highest risks of poor functional outcome after stroke, we overall observed an inconsistent pattern of association between biomarkers linked with an increased risk of vascular events and more impaired functional outcomes from stroke.

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