Association Between Interleukin-6 Levels and First-Ever Cerebrovascular Events in Patients With Vascular Risk Factors

Abstract

Therefore, the objective of this study was to clarify the values of 3 inflammatory markers (hsCRP, for predicting CVEs in a cohort of patients with cardiovascular risk factors without prior CVD, while simultaneously evaluating IMT and the presence of SLI. Materials and MethodsThe participants originated from the Osaka Follow-up Study for Carotid Atherosclerosis, Part 2-a prospective cohort study in which physicians control risk factors in high-risk patients for primary and secondary prevention of CVD.14 Outpatients aged >40 years with >1 cardiovascular risk factor, including hypertension, diabetes mellitus, hyperlipidemia, history of smoking, established arteriosclerosis documented as transient ischemic attack (TIA), stroke, coronary heart disease, or peripheral artery disease, were enrolled. Between Objective-The objective of this study was to examine the association of inflammatory markers with risk of first-ever cerebrovascular events (CVEs), while simultaneously evaluating subclinical vascular disease. Methods and Results-We enrolled 464 outpatients who had vascular risk factors without any preexisting cardiovascular disease. We examined the presence of silent lacunar infarction (SLI) by magnetic resonance imaging; carotid intimamedia thickness by ultrasound; and measured high-sensitivity C-reactive protein, interleukin (IL)-6, and IL-18 at baseline, and assessed their associations with CVEs using Cox proportional hazards models of 4.8±2.6 years followup. We further calculated measures of reclassification and discrimination. In age-and sex-adjusted analysis, IL-6, but neither high-sensitivity C-reactive protein nor IL-18, was associated with CVEs. The association remained significant after adjustment for conventional risk factors, intima-media thickness, and SLI (hazard ratios: 1.80, per 1-SD increase in log IL-6, P=0.03). Compared with the patients with below median IL-6 without SLI, those with above median IL-6 and SLI had a higher risk of CVEs (hazard ratios: 4.14, P=0.0014). The combination of IL-6 and SLI resulted in the net reclassification improvement of 14.3% (P=0.04), and the integrated discrimination improvement gain of 2.1% (P=0.05). Conclusion-IL-6 levels were independently associated with CVEs and could improve reclassification in those with SLI.(Arterioscler Thromb Vasc Biol. 2013;33:400-405.)

Review on Cardiovascular Risk Prediction

“…These appear in the blood stream as a result of the death of a cell, mainly due to ischemia but also as a result of nonischemic events such as pericarditis, trauma, or sepsis [13]. However, the detection of at least one value above the 99th percentile of the high-sensitivity Higher levels associated with increased risk of cardiovascular [35] and cerebrovascular diseases [36]. The cutoff level is 4.43 pg/mL, while the sensitivity and specificity are 89.95% and 77.42%, respectively [37].…”

Multiple or mixed cerebral microbleeds and dementia in patients with vascular risk factors

“…12 The detailed study design has been described elsewhere. 12,13 Briefly, outpatients who visited the Department of Neurology and Stroke Center at Osaka University Hospital, older than 40 years with more than one vascular risk factor, including hypertension, diabetes, dyslipidemia, history of smoking, established arteriosclerosis documented as TIA, stroke, coronary heart disease, or peripheral artery disease, were enrolled. 12 Patients were excluded from the study if they had experienced a symptomatic vascular event during the previous 3 months.…”

“…12,13 Briefly, outpatients who visited the Department of Neurology and Stroke Center at Osaka University Hospital, older than 40 years with more than one vascular risk factor, including hypertension, diabetes, dyslipidemia, history of smoking, established arteriosclerosis documented as TIA, stroke, coronary heart disease, or peripheral artery disease, were enrolled. 12 Patients were excluded from the study if they had experienced a symptomatic vascular event during the previous 3 months. 12 Between January 2001 and December 2009, 729 outpatients who had been enrolled in OSACA2 underwent baseline examinations, including brain MRI and a clinical assessment that included medical history, inquiry into medications, physical and neurologic examination, blood sampling, and carotid ultrasound.…”

“…12 Patients were excluded from the study if they had experienced a symptomatic vascular event during the previous 3 months. 12 Between January 2001 and December 2009, 729 outpatients who had been enrolled in OSACA2 underwent baseline examinations, including brain MRI and a clinical assessment that included medical history, inquiry into medications, physical and neurologic examination, blood sampling, and carotid ultrasound. MRI was generally performed to examine lesions in cases with stroke history or suspicious neurologic symptoms (e.g., headache, vertigo, dizziness, numbness, syncope, or subjective memory impairment).…”

“…13 Briefly, subjects visited outpatient clinic settings regularly to control risk factors for prevention of stroke. 12 Changes in subjects' general medical conditions were obtained yearly through medical records and interviews. Furthermore, several aspects of everyday cognitively driven functioning to rate participants on the CDR were assessed at every clinical visit.…”