N-terminal pro-B-type natriuretic peptide and stroke risk: the reasons for geographic and racial differences in stroke cohort.
N-terminal pro-B-type natriuretic peptide and stroke risk: the reasons for geographic and racial differences in stroke cohort.
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DOI：
10.1161/strokeaha.114.004712
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发表时间：
2014-06
期刊：
影响因子：
8.3
通讯作者：
Zakai NA
中科院分区：
文献类型：
--
作者：
Cushman M;Judd SE;Howard VJ;Kissela B;Gutiérrez OM;Jenny NS;Ahmed A;Thacker EL;Zakai NA
改进对中风高危人群的识别可能会改善预防。我们在30,239名黑人和白人参与者中评估了心功能生物标记物N末端B型利钠肽原(NT-proBNP)与中风风险的关系。对546例缺血性卒中患者和956例非卒中患者的基线血液样本进行了NT-proBNP测定，随访时间为5.4年。NT-proBNP在年龄越大、心脏病、肾脏疾病、心房颤动和低密度脂蛋白胆固醇降低的患者中越高。调整了年龄、种族、性别、收入、教育程度和传统的中风危险因素后，NT-proBNP四分位数的中风风险增加；NT-proBNP在顶部和底部四分位数的参与者的风险比为2.9(95%可信区间1.9-4.5)。对肾功能和心力衰竭的额外调整没有影响。在病因卒中亚型中，心源性卒中的关联最大，风险比为9.1(95%可信区间为2.9-29.2)。不同年龄、性别或种族，或排除心力衰竭或心房颤动患者后的相关性没有差异。如果在传统的卒中危险因素之后考虑NT-ProBNP，27%的参与者预测卒中风险更准确(p<；0.001)。NT-proBNP是卒中的主要独立危险标志物。考虑到这一点以及中风、冠状动脉疾病和房颤的其他数据，应该考虑在一级预防环境中使用NT-proBNP测量的临床应用。
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 cohort. With 5.4 years follow-up after enrollment in 2003–7, 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% CI 1.9–4.5). There was no impact of added adjustment for kidney function and heart failure. Among etiologic stroke subtypes, the association was largest for cardioembolic stroke, with a hazard ratio of 9.1 (95% CI 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, clinical use of NT-proBNP measurement in primary prevention settings should be considered.