title: B-type natriuretic peptide predicts stroke of presumable cardioembolic origin in addition to coronary artery calcification.
abstract: OBJECTIVE
  B-type natriuretric peptide (BNP) is a marker of cardiac dysfunction that is released from myocytes in response to ventricular wall stress. Previous studies suggested that BNP predicts stroke events in addition to classical risk factors. It was suggested that the BNP-associated risk results from coronary atherosclerosis or atrial fibrillation.
  
  
  METHODS
  Three thousand six hundred and seventy five subjects from the population-based Heinz Nixdorf Recall study (45-75 years; 47.6% men) without previous stroke, coronary heart disease, myocardial infarcts, open cardiac valve surgery, pacemakers and defibrillators were followed up over 110.1 ± 23.1 months. Cox proportional hazards regressions were used to examine BNP as a stroke predictor in addition to vascular risk factors (age, gender, systolic blood pressure, low-density lipoprotein, high-density lipoprotein, diabetes, smoking), renal insufficiency, atrial fibrillation/known heart failure and coronary artery calcification.
  
  
  RESULTS
  Eighty-nine incident strokes occurred (80 ischaemic, 9 hemorrhagic). Subjects suffering stroke had significantly higher BNP values at baseline than the remaining subjects [26.3 (Q1; Q3 = 12.9; 51.0) vs. 17.4 (9.4; 31.4); P < 0.001]. In a multivariable regression, log10 BNP was an independent stroke predictor [hazard ratio 1.96, 95% confidence interval (CI) 1.13-3.41; P = 0.017] in addition to age (1.24 per 5 years, CI 1.04-1.49; P = 0.016), systolic blood pressure (1.25 per 10 mmHg, CI 1.14-1.38; P < 0.001), smoking (2.05, CI 1.24-3.39; P = 0.005), atrial fibrillation/heart failure (2.25, CI 1.05-4.83; P = 0.037) and computed-tomography-based log10 (coronary artery calcification + 1) (1.47, CI 1.15-1.88; P = 0.002). Log10 BNP predicted stroke in men but not women, both in subjects ≤65 and >65 years. In subsequent analyses, BNP discriminated the incidence of cardioembolic stroke (P for trend = 0.001), but not stroke of macroangiopathic (P = 0.555), microangiopathic (P = 0.809) or unknown (P = 0.367) origin.
  
  
  CONCLUSIONS
  BNP predicts presumable cardioembolic stroke independent of coronary calcification.
authors.affiliation: Department of Cardiology, University Hospital Essen, Essen, Germany.
authors.forename: K
authors.initials: K
authors.lastname: Kara
authors.forename: J
authors.initials: J
authors.lastname: Gronewold
authors.forename: T
authors.initials: T
authors.lastname: Neumann
authors.forename: A A
authors.initials: AA
authors.lastname: Mahabadi
authors.forename: C
authors.initials: C
authors.lastname: Weimar
authors.forename: N
authors.initials: N
authors.lastname: Lehmann
authors.forename: K
authors.initials: K
authors.lastname: Berger
authors.forename: H I M
authors.initials: HI
authors.lastname: Kälsch
authors.forename: M
authors.initials: M
authors.lastname: Bauer
authors.forename: M
authors.initials: M
authors.lastname: Broecker-Preuss
authors.forename: S
authors.initials: S
authors.lastname: Möhlenkamp
authors.forename: S
authors.initials: S
authors.lastname: Moebus
authors.forename: K-H
authors.initials: KH
authors.lastname: Jöckel
authors.forename: R
authors.initials: R
authors.lastname: Erbel
authors.forename: D M
authors.initials: DM
authors.lastname: Hermann
mesh_terms: D000367:Age Factors; D000368:Aged; D015415:Biomarkers / Q000097:blood; D002114:Calcinosis / Q000097:blood / Q000175:diagnosis*; D003324:Coronary Artery Disease / Q000097:blood / Q000175:diagnosis*; D005260:Female; D006801:Humans; D015994:Incidence; D008297:Male; D008875:Middle Aged; D020097:Natriuretic Peptide, Brain / Q000097:blood*; D011237:Predictive Value of Tests; D012307:Risk Factors; D012737:Sex Factors; D020521:Stroke / Q000097:blood / Q000175:diagnosis* / Q000453:epidemiology
chemical_list: D015415:Biomarkers; D020097:Natriuretic Peptide, Brain
keywords: brain natriuretic peptide; coronary calcium; risk prediction