Mohammed I. Sheta et al. 551 Association of Highly Sensitive C- reactive Protein Rather than Homocysteine with Acute Ischemic Stroke Mohammed I. Sheta 1 , Yasser M. Abdelhamid 1 , Hatem A. Darwish 1 , Gihan M. Ramzy 2 , Amany Ali 3 , Doaa M. Atef 4 Departments of Internal Medicine 1 , Neurology 2 , Clinical Pathology 3 , Cairo University; Internal Medicine, Police Hospital 4 ABSTRACT Background: Single CRP measurement is one of the predictors of cardiovascular events including cerebrovascular stroke. Also, homocysteine was found to have primary atherogenic and prothrombotic properties. Both have been associated with underlying inflammatory processes responsible for atherogenensis and are considered to be "nontraditional" risk factors of atherosclerosis. Objectives: to investigate highly sensitivity CRP (hs-CRP) and homocysteine as nontraditional risk factors of atherosclerosis in the development of stroke in diabetic and non diabetic patients. Methods: 50 patients with acute CVS between the 1 st and 3 rd days of onset were included, classified into two groups: group 1 included 25 patients with type 2 diabetes mellitus; group 2 included non-diabetic 25 patients. All patients were subjected to full history taking and clinical examination, laboratory investigations including: Serum cholesterol, triglycerides, uric acid, blood urea and serum creatinine, highly sensitive CRP and serum homocysteine and brain Computed Tomography (CT). Results: Forty patients (80%) had elevated level of hs-CRP with elevated mean serum hs-CRP (14.66±9.94 μg/ml) while only 13 patients (26%) had hyperhomocysteinemia with normal mean serum homocysteine (12.43±5.67 μmol/L). Mean serum hs-CRP was found to be higher in group 1 patients, while mean serum homocysteine level was higher in group 2 patients. Conclusion: Highly sensitive CRP is better than homocysteine level as a risk factor for acute ischemic stroke. No difference was found between type 2 diabetic patients and non diabetics although higher levels of hs-CRP were found in diabetic patients. (Egypt J. Neurol. Psychiat. Neurosurg., 2009, 46(2): 551--559) Key words: Highly sensitive CRP, homocysteine, ischemic stroke, type 2 diabetes. INTRODUCTION Medical research strongly supports a role for inflammation in pathogenesis, progression and disruption of atherosclerotic plaque 1 . C-reactive protein together with homocysteine has been associated with the underlying inflammatory processes and is considered to be "nontraditional" risk factors of atherosclerosis. 2 C-reactive protein (CRP) is a member of the pentraxin family of innate immune response proteins. Although initially believed to be synthesized only by the liver in response to interleukin-6, recent evidence indicates that CRP is also produced in smooth muscle cells within human coronary arteries and is expressed preferentially in diseased vessels. One report found that levels of CRP mRNA within atherosclerotic plaque were 7 and 10 fold higher than levels found in the liver and normal blood vessels, respectively. 3 Although CRP assays are automated and reproducible, they have a lower detection limit of 3 to 8 mg/L and thus are not sensitive enough to detect the low-end variations required for prediction of vascular risk. 4 High levels of CRP are measured in the serum by conventional CRP assay, while lower CRP levels are detected by a high-sensitivity assay (hs-CRP). Prospective epidemiologic studies with follow-up periods ranging from 3 to 20 years have found that a single hs-CRP measurement is a strong predictor of stroke in individuals without a history of CVD. 5 Correspondence to Yasser M. Abdelhamid, e-mail: dyabdelhamid@hotmail.com . Contact Number: +20233882624