Glycated albumin predicts the effect of dual and single antiplatelet therapy on recurrent stroke

OBJECTIVE: To determine the relationship of glycated albumin (GA) and the recurrence of stroke in patients on either dual or single antiplatelet therapy. METHODS: The Clopidogrel in High-Risk Patients with Acute Nondisabling Cerebrovascular Events trial randomized minor ischemic stroke or TIA patients to antiplatelet therapy of clopidogrel plus aspirin or aspirin alone. A subgroup of 3,044 consecutive patients with baseline GA levels from 73 (64%) prespecified clinical sites was analyzed. Patients were categorized into 2 groups based on GA level of 15.5%, the cut point for development of diabetes. The primary outcome was stroke recurrence during 90-day follow-up. Cox proportional hazards models were used to assess the interaction of GA with randomized antiplatelet therapy on their risk of recurrent stroke. RESULTS: Significant interaction of GA levels with the 2 antiplatelet therapy groups was found after adjustment for age, sex, and other conventional confounding factors (p = 0.009). The interaction remained consistent after further adjustment for history of diabetes (p = 0.010). In patients with lower GA level, stroke occurred in 5.5% of patients in the clopidogrel-aspirin group, and 12.7% in the aspirin group (adjusted hazard ratio [HR] 0.40; 95% confidence interval [CI] 0.26-0.61; p < 0.001). Furthermore, in patients with elevated GA level, stroke occurred in 9.2% of patients in the clopidogrel-aspirin group, and 11.4% in the aspirin group (adjusted HR 0.79; 95% CI 0.60-1.05; p = 0.103). CONCLUSIONS: GA could be a potential biomarker to predict the effects of dual and single antiplatelet therapy in patients with minor stroke or TIA.