Adipocytokines and risk of stroke in older people: a nested case-control study

作者：Stott David J^*; Welsh Paul; Rumley Ann; Robertson Michele; Ford Ian; Sattar Naveed; Westendorp Rudi G J; Jukema J Wouter; Cobbe Stuart M; Lowe Gordon D O

来源：International Journal of Epidemiology, 2009, 38(1): 253-261.

DOI：10.1093/ije/dyn215

• Stroke
• inflammation
• adiponectin
• tumour necrosis factor alpha
• interleukin-18
• case-control study
• aged

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)alpha] 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 alpha 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 TNFa 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 TNFa 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.

• 出版日期2009-2