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.).
Stroke. 2014 Jun;45(6):1646-50. doi: 10.1161/STROKEAHA.114.004712. Epub 2014 Apr 22.
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.
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.
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).
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.
提高对中风风险人群的识别能力可能有助于预防中风。我们评估了心脏功能生物标志物 N 末端脑钠肽前体（NT-proBNP）与 Reasons for Geographic and Racial Differences in Stroke（REGARDS）队列中 30239 名黑人和白人参与者中风风险的关系。
在 2003 年至 2007 年入组后的 5.4 年随访期间，对 546 例缺血性中风患者和 956 例无中风患者的基线血样进行了 NT-proBNP 测量。
NT-proBNP 随着年龄的增长以及存在心脏病、肾病、心房颤动和较低的低密度脂蛋白胆固醇而升高。在调整年龄、种族、性别、收入、教育和传统中风危险因素后，NT-proBNP 四分位数的中风风险增加；NT-proBNP 处于最高四分位数的患者与处于最低四分位数的患者的风险比为 2.9（95%置信区间，1.9-4.5）。肾功能和心力衰竭的额外调整没有影响。在发病机制中风亚型中，心源性栓塞性中风的相关性最大，风险比为 9.1（95%置信区间，2.9-29.2）。在调整年龄、性别和种族，或排除基线心力衰竭或心房颤动患者后，相关性没有差异。如果考虑传统中风危险因素后再考虑 NT-proBNP，27%的参与者的中风预测风险更准确（P<0.001）。
NT-proBNP 是中风的一个主要独立危险因素。考虑到这一点以及中风、冠心病和心房颤动的其他数据，应考虑在初级预防环境中使用 NT-proBNP 测量。
