Leukocyte activation: Relation to cardiovascular mortality after cerebrovascular ischemia

Activated leukocytes are believed to be involved in the pathogenesis and pr ogression of atherosclerotic vascular disease and its consequences. In a 4- year observational follow-up study, we investigated whether markers for sys temic leukocyte activation (leukocyte-derived inflammatory mediators) were related to cardiovascular mortality after cerebrovascular ischemia, Using e nzyme-linked immunosorbent assays, we measured the plasma levels of soluble tumor necrosis factor receptor protein-1 (sTNFR-1), neutrophil gelatinase- associated lipocalin (NGAL) and neutrophil protease-4 (NP4) in 144 patients (90 stroke, 54 transient ischemic attack) 1-3 days after cerebral ischemia . During the 4 years of follow-up, 42 (29%) of the 144 patients died; 38 of cardiovascular causes and 4 of other causes. Patients with evidence of hig her leukocyte activation (n = 47) had a higher 4-year cardiovascular mortal ity rate than those without evidence of leukocyte activation (n = 97; p < 0 .005). Logistic regression analysis with age, sex and other significant pre dictors as covariates showed higher plasma levels of sTNFR1 and NGAL both t o be significant independent predictors of cardiovascular mortality, the re spective odds ratio, 95% confidence intervals, and p values being 2.0, 1.2- 3.4, p < 0.01, and 3.6, 1.2-10.5, p = 0.02, respectively. We concluded that in patients with acute cerebral ischemia, plasma markers of leukocyte acti vation were significant predictors of long-term cardiovascular mortality. T his may indicate an important role of activated leukocytes in the progressi on of these diseases. Copyright (C) 2000 S. Karger AG, Basel.