title: Procalcitonin and Midregional Proatrial Natriuretic Peptide as Biomarkers of Subclinical Cerebrovascular Damage: The Northern Manhattan Study.
abstract: Chronic infections and cardiac dysfunction are risk factors for stroke. We hypothesized that blood biomarkers of infection (procalcitonin) and cardiac dysfunction (midregional proatrial natriuretic peptide [MR-proANP]), previously associated with small vessel stroke and cardioembolic stroke are also associated with subclinical cerebrovascular damage, including silent brain infarcts and white matter hyperintensity volume.
  
  
  
  The NOMAS (Northern Manhattan Study) was designed to assess risk factors for incident vascular disease in a multiethnic cohort. A subsample underwent brain magnetic resonance imaging and had blood samples available for biomarker measurement (n=1178). We used logistic regression models to estimate the odds ratios and 95% confidence intervals (95% CIs) for the association of these biomarkers with silent brain infarcts after adjusting for demographic, behavioral, and medical risk factors. We used linear regression to assess associations with log-white matter hyperintensity volume.
  
  
  
  Mean age was 70±9 years; 60% were women, 66% Hispanic, 17% black, and 15% were white. After adjusting for risk factors, subjects with procalcitonin or MR-proANP in the top quartile, compared with the lowest quartile were more likely to have silent brain infarcts (adjusted odds ratio for procalcitonin, 2.2; 95% CI, 1.3-3.7 and for MR-proANP, 3.3; 95% CI, 1.7-6.3) and increased white matter hyperintensity volume (adjusted mean change in log-white matter hyperintensity volume for procalcitonin, 0.29; 95% CI, 0.13-0.44 and for MR-proANP, 0.18; 95% CI, 0.004-0.36).
  
  
  
  Higher concentrations of procalcitonin, a marker of infection, and MR-proANP, a marker of cardiac dysfunction, are independently associated with subclinical cerebrovascular damage. If further studies demonstrate an incremental value for risk stratification, biomarker-guided primary prevention studies may lead to new approaches to prevent cerebrovascular disease.
authors.affiliation: From the Departments of Neurology (M.K., Y.M., J.D.R., J.G., M.E.) and Epidemiology (M.E.), Columbia University, New York, NY; Departments of Neurology (M.K.) and Clinical Chemistry (A.v.E., K.S.), University Hospital of Zurich, Switzerland; Department of Neurology, University of California at Davis, Sacramento (C.D.C.); and Departments of Neurology (C.W., R.S.), Public Health Sciences (R.S.), and Human Genetics (R.S.), University of Miami, FL. mira.katan@usz.ch.
authors.forename: Mira
authors.initials: M
authors.lastname: Katan
authors.affiliation: From the Departments of Neurology (M.K., Y.M., J.D.R., J.G., M.E.) and Epidemiology (M.E.), Columbia University, New York, NY; Departments of Neurology (M.K.) and Clinical Chemistry (A.v.E., K.S.), University Hospital of Zurich, Switzerland; Department of Neurology, University of California at Davis, Sacramento (C.D.C.); and Departments of Neurology (C.W., R.S.), Public Health Sciences (R.S.), and Human Genetics (R.S.), University of Miami, FL.
authors.forename: Yeseon
authors.initials: Y
authors.lastname: Moon
authors.affiliation: From the Departments of Neurology (M.K., Y.M., J.D.R., J.G., M.E.) and Epidemiology (M.E.), Columbia University, New York, NY; Departments of Neurology (M.K.) and Clinical Chemistry (A.v.E., K.S.), University Hospital of Zurich, Switzerland; Department of Neurology, University of California at Davis, Sacramento (C.D.C.); and Departments of Neurology (C.W., R.S.), Public Health Sciences (R.S.), and Human Genetics (R.S.), University of Miami, FL.
authors.forename: Arnold
authors.initials: A
authors.lastname: von Eckardstein
authors.affiliation: From the Departments of Neurology (M.K., Y.M., J.D.R., J.G., M.E.) and Epidemiology (M.E.), Columbia University, New York, NY; Departments of Neurology (M.K.) and Clinical Chemistry (A.v.E., K.S.), University Hospital of Zurich, Switzerland; Department of Neurology, University of California at Davis, Sacramento (C.D.C.); and Departments of Neurology (C.W., R.S.), Public Health Sciences (R.S.), and Human Genetics (R.S.), University of Miami, FL.
authors.forename: Kathartina
authors.initials: K
authors.lastname: Spanaus
authors.affiliation: From the Departments of Neurology (M.K., Y.M., J.D.R., J.G., M.E.) and Epidemiology (M.E.), Columbia University, New York, NY; Departments of Neurology (M.K.) and Clinical Chemistry (A.v.E., K.S.), University Hospital of Zurich, Switzerland; Department of Neurology, University of California at Davis, Sacramento (C.D.C.); and Departments of Neurology (C.W., R.S.), Public Health Sciences (R.S.), and Human Genetics (R.S.), University of Miami, FL.
authors.forename: Janet
authors.initials: J
authors.lastname: DeRosa
authors.affiliation: From the Departments of Neurology (M.K., Y.M., J.D.R., J.G., M.E.) and Epidemiology (M.E.), Columbia University, New York, NY; Departments of Neurology (M.K.) and Clinical Chemistry (A.v.E., K.S.), University Hospital of Zurich, Switzerland; Department of Neurology, University of California at Davis, Sacramento (C.D.C.); and Departments of Neurology (C.W., R.S.), Public Health Sciences (R.S.), and Human Genetics (R.S.), University of Miami, FL.
authors.forename: Jose
authors.initials: J
authors.lastname: Gutierrez
authors.affiliation: From the Departments of Neurology (M.K., Y.M., J.D.R., J.G., M.E.) and Epidemiology (M.E.), Columbia University, New York, NY; Departments of Neurology (M.K.) and Clinical Chemistry (A.v.E., K.S.), University Hospital of Zurich, Switzerland; Department of Neurology, University of California at Davis, Sacramento (C.D.C.); and Departments of Neurology (C.W., R.S.), Public Health Sciences (R.S.), and Human Genetics (R.S.), University of Miami, FL.
authors.forename: Charles
authors.initials: C
authors.lastname: DeCarli
authors.affiliation: From the Departments of Neurology (M.K., Y.M., J.D.R., J.G., M.E.) and Epidemiology (M.E.), Columbia University, New York, NY; Departments of Neurology (M.K.) and Clinical Chemistry (A.v.E., K.S.), University Hospital of Zurich, Switzerland; Department of Neurology, University of California at Davis, Sacramento (C.D.C.); and Departments of Neurology (C.W., R.S.), Public Health Sciences (R.S.), and Human Genetics (R.S.), University of Miami, FL.
authors.forename: Clinton
authors.initials: C
authors.lastname: Wright
authors.affiliation: From the Departments of Neurology (M.K., Y.M., J.D.R., J.G., M.E.) and Epidemiology (M.E.), Columbia University, New York, NY; Departments of Neurology (M.K.) and Clinical Chemistry (A.v.E., K.S.), University Hospital of Zurich, Switzerland; Department of Neurology, University of California at Davis, Sacramento (C.D.C.); and Departments of Neurology (C.W., R.S.), Public Health Sciences (R.S.), and Human Genetics (R.S.), University of Miami, FL.
authors.forename: Ralph
authors.initials: R
authors.lastname: Sacco
authors.affiliation: From the Departments of Neurology (M.K., Y.M., J.D.R., J.G., M.E.) and Epidemiology (M.E.), Columbia University, New York, NY; Departments of Neurology (M.K.) and Clinical Chemistry (A.v.E., K.S.), University Hospital of Zurich, Switzerland; Department of Neurology, University of California at Davis, Sacramento (C.D.C.); and Departments of Neurology (C.W., R.S.), Public Health Sciences (R.S.), and Human Genetics (R.S.), University of Miami, FL.
authors.forename: Mitchell
authors.initials: M
authors.lastname: Elkind
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D009320:Atrial Natriuretic Factor / Q000097:blood*; D015415:Biomarkers / Q000097:blood; D002116:Calcitonin / Q000097:blood*; D002561:Cerebrovascular Disorders / Q000097:blood* / Q000000981:diagnostic imaging / Q000453:epidemiology; D005260:Female; D006801:Humans; D008297:Male; D009519:New York City / Q000453:epidemiology; D012306:Risk
chemical_list: D015415:Biomarkers; C552580:midregional pro-atrial natriuretic peptide, human; D009320:Atrial Natriuretic Factor; D002116:Calcitonin
keywords: biomarkers; brain infarction; risk factor; stroke; white matter