Endothelial and leukocyte-derived microvesicles and cardiovascular risk after stroke: PROSCIS-B

Objective: To determine the role of circulating endothelial microvesicles
(EMV) and microvesicles (MV) of other origins on long-term cardiovascular
outcomes after stroke, we measured them in a cohort of first-ever stroke
patients and observed them for three years. Methods: In the PROSpective
Cohort with Incident Stroke Berlin (PROSCIS-B), patients with first-ever
ischemic stroke were followed for three years. The primary combined
endpoint consisted of recurrent stroke, myocardial infarction, and
all-cause mortality. Levels of EMV, leukocyte-derived MV (LMV), monocytic
MV (MMV), and platelet-derived MV (PMV) were measured in citrate blood
using flow cytometry. Kaplan-Meier curves and Cox proportional hazards
models were used to estimate the effect of MV levels on the combined
endpoint after adjustment confounding. Results: 571 patients were
recruited (median age 69y; 39% female; median NIHSS 2, interquartile range
1-4). During the follow-up, 95 endpoints occurred. Patients with levels of
EMV [adjusted hazard ratio (HR)=2.5, 95% confidence interval (CI) 1.2-4.9]
or LMV (HR=3.1, 95%CI 1.4-6.8) in the highest quartile were more likely to
experience an event than participants with lower levels using the lowest
quartile as reference category. The association was less pronounced for
PMV (HR=1.7, 95%CI 0.9-3.2) and absent for MMV (HR=1.1, 95%CI 0.6-1.8).
Conclusion: High levels of EMV and LMV after ischemic stroke were
associated with worse cardiovascular outcome within three years. These
results reinforce that endothelial dysfunction and vascular inflammation
affect the long-term prognosis after stroke. EMV and LMV might play a
potential role in risk prediction for stroke patients.