N-Terminal Pro–B-type Natriuretic Peptide and Stroke Risk

Does your doctor know how to test and evaluate your stroke risks with this? Or will you again have to tell them about new or even old research papers?
https://stroke.ahajournals.org/content/early/2014/04/22/STROKEAHA.114.004712.abstract?sid=d0b12f5a-d0a9-48f9-9bf9-6014959fd049

The Reasons for Geographic and Racial Differences in Stroke Cohort

1. Mary Cushman, MD, MSc,
2. Suzanne E. Judd, PhD,
3. Virginia J. Howard, PhD,
4. Brett Kissela, MD, MS,
5. Orlando M. Gutiérrez, MD, MMSc,
6. Nancy S. Jenny, PhD,
7. Ali Ahmed, MD, MPH,
8. Evan L. Thacker, PhD and
9. Neil A. Zakai, MD, MSc

+ Author Affiliations

1. From the Departments of Medicine and Pathology, University of Vermont, Colchester (M.C., N.S.J., N.A.Z.); Departments of Epidemiology and Medicine, University of Alabama at Birmingham (S.E.J., V.J.H., O.M.G., A.A., E.L.T.); Department of Neurology, University of Cincinnati, OH (B.K.); and Department of Medicine, Veterans Affairs Medical Center, Birmingham, AL (A.A.).

1. Correspondence to Mary Cushman, MD, MSc, Departments of Medicine and Pathology, University of Vermont, 208 S Park Dr, Colchester, VT 05446. E-mail mary.cushman@uvm.edu

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. 

But what type of stroke? Ischemic? hemorrhagic?