Cardiovascular

Association of Myeloperoxidase and Granulocyte Colony-Stimulating Factor With Intracranial Atherosclerosis Presence and Progression From a Community-Based Study.

Xu Z, Wang L, et al. • Journal of the American Heart Association • 2026

PubMed 42622237 DOI 10.1161/JAHA.126.049169

TL;DR

Elevated myeloperoxidase and granulocyte colony-stimulating factor levels were associated with intracranial atherosclerosis and plaque progression over approximately 4.7 years, highlighting the role of neutrophil-driven inflammation.

Key Findings

Results

Each 1-SD increase in myeloperoxidase was associated with significantly greater odds of intracranial artery plaque at baseline.

OR 1.12 (95% CI, 1.02–1.23) for intracranial artery plaque presence
Analysis conducted in 3059 participants from the PRECISE study in China
Median participant age was 61 years; 53.4% were women
Restricted cubic spline analyses indicated a linear association between myeloperoxidase and intracranial atherosclerosis

Results

Each 1-SD increase in myeloperoxidase was associated with significantly greater odds of intracranial artery stenosis at baseline.

OR 1.19 (95% CI, 1.02–1.39) for intracranial artery stenosis
Assessed using 3.0-T magnetic resonance imaging at baseline (2017–2019)
Association was independent of other cardiovascular risk factors included in logistic regression models

Results

Each 1-SD increase in myeloperoxidase was associated with higher intracranial atherosclerotic burden at baseline.

Common OR 1.12 (95% CI, 1.02–1.23) for higher intracranial atherosclerotic burden
Intracranial atherosclerotic burden was assessed as an ordinal outcome using logistic regression with common OR
Imaging was performed at baseline (2017–2019)

Results

Higher myeloperoxidase levels were associated with plaque progression at both follow-up waves.

OR 1.18 (95% CI, 1.07–1.30) for plaque progression at wave 2 (2019–2022)
OR 1.13 (95% CI, 1.02–1.26) for plaque progression at wave 3 (2022–2024)
Follow-up spanned approximately 4.7 years total across two follow-up assessments
Each association reflects a 1-SD increase in myeloperoxidase

Results

Continuous granulocyte colony-stimulating factor (G-CSF) levels were not significantly associated with intracranial atherosclerosis outcomes, but the highest tertile was associated with baseline plaque and higher atherosclerotic burden.

Continuous G-CSF was not significantly associated with intracranial artery plaque, stenosis, or atherosclerotic burden as a continuous variable
The highest tertile of G-CSF was associated with baseline intracranial artery plaque and higher intracranial atherosclerotic burden versus the lowest tertile
P for trend <0.05 for the tertile analyses
Restricted cubic spline analyses indicated a linear association between G-CSF and intracranial atherosclerosis

Methods

The study used repeated 3.0-T MRI assessments across three waves to evaluate intracranial atherosclerosis presence and progression in a community-based cohort.

3059 participants from the PRECISE (Polyvascular Evaluation for Cognitive Impairment and Vascular Events) study in China
Baseline imaging conducted 2017–2019, wave 2 imaging 2019–2022, wave 3 imaging 2022–2024
Logistic regression and restricted cubic spline models were used to evaluate associations
Intracranial artery plaque, stenosis, and atherosclerotic burden were each assessed separately as outcomes

What This Means

This research suggests that two proteins linked to immune cell activity — myeloperoxidase (MPO) and granulocyte colony-stimulating factor (G-CSF) — are associated with the buildup and worsening of plaque inside the arteries of the brain (intracranial atherosclerosis). The study followed over 3,000 adults in China for nearly five years, taking brain MRI scans at three time points to measure artery plaque, narrowing of arteries, and overall atherosclerotic burden. Higher blood levels of MPO were consistently linked to more plaque, greater artery narrowing, and worsening plaque over time, while higher G-CSF levels (particularly in the top third of participants) were linked to more plaque and greater atherosclerotic burden at the start of the study. Myeloperoxidase is an enzyme released by neutrophils — a type of white blood cell involved in inflammation — and is thought to destabilize arterial plaques. G-CSF stimulates the production and activity of these same immune cells and may amplify inflammatory processes in artery walls. These findings suggest that neutrophil-driven inflammation plays a role not just in the presence but also in the progression of plaque inside brain arteries over time. This research matters because intracranial atherosclerosis is a major cause of stroke, particularly in Asian populations, and there are limited tools for predicting who is at risk of plaque progression. If MPO and G-CSF serve as markers of this process, they could potentially help identify individuals at higher risk. Further research would be needed to determine whether targeting these inflammatory pathways could slow or prevent plaque progression.

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Citation

Xu Z, Wang L, Cai X, Zhang Y, Liu D, Wang M, et al.. (2026). Association of Myeloperoxidase and Granulocyte Colony-Stimulating Factor With Intracranial Atherosclerosis Presence and Progression From a Community-Based Study.. Journal of the American Heart Association. https://doi.org/10.1161/JAHA.126.049169

Key Findings

What This Means

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