See if your doctor is willing to use this as a predictive basis.
Improvement in stroke risk prediction: role of C-reactive protein and lipoprotein-associated phospholipase A2 in the women's health initiative
Background and Purpose
Classification
of risk of ischemic stroke is important for medical care and public
health reasons. Whether addition of biomarkers adds to predictive power
of the Framingham Stroke Risk or other traditional risk factors has not
been studied in older women.
Methods
The
Hormones and Biomarkers Predicting Stroke Study is a case-control study
of blood biomarkers assayed in 972 ischemic stroke cases and 972
controls, nested in the Women's Health Initiative Observational Study of
93 676 postmenopausal women followed for an average of eight-years. We
evaluated additive predictive value of two commercially available
biomarkers: C-reactive protein and lipoprotein-associated phospholipase A2
to determine if they added to risk prediction by the Framingham Stroke
Risk Score or by traditional risk factors, which included lipids and
other variables not included in the Framingham Stroke Risk Score. As
measures of additive predictive value, we used the C-statistic, net
reclassification improvement, category-less net reclassification
improvement, and integrated discrimination improvement index.
Results
Addition
of C-reactive protein to Framingham risk models or additional
traditional risk factors overall modestly improved prediction of
ischemic stroke and resulted in overall net reclassification improvement
of 6·3%, (case net reclassification improvement = 3·9%, control net
reclassification improvement = 2·4%). In particular, high-sensitivity
C-reactive protein was useful in prediction of cardioembolic strokes
(net reclassification improvement = 12·0%; 95% confidence interval
4·3–19·6%) and in strokes occurring in less than three-years (net
reclassification improvement = 7·9%, 95% confidence interval 0·8–14·9%).
Lipoprotein-associated phospholipase A2 was useful in risk
prediction of large artery strokes (net reclassification
improvement = 19·8%, 95% confidence interval 7·4−32·1%) and in early
strokes (net reclassification improvement = 5·8%, 95% confidence
interval 0·4–11·2%).
Conclusions
C-reactive protein and lipoprotein-associated phospholipase A2
can improve prediction of certain subtypes of ischemic stroke in older
women, over the Framingham stroke risk model and traditional risk
factors, and may help to guide surveillance and treatment of women at
risk.
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