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Circulating biomarkers and ischemic stroke risk in adults with atrial fibrillation taking anticoagulation: the
Samuel A P Short1, Erin Hald2, Katherine Wilkinson3
1Larner College of Medicine, University of Vermont, Burlington, Vermont, USA.
Insights
Certain blood biomarkers like NTproBNP and factor VIII are linked to increased ischemic stroke risk in atrial fibrillation (AF) patients on anticoagulation. Further research is needed to validate these findings for better stroke prevention.
Area of Science:
- Cardiology
- Neurology
- Biomarker Research
Background:
- Anticoagulation therapy is standard for reducing ischemic stroke risk in atrial fibrillation (AF).
- Despite treatment, a subset of AF patients experience "breakthrough" strokes.
- Identifying high-risk individuals using blood biomarkers is crucial but understudied in general populations.
Purpose of the Study:
- To investigate associations between established ischemic stroke risk biomarkers and stroke incidence in a general population of AF patients receiving anticoagulation.
- To identify novel biomarkers for predicting stroke risk in anticoagulated AF patients.
Main Methods:
- Prospective cohort study (REasons for Geographic and Racial Differences in Stroke) of 30,239 adults aged ≥45.
- Analysis included 713 participants with AF, no prior stroke, on oral anticoagulation at baseline.
- Nine biomarkers were measured; Cox models estimated hazard ratios for ischemic stroke, adjusted for confounders.
Main Results:
- Over 12 years, 67 (9%) participants developed ischemic stroke.
- Higher levels of N-terminal pro-B-type natriuretic peptide (NTproBNP) and factor VIII were significantly associated with increased ischemic stroke risk (HRs 1.49 and 1.34 respectively).
- Associations for D-dimer and growth differentiation factor 15 (GDF-15) were not statistically significant.
Conclusions:
- Biomarkers related to atriopathy, coagulation, and vascular inflammation indicate elevated ischemic stroke risk in AF patients on anticoagulation.
- These findings suggest potential new targets for stroke risk reduction strategies in AF.
- Validation in larger cohorts is necessary to confirm these biomarker associations.
Background:
Anticoagulation reduces ischemic stroke risk in atrial fibrillation (AF), but "breakthrough" stroke occurs. Blood biomarkers might help identify patients at risk for this, but existing studies are limited in examining few biomarkers in select populations.
Objectives:
To determine whether established biomarkers of ischemic stroke risk will be associated with ischemic stroke risk in people with AF on anticoagulation sampled from the general population.
Methods:
The REasons for Geographic and Racial Differences in Stroke study is a prospective cohort study of 30 239 Black or White adults aged ≥45 years at enrollment in 2003 to 2007 monitored for stroke. Nine biomarkers were measured at baseline in participants with AF, no prior stroke, and who were taking oral anticoagulation at baseline. Hazard ratios of ischemic stroke were estimated by Cox models adjusted for demographics and stroke risk factors.
Results:
Among 713 participants with AF on warfarin (median age 76, 36% female, 17% Black), 67 (9%) developed a first-time ischemic stroke over 12 years. Adjusting for confounders, each SD higher N-terminal pro-B-type natriuretic peptide (NTproBNP), factor VIII, D-dimer, and growth differentiation factor 15 (GDF-15) were positively associated with incident stroke, with hazard ratios ranging from 1.49 (95% CI, 1.11-2.02) for NTproBNP to 1.28 (95% CI, 0.92-1.77) for GDF-15. Associations for D-dimer and GDF-15 did not meet statistical significance.
Conclusion:
Biomarkers of atriopathy, coagulation, and vascular inflammation were associated with higher ischemic stroke risk in people with AF on anticoagulation at baseline. Findings highlight new avenues for reducing stroke risk in AF, but a larger study is needed for validation.
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