Objective: To determine the role of circulating endothelial microvesicles (EMV) and microvesicles (MV) of other origins on long-term cardiovascular outcomes after stroke, we measured them in a cohort of first-ever stroke patients and observed them for three years.

Methods: In the PROSpective Cohort with Incident Stroke Berlin (PROSCIS-B), patients with first-ever ischemic stroke were followed for three years. The primary combined endpoint consisted of recurrent stroke, myocardial infarction, and all-cause mortality. Levels of EMV, leukocyte-derived MV (LMV), monocytic MV (MMV), and platelet-derived MV (PMV) were measured in citrate blood using flow cytometry. Kaplan-Meier curves and Cox proportional hazards models were used to estimate the effect of MV levels on the combined endpoint after adjustment confounding.

Results: 571 patients were recruited (median age 69y; 39% female; median NIHSS 2, interquartile range 1-4). During the follow-up, 95 endpoints occurred. Patients with levels of EMV [adjusted hazard ratio (HR)=2.5, 95% confidence interval (CI) 1.2-4.9] or LMV (HR=3.1, 95%CI 1.4-6.8) in the highest quartile were more likely to experience an event than participants with lower levels using the lowest quartile as reference category. The association was less pronounced for PMV (HR=1.7, 95%CI 0.9-3.2) and absent for MMV (HR=1.1, 95%CI 0.6-1.8).

Conclusion: High levels of EMV and LMV after ischemic stroke were associated with worse cardiovascular outcome within three years. These results reinforce that endothelial dysfunction and vascular inflammation affect the long-term prognosis after stroke. EMV and LMV might play a potential role in risk prediction for stroke patients.

Study Registration https://clinicaltrials.gov/ct2/show/NCT01363856 UID: NCT01363856