THE ROLE OF INFLAMMATORY MARKERS IN PREDICTING STROKE RISK IN HYPERTENSIVE PATIENTS
Main Article Content
Keywords
Hypertension, stroke risk, inflammatory markers, C-reactive protein (CRP), interleukin-6 (IL-6), tumor necrosis factor-alpha (TNF-α), fibrinogen, Framingham Stroke Risk Score
Abstract
Background
Stroke is a leading cause of death and disability worldwide, with hypertension being the most significant modifiable risk factor. Traditional risk models often overlook the role of chronic inflammation, which plays a crucial role in the pathogenesis of stroke. Identifying key inflammatory markers may improve stroke risk prediction and guide preventive strategies in hypertensive populations.
Objectives
This study aimed to investigate the role of inflammatory markers—C-reactive protein (CRP), interleukin-6 (IL-6), tumor necrosis factor-alpha (TNF-α), and fibrinogen—in predicting stroke risk among hypertensive patients.
Materials and Methods
A cross-sectional study was conducted at People’s University of Medical & Health Sciences, Shaheed Benazirabad, involving 260 hypertensive patients aged ≥30 years. Data on demographics, clinical history, blood pressure, and lifestyle factors were collected. Blood samples were analyzed for CRP, IL-6, TNF-α, and fibrinogen using enzyme-linked immunosorbent assays (ELISA). Stroke risk was assessed using the Framingham Stroke Risk Score. Statistical analysis was performed using Pearson’s correlation and logistic regression to explore associations between inflammatory markers and stroke events.
Results
Among the 260 participants (mean age: 62.5 ± 10.2 years, 50% male), elevated CRP levels (>3 mg/L) were found in 60% of stroke cases. CRP exhibited the strongest correlation with stroke risk (r = 0.62, p < 0.001), followed by IL-6 (r = 0.54, p < 0.001). Logistic regression identified CRP as an independent predictor of stroke (OR: 1.45, 95% CI: 1.25–1.68, p < 0.001), with IL-6 also showing significant predictive value (OR: 1.32, 95% CI: 1.10–1.58, p = 0.004). TNF-α and fibrinogen showed weaker correlations and did not reach statistical significance in multivariable models.
Conclusion
This study highlights the significant role of CRP and IL-6 in predicting stroke risk among hypertensive patients. Incorporating these inflammatory markers into clinical assessments may improve early identification of high-risk individuals, enabling more targeted preventive interventions. Future research should explore the potential benefits of anti-inflammatory therapies in reducing stroke risk in hypertensive populations.
References
2. Groeger, J. L., Ayers, E., Barzilai, N., Beauchet, O., Callisaya, M., Torossian, M. R., Derby, C., Doi, T., Lipton, R. B., Milman, S., Nakakubo, S., Shimada, H., Srikanth, V., Wang, C., & Verghese, J. (2022). Inflammatory biomarkers and motoric cognitive risk syndrome: Multicohort survey. Cerebral Circulation - Cognition and Behavior, 3, 100151. https://doi.org/10.1016/j.cccb.2022.100151
3. Khedr, E. M., Gamea, A., Ahmed, I. G., & Ismail, A. K. (2022). Inflammatory Markers for Predicting Ischemic Stroke Outcome: Review Article. The Egyptian Journal of Hospital Medicine, 89(1), 4187–4190. https://doi.org/10.21608/ejhm.2022.256320
4. Kurth T, Slomke MA, Kase CS, Cook NR, Lee IM, Gaziano JM, Diener HC, Buring JE. Migraine, headache, and the risk of stroke in women: a prospective study. Neurology 2005; 64:1020–1026
5. Monsour, M., & Borlongan, C. V. (2023). The central role of peripheral inflammation in ischemic stroke. Journal of Cerebral Blood Flow & Metabolism, 43(5), 622–641. https://doi.org/10.1177/0271678X221149509
6. Neil, H. P. (2023). Stroke Rehabilitation. Critical Care Nursing Clinics of North America, 35(1), 95–99. https://doi.org/10.1016/j.cnc.2022.11.002
7. Pearson TA, Mensah GA, Alexander RW, Anderson JL, Cannon RO, 3rd, Criqui M, Fadl YY, Fortmann SP, Hong Y, Myers GL, Rifai N, Smith SC, Jr, Taubert K, Tracy RP, Vinicor F. Markers of inflammation and cardiovascular disease: application to clinical and public health practice: a statement for healthcare professionals from the Centers for Disease Control and Prevention and the American Heart Association. Circulation 2003; 107:499–511.
8. Ridker PM, Rifai N, Cook NR, Bradwin G, Buring JE. Non-HDL cholesterol, apolipoproteins A-I and B100, standard lipid measures, lipid ratios, and CRP as risk factors for cardiovascular disease in women. JAMA 2005; 294:326–333
9. Tanaka F, Makita S, Onoda T, Tanno K, Ohsawa M, Itai K, Sakata K, Onodera M, Koeda Y, Kawarura K, Terayama Y, Yoshida Y, Ogawa A, Okayama A, Nakamura M. Prehypertension subtype with elevated C-reactive protein: risk of ischemic stroke in a general Japanese population. Am J Hypertens 2010; 23:1108–1113.
10. Totan, M., Antonescu, E., Catana, M. G., Cernusca-Mitariu, M. M., Duica, L., Roman-Filip, C., Comaneanu, R. M., & Cernusca-Mitariu, S. I. (2019). C-Reactive Protein - A Predictable Biomarker in Ischemic Stroke. Revista de Chimie, 70(6), 2290–2293. https://doi.org/10.37358/RC.19.6.7325
11. van Holten TC, Waanders LF, de Groot PG, Vissers J, Hoefer IE, Pasterkamp G, Prins MW, Roest M. Circulating biomarkers for predicting cardiovascular disease risk; a systematic review and comprehensive overview of meta-analyses. PLoS One 2013; 8:e62080.
12. Webb, A. J. S., & Werring, D. J. (2022). New Insights Into Cerebrovascular Pathophysiology and Hypertension. Stroke, 53(4), 1054–1064. https://doi.org/10.1161/STROKEAHA.121.035850
13. Xue, Y., Zeng, X., Tu, W.-J., & Zhao, J. (2022). Tumor Necrosis Factor-α: The Next Marker of Stroke. Disease Markers, 2022, 1–8. https://doi.org/10.1155/2022/2395269
14. Yihui, C., & Yanfeng, G. (2023). Inflammatory markers in patients with hypertension. British Journal of Hospital Medicine, 84(5), 1–8. https://doi.org/10.12968/hmed.2022.0531
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Dr Mukhtiar Ahmed Abro
FCPS Medicine, Assistant Professor of Medicine, Peoples University of Medical & Health Sciences for Women (PUMHSW), Nawabshah SBA, Pakistan
Dr Noor Nabi Siyal
FCPS Medicine, FCPS Neurology, Assistant Professor of Neurology, Peoples University of Medical & Health Sciences for Women (PUMHSW), Nawabshah SBA, Pakistan
Dr Awais Bashir Larik
FCPS Neurology, Associate Professor of Neurology and HOD Department of Neurology, Peoples University of Medical & Health Sciences for Women (PUMHSW), Nawabshah SBA, Pakistan
Dr Shahzad Memon
MD Medicine, Assistant Professor of Medicine, Peoples University of Medical & Health Sciences for Women (PUMHSW), Nawabshah SBA, Pakistan
Dr. Mohammad Ramzan
MBBS, MD Pulmonology, DTCD, Assistant Professor and Head of Department Pulmonology, Peoples University of Medical & Health Sciences for Women (PUMHSW), Nawabshah SBA,Pakistan
Dr Sajjad Hussain Qureshi
MBBS, MS General Surgery, Assistant Professor, Department of Surgery, Peoples University of Medical & Health Sciences for Women (PUMHSW) Nawabshah SBA, Pakistan
Dr Asif Raza Brohi
MBBS, (FCPS) Diploma Diabetes, MSc Endocrinology, Consultant Endocrinologist, Medical Superintendent, THQ Qazi Ahmed, Sindh Government, Pakistan
Dr Mujeeb ur Rehman Sahito
MBBS, MS General Surgery, MS Urology, M. Phil Anatomy, Associate Professor, Department of Anatomy, Peoples University of Medical and Health Sciences for Women, Nawabshah SBA, Pakistan