Troponin T, N-terminal pro-B-type natriuretic peptide, and incidence of stroke: the atherosclerosis risk in communities study.
Troponin T, N-terminal pro-B-type natriuretic peptide, and incidence of stroke: the atherosclerosis risk in communities study.
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DOI：
10.1161/strokeaha.111.000173
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发表时间：
2013-04
期刊：
影响因子：
8.3
通讯作者：
Ballantyne CM
中科院分区：
文献类型：
--
作者：
Folsom AR;Nambi V;Bell EJ;Oluleye OW;Gottesman RF;Lutsey PL;Huxley RR;Ballantyne CM
血浆肌钙蛋白和利钠肽水平升高与心血管疾病风险增加相关，但关于这些生物标志物和卒中发生率的信息有限。在一项前瞻性流行病学研究中，我们检验了高敏肌钙蛋白T（TnT）和N末端B型利钠肽前体（NT-proBNP）与卒中发病率呈正相关的假设。社区动脉粥样硬化风险（ARIC）研究测量了10，902名最初无卒中的男性或女性的血浆TnT和NT-proBNP，并对他们进行了平均11.3年的卒中发生随访（n=507）。两种生物标志物与总卒中、非腔隙性缺血性卒中、尤其是心源性栓塞性卒中呈正相关，但与腔隙性或出血性卒中无关。例如，在调整流行风险因素和心脏疾病后，TnT和NT-proBNP联合高值（与两种生物标志物均不高值相比）的风险比（95%置信区间）为总卒中2.70（1.92，3.79）和心源性栓塞性卒中6.26（3.40，11.5）。NT-proBNP与卒中的相关性似乎比TnT更强。值得注意的是，约58%的心源性卒中发生在卒中前NT-proBNP水平最高的五分位数中，32%的心源性卒中发生在NT-proBNP水平最高的五分位数中且ARIC已知在心源性卒中发生前某个时间患有房颤的参与者中。在一般人群中，血浆TnT和NT-proBNP浓度升高与心源性栓塞和其他非腔隙性缺血性卒中风险增加相关。
Increased levels of plasma troponins and natriuretic peptides are associated with increased risk of cardiovascular disease, but only limited information exists on these biomarkers and stroke occurrence. In a prospective epidemiological study, we tested the hypothesis that high-sensitivity troponin T (TnT) and N-terminal pro B-type natriuretic peptide (NT-proBNP) are associated positively with incidence of stroke. The Atherosclerosis Risk in Communities (ARIC) Study measured plasma TnT and NT-proBNP in 10,902 men or women initially free of stroke and followed them for a mean of 11.3 years for stroke occurrence (n=507). Both biomarkers were associated positively with total stroke, nonlacunar ischemic, and especially, cardioembolic stroke, but not with lacunar or hemorrhagic stroke. For example, after adjustment for prevalent risk factors and cardiac diseases, the hazard ratios (95% confidence intervals) for jointly high values of TnT and NT-proBNP (versus neither biomarker high) were 2.70 (1.92, 3.79) for total stroke and 6.26 (3.40, 11.5) for cardioembolic stroke. Associations with stroke appeared somewhat stronger for NT-proBNP than TnT. Strikingly, approximately 58% of cardioembolic strokes occurred in the highest quintile of pre-stroke NT-proBNP, and 32% of cardioembolic strokes occurred in participants who had both NT-proBNP in the highest quintile and were known by ARIC to have atrial fibrillation sometime before their cardioembolic stroke occurrence. In the general population, elevated plasma TnT and NT-proBNP concentrations are associated with increased risk of cardioembolic and other nonlacunar ischemic strokes.