A Medical Device Daily

diaDexus (South San Francisco, California) reported that data presented at the International Stroke Conference sponsored by the American Stroke Association (Dallas), ongoing this week in Kissimmee, Florida, showed that a novel biomarker is predictive for recurrent stroke in a multi-ethnic population that included both men and women.

Dr. Mitchell Elkind and colleagues at Columbia University (New York) followed a cohort of patients from the Northern Manhattan Study (NOMAS) for an average of four years to identify the utility of novel, but easy to apply, biomarkers for patients who have already experienced an ischemic stroke. In that period, 80 recurrent strokes were recorded.

The results came from a study titled “Lp-PLA2 and CRP as Predictors of Stroke Recurrence and Death: The Northern Manhattan Study.“

“These data provide us with important observations linking higher than normal levels of the enzyme Lp-PLA2 with the risk of recurrent stroke in a multi-ethnic population. Women, Hispanics and African-Americans – groups that are frequently overlooked in major studies – were also well-represented in our study,“ said Mitchell Elkind, MD, assistant professor of neurology in the division of stroke and critical care at Columbia.

“Previous studies have demonstrated that this biomarker can help determine risk for a first stroke, but this study shows that it may also predict a second stroke. Because women and minorities are at higher risk for stroke, and yet are relatively medically underserved, these findings may have special importance,“ Elkind said.

The researchers assessed Lp-PLA2 levels using the diaDexus PLAC test, which the company calls the first blood test approved by the FDA to aid in predicting ischemic stroke. The study followed 467 patients who had experienced an initial stroke: 55% were women, 53% hispanic, 27% African-American and 18% caucasian. Patients were more than 40 years old.

The study was conducted at the university's Neurological Institute.

Data showed there was an increased risk of recurrent ischemic stroke in patients with high levels of the enzyme Lp-PLA2. Using a Cox proportional hazards model, the study demonstrated that increased levels of Lp-PLA2 were associated with risk for recurrent stroke after adjusting for demographics, hypertension, diabetes, hyperlipidemia, smoking, atrial fibrillation, and coronary disease.

Researchers also found that high levels of hs-CRP, a marker of general inflammation, did not predict stroke recurrence but was associated with stroke severity and predicted death.

As part of an effort to highlight the value of stroke assessment and prevention, diaDexus is offering free stroke risk screening with the PLAC test during the ASA meeting.

Another study indicated that the risk for stroke is greater when you are younger and newly diagnosed with diabetes. Occurrence of stroke increases among newly diagnosed adults with Type 2 diabetes and diabetic adults who are younger than age 55, according to one study looking at this population.

“One would think that the consequences of diabetes would occur over a long period, but we found that new-onset diabetics have double the rate of stroke in the first five years after diagnosis as the general population,“ said Thomas Jeerakathil, MD, lead author and assistant professor of medicine and neurology at the University of Alberta (Edmonton, Alberta). “The finding suggests some of the cardiovascular effects of diabetes are already established at the time of diagnosis and aggressive prevention is justified in this patient group.“

Most studies have focused on people who have had diabetes for years, and researchers have known that diabetic patients tend to focus on blood sugar control but don't have optimum control of blood pressure.

To examine the short-term risk for stroke in newly diagnosed diabetics, Jeerakathil and colleagues analyzed a database of people in the province of Saskatchewan. They identified 12,272 people (average age 64) who had new prescriptions for diabetes medications between 1991 and 1996, and followed them for about five years.

More than 9% were admitted to the hospital for stroke and one-fifth of that population died during those five years. Researchers compared stroke rates to a similar-aged group in the general population.

“Our findings suggest that, particularly if people have a new diagnosis of diabetes, they should have all their cardiovascular risk factors managed optimally,“ Jeerakathil said. “That means strict control of blood pressure and elevated cholesterol, avoiding a sedentary lifestyle and an adequate diet high in vegetables and whole grains – things that we've found in other studies to lower the risk of heart disease.“