Abstract
Background: Studies have found an association between elevated serum C reactive protein (CRP) levels and increased ischemic stroke risk 2,4-5 . Other studies have looked at whether CRP levels correlate with outcome and severity after ICH 1,3 . Less research has been done looking at CRP levels and the risk for hemorrhagic stroke. This study aims to confirm the association of baseline elevated serum CRP levels and increased risk for ischemic stroke, thus validating this dataset, and to evaluate whether these levels correlate with an increased risk for hemorrhagic stroke. Methods: This is a secondary analysis of the data from the Cardiovascular Health Study (CHS). The primary outcome is ischemic stroke and the secondary outcome is hemorrhagic stroke. The primary predictor is CRP level at baseline, as a continuous value and, after dividing into quintiles, a comparison between the lowest and highest quintiles. We fit Cox proportional hazards models and adjusted for baseline covariates that were associated with the outcomes, which for ischemic stroke included age, race, cholesterol, diabetes, hypertension, atrial fibrillation, and history of TIA or myocardial infarction; and for hemorrhagic stroke included age, cholesterol, diabetes, and hypertension. Results: We included 5,681 patients, of whom 918 (16.2%) had ischemic stroke and 150 (2.6%) had hemorrhagic stroke. Mean (SD) days of follow-up was 4,403 (2,504) and mean (SD) CRP was 4.8 (8.3). We found that baseline CRP was associated with ischemic stroke (HR 1.01, 95% CI 1.00-1.02, p=0.005), but not hemorrhagic stroke (HR 1.00, 95% CI 0.97-1.02, p=0.781). When comparing the highest to lowest quintile of CRP, we found a clinically significant increased risk of ischemic stroke (HR 1.37, 95% CI 1.11-1.70, p=0.004) (Figure 1), but again not for hemorrhagic stroke (p=0.852). Conclusion: Our analysis found that elevated baseline CRP levels are associated with an increased risk for ischemic stroke, but not hemorrhagic stroke.
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