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High OxPL-apoB levels linked to recurrent stroke, first major coronary events
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Elevated oxidized phospholipids on apolipoprotein B-100 levels are an indicator of recurrent stroke and first major coronary events in patients who had prior stroke or transient ischemic attack, according to recently published data.
“Although ischemic heart disease and ischemic stroke have commonalities in risk factors and underlying disease mechanisms, the strength of the association varies according to individual risk factors,” Young Sup Byun, MD, from the division of cardiovascular diseases at the University of California, San Diego, and colleagues wrote. “Novel biomarkers and therapeutic targets would be useful to predict new or recurrent stroke and identify high-risk individuals for preventive measures.”
The SPARCL trial was designed to assess the predictive value of oxidized phospholipids on apolipoprotein B-100 (OxPL-apoB) levels, the efficacy of atorvastatin therapy and their relationship to recurrent stroke or first major CV event, the researchers wrote. The study evaluated whether patients who had prior cerebrovascular events and high levels of OxPL-apoB, but no prior CAD, are at elevated recurrent stroke risk and CAD events after high-dose statin therapy.
At baseline, the SPARCL trial measured levels of OxPL-apoB in 4,385 patients with stroke or TIA and in 3,106 patients at 5 years after randomization to placebo or 80 mg atorvastatin.
The primary endpoint was the time from randomization to second nonfatal or fatal stroke. Secondary endpoints included first major coronary events and any CV event.
Patients with recurrent stroke had higher median OxPL-apoB levels at baseline than patients without (15.5 nmol/L vs. 11.6 nmol/L; P < .0001).
After multivariable adjustment, elevated OxPL-apoB at baseline predicted recurrent stroke (HR = 4.3; P < .0001), first major coronary events (HR = 4; P < .0001) and any CV event (HR = 4.4; P < .0001). There was no difference by treatment in comparison for any endpoint, shown as a nonsignificant interaction test, according to the researchers.
There was a significant improvement in net reclassification improvement, integrated discrimination improvement and area under the receiver-operating characteristic curve (AUC) when OxPL-apoB was added to the models, with change in AUC of 0.0505 (P < .0001) for recurrent stroke, 0.0409 (P < .0001) for first major coronary event and 0.0791 (P < .0001) for any CV event.
“A major proportion of ischemic stroke results directly from atherosclerosis in large arteries or indirectly from coronary atherosclerotic disease,” Steven K. Feske, MD, from the neurology department at Brigham and Women’s Hospital, wrote in a related editorial. “These new findings suggest that from these discoveries, patients at risk will likely see the benefit of more effective prevention of stroke as well as the atherosclerotic heart and peripheral vascular disease.” – by Dave Quaile
Disclosure: Byun reports receiving support from the Inje Research and Scholarship Foundation. Please see the full study for a list of all other researchers’ relevant financial disclosures. Feske reports no relevant financial disclosures.
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