April 23, 2014Stroke131 citationsOpen Access
View Full PaperN-Terminal Pro–B-type Natriuretic Peptide and Stroke Risk
Key Result
Participants with baseline NT-proBNP in the top versus the bottom quartile had a significantly increased risk of incident ischemic stroke (HR 2.9; 95% CI 1.9-4.5) over 5.4 years of follow-up.
Study Design
Type
Cohort (n=1,502)
Multicenter
Yes
Structured PICO
Does higher baseline NT-proBNP level predict an increased risk of incident ischemic stroke in a general population cohort?
P
Population
1,502 participants (546 with incident ischemic stroke and 956 without stroke) drawn from the 30,239 black and white participants of the Reasons for Geographic and Racial Differences in Stroke (REGARDS) cohort.
I
Intervention
Higher baseline N-terminal pro-B-type natriuretic peptide (NT-proBNP) levels (top quartile)
C
Comparator
Lower baseline NT-proBNP levels (bottom quartile)
O
Outcome
Incident ischemic strokehard clinical
Elevated baseline NT-proBNP is a strong, independent risk marker for incident ischemic stroke, particularly cardioembolic stroke, suggesting its potential utility in primary prevention risk stratification.
Main Result
Effect estimate: HR 2.9 (95% CI 1.9-4.5)
Abstract
BACKGROUND AND PURPOSE: Improved identification of those at risk of stroke might improve prevention. We evaluated the association of the cardiac function biomarker N-terminal pro-B-type natriuretic peptide (NT-proBNP) with stroke risk in the 30 239 black and white participants of the Reasons for Geographic and Racial Differences in Stroke (REGARDS) cohort. METHODS: During 5.4 years of follow-up after enrollment in 2003 to 2007, NT-proBNP was measured in baseline blood samples of 546 subjects with incident ischemic stroke and 956 without stroke. RESULTS: NT-proBNP was higher with older age and in those with heart disease, kidney disease, atrial fibrillation, and lower low-density lipoprotein-cholesterol. Adjusting for age, race, sex, income, education, and traditional stroke risk factors, there was an increased risk of stroke across quartiles of NT-proBNP; participants with NT-proBNP in the top versus the bottom quartile had a hazard ratio of 2.9 (95% confidence interval, 1.9-4.5). There was no impact of added adjustment for kidney function and heart failure. Among pathogenetic stroke subtypes, the association was largest for cardioembolic stroke, with a hazard ratio of 9.1 (95% confidence interval, 2.9-29.2). Associations did not differ by age, sex, or race, or after excluding those with baseline heart failure or atrial fibrillation. Predicted stroke risk was more accurate in 27% of participants if NT-proBNP was considered after traditional stroke risk factors (P<0.001). CONCLUSIONS: NT-proBNP was a major independent risk marker for stroke. Considering this and other data for stroke, coronary disease, and atrial fibrillation, the clinical use of NT-proBNP measurement in primary prevention settings should be considered.