N-Terminal Pro–B-type Natriuretic Peptide and Stroke Risk: The Reasons for Geographic and Racial Differences in Stroke Cohort

• Published in: Stroke (1970) Vol. 45; no. 6; pp. 1646 - 1650
• Main Authors: Cushman, Mary, Judd, Suzanne E., Howard, Virginia J., Kissela, Brett, Gutiérrez, Orlando M., Jenny, Nancy S., Ahmed, Ali, Thacker, Evan L., Zakai, Neil A.
• Format: Journal Article
• Language: English
• Published: Hagerstown, MD American Heart Association, Inc 01.06.2014; Lippincott Williams & Wilkins
• Subjects: Age Factors; Aged; Aged, 80 and over; Atrial Fibrillation - blood; Atrial Fibrillation - epidemiology; Atrial Fibrillation - ethnology; Biological and medical sciences; Biomarkers - blood; Coronary Artery Disease - blood; Coronary Artery Disease - epidemiology; Coronary Artery Disease - ethnology; Female; Follow-Up Studies; Headache. Facial pains. Syncopes. Epilepsia. Intracranial hypertension. Brain oedema. Cerebral palsy; Heart Failure - blood; Heart Failure - epidemiology; Heart Failure - ethnology; Humans; Male; Medical sciences; Middle Aged; Natriuretic Peptide, Brain - blood; Nervous system (semeiology, syndromes); Neurology; Peptide Fragments - blood; Racial Groups; Retrospective Studies; Sex Factors; Stroke - blood; Stroke - epidemiology; Stroke - ethnology; Vascular diseases and vascular malformations of the nervous system; Vascular disease; natriuretic peptides; Stroke; Nervous system diseases; risk factors; Central nervous system disease; Risk factor; Cardiovascular disease; Cerebrovascular disease; Cerebral disorder; stroke
• ISSN: 0039-2499; 1524-4628; 1524-4628
• DOI: 10.1161/STROKEAHA.114.004712

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.