Correlation of hsCRP to carotid intima media thickness in acute ischemic stroke

Background: Incidence and prevalence of stroke has risen exponentially worldwide in last few decades and incidence of stroke is also rising among Indians. Carotid intima media thickness (CIMT) is a non-invasive test for assessment of atherosclerosis in different arteries. There is a direct correlation with incidence of stroke. Systemic inflammation is now thought to be a part of the process for accelerated atherosclerosis. Measurements of the marker of systemic inflammation, i.e. hsCRP, may provide a good indication of the risk to develop stroke. Objectives: To measure the hsCRP and carotid intima media thickness in patients with ischemic stroke and to establish the correlation of hsCRP to carotid intima media thickness in patients with ischemic stroke. Methods: An observational study done at Kempegowda institute of medical sciences, Bangalore over a period of 18 months that included established cases of ischemic stroke diagnosed on the basis of clinical history, examination and neuroimaging. 60 cases of ischemic stroke aged 45 yrs or more were taken, hsCRP and Carotid intima media thickness were measured. Data were collected through a proforma specially designed for this study where patients detailed history, clinical examination and laboratory investigations were collected. Individuals with acute ischemic stroke over 45years of age, confirmed by CT scan or MRI scan were included in the study. Exclusion criteria were for the patients with hemorrhagic stroke, cerebral emboli of cardiac origin diagnosed clinically and by ECG and echo, patients on statins, patients with meningitis, brain abscess and other intracranial infections or other space occupying lesions. Patients with head injury, post operative patients suffering from rheumatoid arthritis, ankylosing spondylitis, chronic infection and inflammatory conditions. Results: Out of 60 patients, 63.3% were hypertensive and 50% were smokers. 72% of our patients had high Carotid intima media thickness (CIMT). CIMT was significantly related to hsCRP, LDL, HDL levels and age of the patient. Conclusion: This study has shown a significant association between CIMT and the atherogenic variables like age, hsCRP, HDL and LDL.This may indicate the need to screen patients for these risk factors. Also, in places where CIMT measurement is not available, these blood tests can be used as surrogate markers to define the patient population at risk of ischemic stroke. Conversely, in patients with ischemic stroke, these markers can be used to monitor and prevent further events by appropriate interventions.