Di Castelnuovo A, et al. – In this study using data from the BiomarCaRE Consortium, researchers assessed the correlation between N-terminal pro-B-type natriuretic peptide (NT-proBNP) and stroke, and determined the predictive value beyond a panel of risk factors established. Overall, they noted a positive association of NT-proBNP levels with ischemic and hemorrhagic stroke risk, irrespective of several other risk factors and conditions in this cohort of stroke-free European adults. Furthermore, the addition of NT-proBNP to established risk scoring variables improved stroke prediction with a medium size effect.

Methods

• The study sample consisted of 58,173 stroke-free individuals (50% men; mean age: 52 years) from 6 community-based cohorts.
• They measured NT-proBNP in the central Biomarkers for Cardiovascular Risk Assessment in Europe laboratory.
• Total stroke and subtypes of stroke (ischemic/hemorrhagic) comprised outcomes.

Results

• In all, 1,550 stroke events (1,176 ischemic) occurred during a median follow-up time of 7.9 years.
• An association of increasing quarters of the NT-proBNP distribution with increasing risk of stroke was evident.
• Investigators found that individuals in the highest NT-proBNP quarter (NT-proBNP > 82.2 pg/mL) had a twofold (95% CI, 75% to 151%) greater risk of stroke vs those in the lowest quarter (NT-proBNP < 20.4 pg/mL).
• When adjusted for interim coronary events during follow-up, the association remained unchanged; although it was somewhat heterogeneous across cohorts, it was highly homogeneous depending on the cardiovascular risk profile or stroke subtypes.
• The addition of NT-proBNP to a reference model elevated the C-index discrimination measure by 0.006 (P=0.0005), and resulted in a categorical net reclassification improvement of 2.0% in events and 1.4% in nonevents and an integrated discrimination improvement of 0.007.