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Adding Two Biomarkers Improves Prediction of Stroke

Addition of biomarkers significantly improves traditional classification of ischemic stroke risk

MONDAY, Jan. 12 (HealthDay News) -- Stratification of ischemic stroke risk is greatly improved with the use of two markers -- lipoprotein-associated phospholipase A2 (Lp-PLA2) and high-sensitivity C-reactive protein (hs-CRP), according to research published in the January issue of Stroke.

Vijay Nambi, M.D., of the Baylor College of Medicine in Houston, and colleagues performed a prospective case-cohort study as part of the larger Atherosclerosis Risk in Communities (ARIC) study. In 12,762 middle-aged men and women who were apparently healthy, the investigators evaluated if Lp-PLA2 and hs-CRP improved the area under the curve (AUC) for five-year ischemic stroke risk, and subsequently determined whether levels of these markers affected low-, intermediate- or high-risk classification of participants based on traditional risk factors.

Adding hs-CRP and Lp-PLA2 separately to an ischemic stroke risk predictive model each improved the AUC generated using traditional risk factors, the investigators found. When the interaction between the two markers was added, the AUC was significantly improved. When the investigators added hs-CRP, Lp-PLA2, and their interaction, they observed a reclassification in predicted ischemic stroke risk of 4 percent, 39 percent and 34 percent of low-, intermediate- and high-risk individuals, respectively.

The authors conclude that "hs-CRP and Lp-PLA2 improved ischemic stroke risk prediction in the ARIC study. The improvement was most enhanced when the markers were combined, with the greatest benefit in reclassification present in individuals who were intermediate risk for ischemic stroke by traditional risk factors."

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