Recurrent stroke and vascular events in elderly patients with anticardiolipin antibodies: a prospective study

The presence of anti-cardiolipin antibodies (aCL) is a recognized risk fact or for ischaemic stroke and a predictor of recurrent ischaemic events in yo ung patients, but the significance of positive aCL tests is uncertain in th e elderly. We evaluated the frequency of aCL and the risk of recurrence of stroke and other vascular events in a series of 242 consecutive patients ag ed over 60 years, admitted for brain infarction. Ail underwent aCL immunore activity (ELISA; measured by IgG antiphospholipid, GPL, units) and transoes ophageal echocardiography and were later examined or contacted by telephone (mean 2.33 +/-1.25 years, max. 4). Fifty patients (21 %) had at least10 GP L units aCL. There were no differences between these and the other patients in the results of transoesophageal echocardiography, including mitral or a ortic valvular thickening, atrial thrombus, atrial spontaneous contrast, st rands, and aortic plaques thickness. None had IgG higher than 80 GPL units or was positive for anti-beta2 glycoprotein I. Patients with at least 10 GP L units more often had a past history of cerebral infarction than patients lower aCL level. However, the incidence of recurrent stroke was 4.5 per 100 person-year in patients with more than 10 GPL units, and 2.7 per 100 perso n-year in those with more than 10 GPL units. Kaplan-Meier analysis for any vascular events showed no differences between the two groups. In contrast t o young patients, elderly patients with 10 or more GPL units aCL and negati ve for anti-beta2 glycoprotein I do not seem to have a higher risk of vascu lar events.