A study published online on August 24 in Neurology reported on the findings from a study showing that the elevated presence of four circulating biomarkers can increase the risk of incident ischemic stroke. The four bio markers – C-reactive protein (CRP), tumor necrosis factor receptor 2 (TNFR2), homocysteine, and vascular endothelial growth factor (VEGF) – are predictive of having a first (incident) stroke even above classic predictors like high blood pressure and diabetes.

The study included 3,224 patients in the Framingham Offspring Study who were examined between the years of 1998 and 2001 for 15 biomarkers of inflammation and endothelial dysfunction. Of those participants, 98 had an ischemic stroke during the mean follow-up of 9.3 years.

Adding the four biomarkers to the Framingham Stroke Risk Profile significantly improved the ability of the profile to predict ischemic stroke risk.

VEGF provided the greatest discrimination for future ischemic stroke, but other studies have produced contrasting results. This indicates a potentially indirect rather than causal link between VEGF and stroke. The connection between stroke and elevated levels of homocysteine and CRP is more clear since each accelerates atherosclerotic disease and flags systematic inflammation and plaque instability, respectively. TNFR2, on the other hand, is not known to have previously been found as an indicator of incident ischemic stroke in other studies.

The researchers from the Boston University School of Medicine and Public Health note the limitations of the study including its observational nature, small number of participants who experienced stroke, and lack of consideration of the treatments participants may have received to control stroke risk.

For more information

https://www.neurology.org/content/early/2016/08/24/WNL.0000000000003115