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From the Department of Neurology (M.S.V.E., Y.P.M.), Department of Pathology (K.M.L., S.L.S.), and Department of Cell Biology (S.L.S.), Columbia University College of Physicians and Surgeons, New York, NY; Department of Epidemiology (J.M.L.) and Division of Biostatistics (M.C.P.), Joseph Mailman School of Public Health, New York; and Departments of Neurology, Epidemiology, and Genetics (R.L.S.), Miller School of Medicine, University of Miami, FL.
Address correspondence and reprint requests to Dr. Mitchell S.V. Elkind, Neurological Institute, Box 182, 710 W. 168 St., New York, NY 10032
Objective: To determine whether high-sensitivity C-reactive protein (hsCRP) and serum amyloid A (SAA) predict stroke, vascular events, and mortality in a prospective cohort study.
Background: Markers of inflammation have been associated with risk of myocardial infarction (MI). Their association with stroke is controversial.
Methods: The Northern Manhattan Study includes a stroke-free community-based cohort study in participants aged 
40 years (median follow-up 7.9 years). hsCRP and SAA were measured using nephelometry. Cox proportional hazards models were used to calculate hazard ratios (HR) and 95% confidence intervals (CI) for the association of markers with risk of ischemic stroke and other outcomes after adjusting for demographics and risk factors.
Results: hsCRP measurements were available in 2,240 participants (mean age 68.9 ± 10.1 years; 64.2% women; 18.8% white, 23.5% black, and 55.1% Hispanic). The median hsCRP was 2.5 mg/L. Compared with those with hsCRP <1 mg/L, those with hsCRP >3 mg/L were at increased risk of ischemic stroke in a model adjusted for demographics (HR = 1.60, 95% CI 1.06–2.41), but the effect was attenuated after adjusting for other risk factors (adjusted HR = 1.20, 95% CI 0.78–1.86). hsCRP >3 mg/L was associated with risk of MI (adjusted HR = 1.70, 95% CI 1.04–2.77) and death (adjusted HR = 1.55, 95% CI 1.23–1.96). SAA was not associated with stroke risk.
Conclusion: In this multiethnic cohort, high-sensitivity C-reactive protein (hsCRP) was not associated with ischemic stroke, but was modestly associated with myocardial infarction and mortality. The value of hsCRP and serum amyloid A may depend on population characteristics such as age and other risk factors.
Abbreviations: AHA = American Heart Association; BP = blood pressure; CDC = Centers for Disease Control and Prevention; CI = confidence interval; CRP = C-reactive protein; CUMC = Columbia University Medical Center; HR = hazard ratio; hsCRP = high-sensitivity C-reactive protein; IQR = interquartile range; JUPITER = Justification for the Use of Statins in Prevention: An Intervention Trial Evaluating Rosuvastatin; MI = myocardial infarction; NOMAS = Northern Manhattan Study; SAA = serum amyloid A.
Supplemental data at www.neurology.org
Supported by the NIH/National Institute of Neurological Disorders and Stroke (R01 NS48134 and R37 29993).
Disclosure: Author disclosures are provided at the end of the article.
Presented at the American Academy of Neurology Annual Meeting, April 2008, Chicago, IL.
Received December 16, 2008. Accepted in final form July 17, 2009.
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