Association of Polyvascular Disease and Elevated Interleukin-6 With Outcomes in Acute Ischemic Stroke or Transient Ischemic Attack

Ye Tian,Li Guo,Xia Meng,Jing Jing,Hao Li,Yijun Zhang,Anxin Wang,Xingquan Zhao,Yongjun Wang,Jinxi Lin,Yong Jiang,Huijuan Wang

doi:10.3389/fneur.2021.661779

Abstract

Background: Polyvascular disease (PolyVD) and interleukin (IL)-6 are associated with poor outcomes in patients with stroke respectively. However, whether combined PolyVD and elevated IL-6 levels would increase the risk of poor outcomes of stroke patients is yet unclear.Methods: Data were obtained from the Third China National Stroke Registry (CNSR-III). PolyVD was defined as acute ischemic stroke (AIS) or transient ischemic attack (TIA) with coronary artery disease (CAD) and/or peripheral artery disease (PAD). Patients were divided into four groups according to the combination of vascular beds number (non-PolyVD or PolyVD) and IL-6 levels (IL-6 < 2.64 pg/mL or IL-6 ≥ 2.64 pg/mL). The primary outcome was a recurrent stroke at 1-year follow-up. Cox proportional hazard models were employed to identify the association of the combined effect of PolyVD and IL-6 with the prognosis of patients.Results: A total of 10,773 patients with IL-6 levels and 1-year follow-up were included. The cumulative incidence of recurrent stroke was 9.87% during the 1-year follow-up. Compared to non-PolyVD and IL-6<2.64 pg/mL patients, patients had non-PolyVD with IL-6 ≥ 2.64 pg/mL (HR 1.245 95%CI 1.072–1.446; P < 0.001) and PolyVD with IL-6 <2.64 pg/mL (HR 1.251 95%CI 1.002–1.563; P = 0.04) were associated with an increased risk of recurrent stroke during 1-year follow-up. Likewise, patients with PolyVD and IL-6 ≥ 2.64 pg/mL (HR 1.290; 95% CI 1.058–1.572; P = 0.01) had the highest risk of recurrent stroke at 1-year follow-up among groups.Conclusion: PolyVD and elevated IL-6 levels are both associated with poor outcomes in patients with AIS or TIA. Moreover, the combination of them increases the efficiency of stroke risk stratification compared with when used alone. More attention and intensive treatment should be given to those patients with both PolyVD and elevated IL-6 levels.

Highlights

Stroke, a major health concern, is one of the leading causes of mortality and disability worldwide in recent decades [1,2,3,4]
Patients were divided into four groups according to different combinations of vascular bed involvement numbers and IL-6 levels
This study demonstrated that polyvascular disease (PolyVD) together with the elevated IL-6 levels increased the risk of stroke recurrence, major adverse cardiovascular events (MACEs), allcause mortality, and poor functional outcomes in patients with AIS or TIA at 1-year follow-up

Summary

Introduction

A major health concern, is one of the leading causes of mortality and disability worldwide in recent decades [1,2,3,4]. Atherosclerosis is the main cause of ischemic stroke and chronic systemic disease with a variety of clinical manifestations. An atherosclerotic disease involving more than two vascular beds is known as polyvascular disease (PolyVD), and the most common manifestations are coronary artery disease (CAD), cerebrovascular disease (CVD), and peripheral artery disease (PAD) [10]. Poor outcomes of atherosclerotic diseases were affected by the number of vascular bed injuries, and closely related to the stability of plaques. Polyvascular disease (PolyVD) and interleukin (IL)-6 are associated with poor outcomes in patients with stroke respectively. Whether combined PolyVD and elevated IL-6 levels would increase the risk of poor outcomes of stroke patients is yet unclear

Methods

Results

Conclusion