Background and Purpose: The association between anticardiolipin antibody (aCL) and ischemic stroke is controversial, and there are few case-control studies of Asian populations. The aim of this study, therefore, was to determine whether aCL is an independent risk factor for ischemic stroke in Taiwanese patients over the age of 40 years. Methods: Both the IgG and IgM isotypes of aCL were measured in 273 patients (>40 years of age) hospitalized for first-ever ischemic stroke and in 181 non-stroke controls. Results were defined as: negative (<10 IgG phospholipid units [GPL] or <7.5 IgM phospholipid units [MPL]); low positive (10–20 GPL or 7.5–15 MPL); or, high positive (>20 GPL or >15 MPL). Odds ratios (OR) were estimated by logistic regression with adjustment for potential confounders. Results: A high positive IgG aCL was present in 4.4% of the stroke patients and 1.2% of the controls. Age- and sex-adjusted analysis showed a borderline association between a high positive level for aCL IgG titer and stroke, with an OR of 4.01 (95% CI 0.87–18.37; p = 0.0739). Final analysis, with adjustments for age, sex, hypertension, diabetes, tobacco smoking, atrial fibrillation, left ventricular hypertrophy and hyperlipidemia, revealed an OR of 5.25 (95% CI 1.06–25.89; p = 0.0419). Conclusions: The results of this study suggest that elevated titer of aCL IgG (>20 GPL) is associated with first-ever ischemic stroke in Taiwanese patients aged over 40 years. High positive aCL titer is related to ischemic stroke after adjustment for conventional cerebrovascular risk factors, indicating that it is probably an independent risk factor for ischemic stroke.

Hughes GRV: The antiphospholipid syndrome: ten years on. Lancet 1993;342:341–344.
Finnazi G, Brancaccio V, Moia M, et al: Natural history and risk factors for thrombosis in 360 patients with antiphospholipid antibodies: a 4-year prospective study from the Italian registry. Am J Med 1996;100:530–536.
Verro P, Levine SR, Tietjen GE: Cerebrovascular ischemic events with high positive anticardiolipin antibodies. Stroke 1998;29:2245–2253.
Brey RL, Stallworth CL, McGlasson DL, Wozniak MA, Wityk RJ, Stern BJ, et al: Antiphospholipid antibodies and stroke in young women. Stroke 2002;33:2396–2401.
Metz LM, Edworthy S, Mydlarski R, Fritzler MJ: The frequency of phospholipid antibodies in an unselected stroke population. Can J Neurol Sci 1998;25:64–69.
Ahmed E, Stegmayr B, Trifunovic J, Weinehall L, Hallmans G, Lefvert AK: Anticardiolipin antibodies are not an independent risk factor for stroke: an incident case-referent study nested within the MONICA and Vasterbotten cohort project. Stroke 2000;31:1289–1293.
Zielinska J, Ryglewicz D, Wierzchowska E, Lechowicz W, Hier DB, Czlonkowska A: Anticardiolipin antibodies are an independent risk factor for ischemic stroke. Neurol Res 1999;21:653–657.
Tuhrim S, Rand JH, Wu X, et al: Elevated anticardiolipin antibody titer is a stroke risk factor in a multiethnic population independent of isotype or degree of positivity. Stroke 1999;30:1561–1565.
Levins JS, Branch DW, Rauch J: The antiphospholipid syndrome. N Engl J Med 2002;346:752–763.
The Antiphospholipid Antibodies in Stroke Study (APASS) Investigators: Antiphospholipid antibodies and subsequent thrombo-occlusive event in patients with ischemic stroke. JAMA 2004;291:576–584.
Caso V, Parnetti L, Panarelli P, Magni MPV, Gallai V, Albi E: Selection of thrombogenetic antiphospholipid antibodies in cerebrovascular disease patients. J Neurol 2003;250:593–597.
Wang PY, Leu TM, Tasi SJ, Tsay GJ: Anticardiolipin antibody in stroke. Chung Hua I Hsueh Tsa Chih (Taipei) 1992;49:67–71.
Kitagawa Y, Okayasu H, Matsuoka Y, Mihara B, Koto A: Anticardiolipin antibody in cerebral infarction. Clin Neurol 1991;31:391–395.
Loizous S, McCrea JD, Rudge AC, Reynolds R, Boyle CC, Haris EN: Measurement of anticardiolipin antibodies by enzyme-linked immunoabsorbent assay (ELISA): standardization and quantification of results. Clin Exp Immunol 1985;62:738–745.
Harris EN: Special report. The second international anticardiolipin standardization workshop/The Kingston (KAPS) Group. Am J Clin Pathol 1990;94:476–484.
Levine SR, Deegan MJ, Futrell N, Welch KM: Cerebrovascular disease and neurological disease associated with antiphospholipid antibodies: 48 cases. Neurology 1990;40:1181–1189.
Tanne D, D’Olhaberriague L, Schultz LR, Salowich-Palm L, Sawaya KL, Levin SR: Anticardiolipin antibodies and their associations with cerebrovascular risk factors. Neurology 1999;52:1368–1373.
Tanne D, D’Olhaberriague L, Trivedi AM, Salowich-Palm L, Schultz LR, Levine SR: Anticardiolipin antibodies and mortality in patients with ischemic stroke: a prospective follow-up study. Neuroepidemiology 2002;21:93–99.
Janardhan V, Wolf PA, Kase CS, Massaro JM, D’Agostino RB, Franzblau C, Wilson PW: Anticardiolipin antibodies and risk of ischemic stroke and transient ischemic attack: the Framingham cohort and offspring study. Stroke 2004;35:736–41.
Ginsburg KS, Liang MH, Newcomer L, Goldhaber SZ, Schur PH, Hennekens CH, Stampfer MJ: Anticardiolipin antibodies and the risk for ischemic stroke and venous thrombosis. Ann Intern Med 1992;117:997–1002.
D’Olhaberriague L, Levin SR, Salowish-Palm L, Tanne D, Sawaya KL, Aurora TK: Specificity, isotype, and titer distribution of anticardiolipin antibodies in CNS diseases. Neurology 1998;51:1376–1380.
Galli M, Luciani D, Bertolini G, Barbui T: Lupus anticoagulants are stronger risk factors for thrombosis than anticardiolipin antibodies in the antiphospholipid syndrome: a systematic review of the literature. Blood 2003;101:1827–1832.
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