β2-glycoprotein 1-dependent anticardiolipin antibodies and risk of ischemic stroke and myocardial infarction -: The Honolulu Heart Program

Background-It has been hypothesized that immunoreactivity to beta (2)-glycoprotein 1 (beta 2GP1)-dependent anticardiolipin antibody (aCL), but not beta 2GP1 -independent aCL, is associated with increased risk of ischemic stroke and myocardial infarction (MI). Methods-We performed a nested case-control study examining aCL as a risk factor for ischernic stroke and MI by using stored frozen sera obtained from subjects enrolled in the Honolulu Heart Program and followed for up for 20 years. We measured beta 2GP1-dependent and beta 2GP1-independent aCL and anti-beta 2GP1 immunoreactivity in 259 men who developed an ischemic stroke, in 374 men who developed an MI. and in a control group of 1360 men who remained free of both conditions. Results-Only beta 2GP1-dependent aCL of the IgG class was significantly associated with both incident ischemic stroke and MI. This association was attenuated in the last 5 years of the 20-year follow-up. For stroke, the risk factor-adjusted relative odds for men with a positive versus a negative beta 2GP1-dependent aCL of the IgG class were 2.2 (95% CI 1.5 to 3.4) at 15 years and 1.5 (95% CI 1.0 to 2.3) at 20 years. For MI, the adjusted relative odds were 1.8 (95% CI 1.2 to 2.6) at 15 years and 1.5 (95% CI 1.1 to 2.1) at 20 years. Conclusions-These data suggest that aCL IgG, particularly the beta 2GP1 -dependent variety, is an important predictor of future stroke and MI in men.