Plasma N-Terminal Fragments of Natriuretic Peptides Predict the Risk of Stroke and Atrial Fibrillation in Men

Sudhir Kurl ^1*, Minna Ala-Kopsala ², Heikki Ruskoaho ², Timo Mäkikallio ³, Kristiina Nyyssönen ¹, Olli Vuolteenaho ⁴, Juhani Sivenius ⁵, Jukka Salonen Salonen ⁶ and Jari A Laukkanen ⁷

¹ Research Institute of Public Health, School of Public Health and Clinical Nutrition, Finland
² Department of Pharmacology and Toxicology, Biocenter Oulu, University of Oulu, Oulu, Finland
³ Division of Cardiology, Department of Internal Medicine, University of Oulu, Oulu, Finland
⁴ Department of Physiology, University of Oulu, Oulu, Finland
⁵ Department of Neurology, University Hospital of Kuopio and Brain Research and Rehabilitation Centre, Finland
⁶ Research Institute of Public Health, University of Kuopio, Kuopio, Finland
⁷ Research Institute of Public Health, University of Kuopio, Kuopio,Department of Internal Medicine, Finland

^* To whom correspondence should be addressed. E-mail: sudhir.kurl{at}uku.fi.

Accepted 24 February 2009

Abstract

Background: Risk stratification for cardiovascular outcomes is gaining importance in general population. Prognostic value of natriuretic peptides has been established in patients with heart failure. However, the prognostic significance of natriuretic peptides with respect to stroke is not well known in general populations.

Methods: Plasma natriuretic peptides were measured in a representative population-based sample of 958 men (age 46-65 years) from Eastern Finland. There were 46 cases of stroke, 74 of atrial fibrillation, and 31 cases of ischemic strokes during a follow-up of 9.6 years.

Results: The multivariable adjusted risk was 1.35-fold (95 % confidence intervals 1.01 to 1.84, p=0.049) for any stroke and 1.30-fold (95 % confidence intervals 0.90 to 1.91, p=0.0150) for ischemic stroke for each log transformed SD (0.240 pmol/L) increment in N-terminal fragment of proA-type natriuretic peptide. The respective risks were 1.36-fold (95 % confidence intervals 1.05 to 1.76, p=0.010) and 1.50-fold (95 % confidence intervals 1.12 to 2.02, p= 0.007) for each log transformed SD (0.237 pmol/L) increment in N-terminal fragment of proB-type natriuretic peptide. The multivariate adjusted risks for future atrial fibrillation were 1.71 (95 % confidence intervals 1.32 to 2.22, p<0.001) and 1.68-fold (95 % confidence intervals 1.38 to 2.07, p<0.001) for each log transformed SD increment in N-terminal fragments of proA- and proB- type natriuretic peptides, respectively.

Conclusions: N-terminal fragments of proANP and proBNP are new additional predictors of any stroke and atrial fibrillation. Natriuretic peptides provide prognostic information for stroke and atrial fibrillation and may help in identifying subjects at risk for stroke and atrial fibrillation.