IJE Advance Access published online on October 24, 2008
International Journal of Epidemiology, doi:10.1093/ije/dyn215
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Adipocytokines and risk of stroke in older people: a nested case–control study
1 Division of Cardiovascular and Medical Sciences, Faculty of Medicine, University of Glasgow, Scotland, UK.
2 Robertson Centre for Biostatistics, University of Glasgow, Scotland, UK.
3 Department of Vascular Biochemistry, Faculty of Medicine, University of Glasgow, Scotland, UK.
4 Section of Gerontology and Geriatrics, Department of General Internal Medicine, Leiden University Medical Centre, The Netherlands.
5 Department of Cardiology, Leiden University Medical Centre, The Netherlands.
* Corresponding author. Academic Section of Geriatric Medicine, 3rd Floor Queen Elizabeth Building, Glasgow Royal Infirmary, Glasgow G31 2ER, Scotland, UK. E-mail: d.j.stott{at}clinmed.gla.ac.uk
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Abstract |
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Background Inflammation may play an important role in atherothrombosis and in promoting cerebral damage after stroke. We hypothesized that plasma adipocytokine concentrations would be associated with risk of stroke in older people.
Methods Nested case–control study from the Prospective Study of Pravastatin in the Elderly (PROSPER). Subjects were aged 70–82 years and followed up for a mean of 3.2 years: 266 incident stroke cases (179 confirmed as ischaemic) were compared with 532 controls matched for age, gender and treatment allocation (pravastatin or placebo). Adipocytokines [adiponectin, interleukin- (IL-)18 and tumour necrosis factor (TNF)
] were measured on stored baseline plasma samples.
Results Elevated plasma adiponectin was associated with lower risk of ischaemic stroke on univariate analysis: odds ratio (OR) 0.78 per 1 SD increase (95% CI 0.62–0.97). There were no associations of IL-18 or TNF with risk for ischaemic or total strokes. In multivariate models the independent predictors of ischaemic stroke were prior cerebrovascular accident (OR 2.68, 95% CI 1.60–4.50), any alcohol use (1.98, 1.33–2.94), triglycerides (1.40, 1.11–1.77), Barthel score (0.75, 0.58–0.96) and known diabetes (1.72, 1.04–2.83); adiponectin, IL-18 and TNF did not contribute. A similar pattern of risk was seen for total stroke.
Conclusions Reduced adiponectin may have a modest role in the aetiology of ischaemic stroke in older people, however IL-18 and TNF are unlikely to play any important part. These adipocytokines do not have clinical predictive utility; history of prior cerebrovascular accident, known diabetes mellitus, prior disability and higher alcohol intake explain much of the stroke risk.
Keywords Stroke, inflammation, adiponectin, tumour necrosis factor , interleukin-18, case–control study, aged
Accepted 3 September 2008
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