Anticardiolipin Antibodies and Risk of Ischemic Stroke and Transient Ischemic Attack: The Framingham Cohort and Offspring Study
Abstract
Background and Purpose— The role of anticardiolipin antibodies (aCLs) as novel risk factors for ischemic stroke and transient ischemic attacks (TIAs) has been a matter of debate. Prior cohort studies included only selected subjects, mostly men. We related serum concentrations of aCLs to incident first ischemic stroke/TIA among men and women in the Framingham Heart Study cohort and offspring. Methods— There were a total of 2712 women (mean age, 59.3 years) and 2262 men (mean age, 58.3 years) free of stroke/TIA at the time of their baseline examinations. An enzyme immunoassay was used to measure aCLs. Optical density of the sample serum compared with the reference serum was defined as the aCL screening ratio (aCL SR). Analyses were based on sex-specific aCL SR quartiles and individual ratios. Results— During the 11-year follow-up, 222 ischemic strokes/TIAs occurred. In multivariate analysis, after adjustment for age, prior cardiovascular disease, systolic blood pressure, diabetes, smoking, C-reactive protein, and total and high-density lipoprotein cholesterol levels, an aCL SR of >0.4 (78% of sample) was significantly associated with an increased risk of ischemic stroke/TIA for women (hazard ratio [HR], 2.6; 95% confidence interval [CI], 1.3 to 5.4; absolute risk, 3.2%, 95% CI, 2.2 to 4.3) but not in men (HR, 1.3; 95% CI, 0.7 to 2.4; absolute risk, 4.5%; 95% CI, 3.0 to 6.0). Similar results were obtained when the higher 3 aCL SR quartiles were compared with the lowest. Conclusions— Elevated serum concentrations of aCLs, independently of other cardiovascular risk factors, significantly predict the risk of future ischemic stroke and TIA in women but not in men.
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Retrospective, case-control and cross-sectional studies with different designs, patient selection criteria, aPL profiles and risk factors have produced contradictory results.
“Retrospective, [1][2][3][4] case-control [5][6][7][8][9][10][11][12] and cross-sectional 13,14 studies with different designs, patient selection criteria, aPL profiles and risk factors have produced contradictory results.”
From Risk factors for a first thrombotic event in antiphospholipid antibody carriers: a prospective multicentre follow-up study. (2011) · cites this paper as [4]
The cited paper is not a retrospective, case-control, or cross-sectional study of the kind listed in the citing sentence. Its Subjects and Definition of Clinical Outcome section says participants were followed for 11 years to identify incident stroke or TIA, and its Discussion explicitly calls the design a prospective population-based cohort study. The paper does acknowledge conflicting earlier findings, but its classification in this list is contrary to our copy. (LLM, conf=0.88)
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Cites
Anticardiolipin Antibodies and the Risk for Ischemic Stroke and Venous Thrombosis
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- Authors
- Janardhan, V., Wolf, P. A., Kase, C. S., Massaro, J. M., D’Agostino, R. B., Franzblau, C., & Wilson, P. W. F.
- Affiliations
- Boston University (US)
- ORCID
- Venue
- Stroke
- Published
- 2004-03
- Volume
- 35
- Issue
- 3
- Pages
- 736-741
- ISSN
- 0039-2499 (ISSN-L)
- 1524-4628
- OpenAlex
- W2152437468
- Cited by
- 116
- References
- 1
- Citations by year
- 2026: 1 · 2025: 2 · 2024: 4 · 2023: 2 · 2022: 1 · 2021: 5 · 2020: 3 · 2019: 5 · 2017: 3 · 2016: 4 · 2015: 6 · 2014: 9 · 2013: 4 · 2012: 7
- FWCI
- 6.03
- Type
- journal article
- Language
- en
- Open access
- closed
- Locations
- Stroke (publishedVersion)
- PubMed (publishedVersion)
- Funders
- School of Medicine, Boston University (N01-HC25195)
- National Institutes of Health (n01hc25195-41-0-1)
- National Heart, Lung, and Blood Institute (N01‐HC25195)
- National Institute of Neurological Disorders and Stroke (NS17950, N01‐HC‐25195, 5R01 NS 17950-21, R01NS017950)
- Topics
- Health Sciences › Medicine › Rheumatology › Systemic Lupus Erythematosus Research
- Health Sciences › Medicine › Epidemiology › Acute Ischemic Stroke Management
- Health Sciences › Medicine › Hematology › Blood Coagulation and Thrombosis Mechanisms
- Keywords
- anticardiolipin antibodies, ischemic stroke, transient ischemic attack, sex differences, stroke risk prediction, Framingham Heart Study
- MeSH terms
- Aged, Brain Ischemia, Ischemic Attack, Transient, Female, Follow-Up Studies, Humans, Male, Massachusetts, Middle Aged, Predictive Value of Tests, Risk Factors, Sex Factors, Cohort Studies, Incidence, Prevalence, Multivariate Analysis, Antibodies, Anticardiolipin, Age Distribution, Sex Distribution, Risk Assessment, Stroke
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