Data Management And Sharing System of China National Clinical Research Center for Neurological Diseases
The association between plasma ACE2 level and stroke recurrence in patients with ischemic stroke or TIA
First author：Jing Xue
Corresponding author：Yongjun Wang
essential_information
2024-03-12
Published articles
Journal：Cerebrovascular Diseases
Publication type: Article
IF(IF): 2.9
PMID: 38471482 Link To Pubmed Full text Download
Background And Purpose
Angiotensin-converting enzyme 2 (ACE2) is an endogenous counter-regulator of the renin–angiotensin hormonal cascade, which has emerged as an important player in the pathogenesis of hypertension and consequently stroke. Currently, there are no robust data on the importance of plasma ACE2 in patients with established ischemic stroke or TIA (IS/TIA). We aimed to assess whether plasma ACE2 concentrations is associated with stroke recurrence.
Method
ACE2 levels were measured at baseline in the prespecified New Biomarker Validation (NBV) subgroup of CNSR-III, a prospective nested case-control study, consisting of 1108 patients with ischemic stroke or TIA with baseline plasma ACE2 measured. Among 1108 patients, 539 cases of stroke recurrence (ischemic or hemorrhagic recurrence) were compared to 569 age- and sex-matched controls. Cox proportional hazard regression models were used to evaluate the associations between plasma ACE2 level and stroke recurrence. We further estimate the association between ACE2 and stroke recurrence in patients with concurrency of hypertension and pneumonia.
Conclusion
Elevated plasma sACE-2 concentration was associated with increased risk of recurrent stroke.
Main results
Among 988 patients included in this study, the median (interquartile range) of sACE-2 was 25.17 (12.29-45.56) ng/mL. After adjustment for conventional confounding factors, the odds ratio with 95% confidence interval in the highest quartile versus the lowest quartile was 1.68 (1.12-2.53) for recurrent stroke within 1-year follow-up. Subgroup analysis showed that the association between elevated plasma level of sACE-2 and stroke recurrence was significant in patients with higher systemic inflammation, as indicated by high sensitivity C reactive protein (hsCRP) ≥ 2 mg/L (adjusted OR: 2.33 [95% CI, 1.15–4.72]) and neutrophil (NEUT) counts ≥ median (adjusted OR: 2.66 [95% CI, 1.35–5.23]), but not significant in patients with lower systemic inflammation.