High-Sensitivity C-Reactive Protein and Risk of Stroke in Atrial Fibrillation (from the Reasons for Geographic and Racial Differences in Stroke Study)

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• 作者：Farah Z. Dawood ; MD^a ; Suzanne Judd ; PhD^b ; Virginia J. Howard ; PhD^c ; Nita A. Limdi ; PharmD ; PhD ; MSPH^d ; James F. Meschia ; MD^e ; Mary Cushman ; MD^f ; George Howard ; DrPH^b ; David M. Herrington ; MD^a ; Elsayed Z. Soliman ; MD ; MSc ; MS^a ; ^g ; ^{esoliman@wakehealth.edu}
• 刊名：The American Journal of Cardiology
• 出版年：2016
• 出版时间：15 December 2016
• 年：2016
• 卷：118
• 期：12
• 页码：1826-1830
• 全文大小：222 K
• 卷排序：118

文摘

The relation between inflammation and prothrombotic state in atrial fibrillation (AF) is well recognized. This suggests a potential role for high-sensitivity C-reactive protein (hs-CRP), a marker of systemic inflammation, in improving prediction of stroke in participants with AF. Cox proportional hazard analysis was used to examine the risk of stroke in 25,841 participants (40% black and 55% women) with and without AF who were enrolled in the Reasons for Geographic and Racial Differences in Stroke study from 2003 to 2007. Baseline AF (n = 2,132) was ascertained by electrocardiogram and self-reported history of previous physician diagnosis. Stroke events were identified and adjudicated during 8.3 years of follow-up. A total of 655 incident strokes occurred during follow-up. In a model adjusted for sociodemographics, traditional stroke risk factors, and use of aspirin and warfarin, higher levels of hs-CRP were associated with increased overall stroke risk (hazard ratio [HR] 1.30, 95% confidence interval [CI] 1.10 to 1.54, and HR 1.06, 95% CI 1.01 to 1.12 for hs-CRP >3 mg/L and per 1-SD increase, respectively). Higher levels of hs-CRP continued to be associated with incident stroke in participants without AF (HR 1.31, 95% CI 1.09 to 1.57, and HR 1.06, 95% CI 1.01 to 1.12 for hs-CRP >3 mg/L and per 1-SD increase, respectively) but not in those with AF (HR 1.22, 95% CI 0.78 to 1.91, and HR 1.01, 95% CI 0.82 to 1.23 for hs-CRP >3 mg/L and per 1-SD increase, respectively). In conclusion, although hs-CRP was significantly associated with stroke risk in this population, it seems to be limited to those without AF. These findings suggest a limited value of hs-CRP in improving stroke risk stratification in subjects with AF.