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Dried Blood Spot Collection of Health Biomarkers to Maximize Participation in Population Studies
Published on: January 28, 2014
Biomarkers
Zhe Li1, Danielle Marion2, Jessica Blair3
1University of Ottawa Heart Institute, Ottawa, ON, Canada.
Insights
N-terminal pro-Brain Natriuretic Peptide (NT-pro BNP) levels, a marker of atrial cardiopathy, improve dementia risk prediction beyond traditional vascular risk factors. This aids in early dementia screening and prevention before atrial fibrillation onset.
Area of Science:
- Cardiology
- Neurology
- Biomarkers
Background:
- Atrial fibrillation (AF) is a common arrhythmia linked to dementia.
- Atrial cardiopathy, characterized by atrial remodeling, is independently associated with dementia, even without AF.
- Existing dementia risk models may not fully capture AF-related risks.
Purpose of the Study:
- To develop and validate a dementia risk prediction model incorporating atrial cardiopathy markers.
- To assess the added value of atrial cardiopathy markers over traditional vascular risk factors (CHA2DS2-VASc).
- To explore dementia risk prediction in the context of subclinical atrial changes.
Main Methods:
- Utilized data from 3,608 Cardiovascular Health Study (CHS) participants with MRI and cognitive testing (1992-1994).
- Included markers of left atrial cardiopathy: left atrial dimension, p-wave terminal in lead V1 (PTFV1), and N-Terminal pro-Brain Natriuretic Peptide (NT-pro BNP).
- Developed prediction models following TRIPOD guidelines, comparing models with and without atrial cardiopathy markers.
Main Results:
- During 7.6 years of follow-up, 322 participants developed dementia.
- Higher NT-pro BNP levels correlated with increased cumulative incidence of dementia.
- NT-pro BNP and PTFV1 improved dementia prediction model fit, particularly in females; NT-pro BNP improved fit in males compared to CHA2DS2-VASc.
Conclusions:
- NT-pro BNP levels enhance dementia risk prediction compared to the CHA2DS2-VASc score alone.
- These findings support NT-pro BNP as a valuable indicator for atrial cardiopathy in dementia risk assessment.
- The results suggest potential for early dementia screening and prevention strategies targeting subclinical atrial changes before AF diagnosis.
Background:
Atrial fibrillation (AF) is the most common cardiac arrhythmia. Several population-based studies report associations between AF and dementia. Clinical AF is often preceded by substantive atrial structural and electrical remodeling, termed atrial cardiopathy and prior studies have shown that atrial cardiopathy is independently associated with dementia in the absence of AF. This study aims to develop and validate a prediction model for dementia risk using markers of atrial in addition to traditional vascular risk factors (i.e., CHA2DS2-VASc).
Method:
This study utilized data from the Cardiovascular Health Study (CHS). A cohort of 3,608 participants who completed magnetic resonance imaging (MRI) and cognitive testing during 1992-1994 were included for analysis. Markers of left atrial cardiopathy included left atrial dimension, p-wave terminal in lead V1 (PTFV1), and N-Terminal pro-Brain Natriuretic Peptide (NT-pro BNP) level, all previously shown to be associated with left atrial function. Prediction models were built to estimate the predictive accuracy of combining markers of atrial cardiopathy with traditional clinical risk variables (CHA2DS2-VASc) for dementia risk, in accordance with TRIPOD (Transparent Reporting of a multivariable prediction model for Individual Prognosis Or Diagnosis) prediction model recommendations.
Result:
During a mean follow-up of 7.6 years, 322 participants had incident dementia. Individuals with higher NT-pro BNP levels had significantly higher cumulative incidence rates for incident dementia. Compared to the reference model, continuous PTFV1 and NT-pro BNP level in both the categorical scale and log scale improved model fit for incident dementia in females. Compared to the reference model (CHA2DS2-VASc), continuous NT-pro BNP level improved model fit in males.
Conclusion:
NT-pro BNP, an emerging indicator of atrial cardiopathy, improves dementia risk prediction model fit compared to that obtained using the CHA2DS2-VASc score. These findings have implications for dementia risk prediction and the development of screening tools for dementia prevention before the onset of clinical AF.
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