Stroke, TIA Risk Biomarker Is Identified in Patients With CAD

Individuals with coronary artery disease (CAD) who have a high apolipoprotein CIII (Apo CIII) plasma concentration may be at an increased risk for ischemic stroke or transient ischemic attacks (TIAs), according to a new study.

Because Apo CIII has been associated with an increased risk of arterial and venous thromboembolic events, the researchers hypothesized that Apo CIII may impact the risk of acute ischemic cerebrovascular events among patients with cardiovascular disease.

To test this hypothesis, the researchers analyzed the medical records and quantified cerebral ischemic events of 774 patients with angiographically defined CAD and of 176 patients without CAD. The median age of all the patients was 65 years, and 30.7% of them were women. 

Assessments of complete plasma lipid and apolipoprotein profiles, including Apo A-I, B, CIII, and E, were available for all subjects at enrollment (May 1999-December 2006). 

The participants were prospectively followed until mortality or July 31, 2018, with a median follow-up duration of 130 months.

After the median follow-up time, 95 participants (10%) had ischemic stroke or TIA. The participants who had had such an event had higher Apo CIII plasma concentration (11.4 mg/dL) than participants who had not experienced ischemic stroke or a TIA event (10.4 mg/dL).

The overall median value of Apo CIII levels was 10.6 mg/dL. Participants whose levels were greater than this value had an approximately 2-fold increased risk of stroke or TIA. This risk remained even after adjusting for potential confounders such as gender, age, CAD diagnosis, hypertension, atrial fibrillation, oral anticoagulant treatment, and all plasma lipid parameters.

According to the researchers, this result was confirmed separately among populations with and without CAD using a propensity-score-matching method. For this confirmation method, 98 patients with CAD and 98 patients without CAD were matched 1:1 for all clinical and laboratory characteristics.

—Colleen Murphy

Reference:

Olivieri O, Cappellari M, Turcato G, et al. Increased incidence of ischemic cerebrovascular events in cardiovascular patients with elevated apolipoprotein CIII. Stroke. 2020;51(1):61-68. https://doi.org/10.1161/STROKEAHA.119.026811.