Plasma bone morphogenetic proteins 9 and major cardiovascular events and mortality after acute ischemic stroke: a...

Bone morphogenetic proteins 9 (BMP9) has been implicated in endothelial protection and vascular development. In this study, we investigated the association of circulating BMP9 and clinical outcomes after acute ischemic stroke onset.

Plasma BMP9 levels were measured in 3400 patients with ischemic stroke recruited between August 2009 and May 2013 from 26 hospitals across China. Study outcomes included cardiovascular events, recurrent stroke, and all-cause mortality. Hazard ratios (HR) and 95 % confidence intervals (CI) were calculated using Cox regression models to examine the association between plasma BMP9 levels and study outcomes. During 3 months of follow-up, 96 participants (2.85 %) experienced cardiovascular events, and 62 (1.84 %) experienced recurrent stroke,102 (3.00 %) were reported all-cause mortality, 157 (4.62 %) were reported the composite outcome of cardiovascular events or all-cause mortality. Participants in the highest tertile of plasma BMP9 level had a decreased risk of cardiovascular events (multivariable-adjusted HR = 0.42, 95 % CI = 0.24-0.73), recurrent stroke (multivariable-adjusted HR = 0.44, 95 % CI = 0.22-0.87), all-cause mortality (multivariable-adjusted HR = 0.60, 95 % CI = 0.37-0.97), and the composite outcome of cardiovascular events or all-cause mortality (multivariable-adjusted HR = 0.55, 95 % CI = 0.37-0.83), compared with those in the lowest tertile. Addition of plasma BMP9 to a model with conventional risk factors significantly improved the risk reclassification for the study outcomes.

In this multicenter prospective study, increased plasma BMP9 levels associated with decreased risk of adverse clinical outcomes after acute ischemic stroke, suggesting that the BMP9 signaling pathway may serve as a promising therapeutic target for future interventions in ischemic stroke and related cardiovascular complications.