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Kalani R, Bartz TM, Psaty BM, Elkind MSV, Floyd JS, Gerszten RE, Shojaie A, Heckbert SR, Bis JC, Austin TR, Tirschwell DL, Delaney JAC, Longstreth WT. Plasma Proteomic Associations With Incident Ischemic Stroke in Older Adults: The Cardiovascular Health Study. Neurology 2023; 100:e2182-e2190. [PMID: 37015819 PMCID: PMC10238156 DOI: 10.1212/wnl.0000000000207242] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/30/2022] [Accepted: 02/16/2023] [Indexed: 04/06/2023] Open
Abstract
BACKGROUND AND OBJECTIVES Plasma proteomics may elucidate novel insights into the pathophysiology of ischemic stroke (IS), identify biomarkers of IS risk, and guide development of nascent prevention strategies. We evaluated the relationship between the plasma proteome and IS risk in the population-based Cardiovascular Health Study (CHS). METHODS Eligible CHS participants were free of prevalent stroke and underwent quantification of 1,298 plasma proteins using the aptamer-based SOMAScan assay platform from the 1992-1993 study visit. Multivariable Cox proportional hazards regression was used to evaluate associations between a 1-SD increase in the log2-transformed estimated plasma protein concentrations and incident IS, adjusting for demographics, IS risk factors, and estimated glomerular filtration rate. For proteins independently associated with incident IS, a secondary stratified analysis evaluated associations in subgroups defined by sex and race. Exploratory analyses evaluated plasma proteomic associations with cardioembolic and noncardioembolic IS and proteins associated with IS risk in participants with left atrial dysfunction but without atrial fibrillation. RESULTS Of 2,983 eligible participants, the mean age was 74.3 (±4.8) years, 61.2% were women, and 15.4% were Black. Over a median follow-up of 12.6 years, 450 participants experienced an incident IS. N-terminal probrain natriuretic peptide (NTproBNP, adjusted HR 1.37, 95% CI 1.23-1.53, p = 2.08 × 10-08) and macrophage metalloelastase (MMP12, adjusted HR 1.30, 95% CI 1.16-1.45, p = 4.55 × 10-06) were independently associated with IS risk. These 2 associations were similar in men and women and in Black and non-Black participants. In exploratory analyses, NTproBNP was independently associated with incident cardioembolic IS, E-selectin with incident noncardioembolic IS, and secreted frizzled-related protein 1 with IS risk in participants with left atrial dysfunction. DISCUSSION In a cohort of older adults, NTproBNP and MMP12 were independently associated with IS risk. We identified plasma proteomic determinants of incident cardioembolic and noncardioembolic IS and found a novel protein associated with IS risk in those with left atrial dysfunction.
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Affiliation(s)
- Rizwan Kalani
- From the Departments of Neurology (R.K., D.L.T., W.T.L.), Biostatistics (T.M.B., A.S.), Cardiovascular Health Research Unit (B.M.P., J.S.F., S.R.H., J.C.B., T.R.A.), Medicine, Epidemiology (B.M.P., J.S.F., S.R.H., J.A.C.D., W.T.L.), and Health Services (B.M.P.), University of Washington, Seattle; Department of Neurology (M.S.V.E.), Vagelos College of Physicians and Surgeons, and Department of Epidemiology (M.S.V.E.), Mailman School of Public Health, Columbia University, New York, NY; Division of Cardiovascular Medicine (R.E.G.), Department of Medicine, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA; and College of Pharmacy (J.A.C.D.), University of Manitoba, Winnipeg, Canada.
| | - Traci M Bartz
- From the Departments of Neurology (R.K., D.L.T., W.T.L.), Biostatistics (T.M.B., A.S.), Cardiovascular Health Research Unit (B.M.P., J.S.F., S.R.H., J.C.B., T.R.A.), Medicine, Epidemiology (B.M.P., J.S.F., S.R.H., J.A.C.D., W.T.L.), and Health Services (B.M.P.), University of Washington, Seattle; Department of Neurology (M.S.V.E.), Vagelos College of Physicians and Surgeons, and Department of Epidemiology (M.S.V.E.), Mailman School of Public Health, Columbia University, New York, NY; Division of Cardiovascular Medicine (R.E.G.), Department of Medicine, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA; and College of Pharmacy (J.A.C.D.), University of Manitoba, Winnipeg, Canada
| | - Bruce M Psaty
- From the Departments of Neurology (R.K., D.L.T., W.T.L.), Biostatistics (T.M.B., A.S.), Cardiovascular Health Research Unit (B.M.P., J.S.F., S.R.H., J.C.B., T.R.A.), Medicine, Epidemiology (B.M.P., J.S.F., S.R.H., J.A.C.D., W.T.L.), and Health Services (B.M.P.), University of Washington, Seattle; Department of Neurology (M.S.V.E.), Vagelos College of Physicians and Surgeons, and Department of Epidemiology (M.S.V.E.), Mailman School of Public Health, Columbia University, New York, NY; Division of Cardiovascular Medicine (R.E.G.), Department of Medicine, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA; and College of Pharmacy (J.A.C.D.), University of Manitoba, Winnipeg, Canada
| | - Mitchell S V Elkind
- From the Departments of Neurology (R.K., D.L.T., W.T.L.), Biostatistics (T.M.B., A.S.), Cardiovascular Health Research Unit (B.M.P., J.S.F., S.R.H., J.C.B., T.R.A.), Medicine, Epidemiology (B.M.P., J.S.F., S.R.H., J.A.C.D., W.T.L.), and Health Services (B.M.P.), University of Washington, Seattle; Department of Neurology (M.S.V.E.), Vagelos College of Physicians and Surgeons, and Department of Epidemiology (M.S.V.E.), Mailman School of Public Health, Columbia University, New York, NY; Division of Cardiovascular Medicine (R.E.G.), Department of Medicine, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA; and College of Pharmacy (J.A.C.D.), University of Manitoba, Winnipeg, Canada
| | - James S Floyd
- From the Departments of Neurology (R.K., D.L.T., W.T.L.), Biostatistics (T.M.B., A.S.), Cardiovascular Health Research Unit (B.M.P., J.S.F., S.R.H., J.C.B., T.R.A.), Medicine, Epidemiology (B.M.P., J.S.F., S.R.H., J.A.C.D., W.T.L.), and Health Services (B.M.P.), University of Washington, Seattle; Department of Neurology (M.S.V.E.), Vagelos College of Physicians and Surgeons, and Department of Epidemiology (M.S.V.E.), Mailman School of Public Health, Columbia University, New York, NY; Division of Cardiovascular Medicine (R.E.G.), Department of Medicine, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA; and College of Pharmacy (J.A.C.D.), University of Manitoba, Winnipeg, Canada
| | - Robert E Gerszten
- From the Departments of Neurology (R.K., D.L.T., W.T.L.), Biostatistics (T.M.B., A.S.), Cardiovascular Health Research Unit (B.M.P., J.S.F., S.R.H., J.C.B., T.R.A.), Medicine, Epidemiology (B.M.P., J.S.F., S.R.H., J.A.C.D., W.T.L.), and Health Services (B.M.P.), University of Washington, Seattle; Department of Neurology (M.S.V.E.), Vagelos College of Physicians and Surgeons, and Department of Epidemiology (M.S.V.E.), Mailman School of Public Health, Columbia University, New York, NY; Division of Cardiovascular Medicine (R.E.G.), Department of Medicine, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA; and College of Pharmacy (J.A.C.D.), University of Manitoba, Winnipeg, Canada
| | - Ali Shojaie
- From the Departments of Neurology (R.K., D.L.T., W.T.L.), Biostatistics (T.M.B., A.S.), Cardiovascular Health Research Unit (B.M.P., J.S.F., S.R.H., J.C.B., T.R.A.), Medicine, Epidemiology (B.M.P., J.S.F., S.R.H., J.A.C.D., W.T.L.), and Health Services (B.M.P.), University of Washington, Seattle; Department of Neurology (M.S.V.E.), Vagelos College of Physicians and Surgeons, and Department of Epidemiology (M.S.V.E.), Mailman School of Public Health, Columbia University, New York, NY; Division of Cardiovascular Medicine (R.E.G.), Department of Medicine, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA; and College of Pharmacy (J.A.C.D.), University of Manitoba, Winnipeg, Canada
| | - Susan R Heckbert
- From the Departments of Neurology (R.K., D.L.T., W.T.L.), Biostatistics (T.M.B., A.S.), Cardiovascular Health Research Unit (B.M.P., J.S.F., S.R.H., J.C.B., T.R.A.), Medicine, Epidemiology (B.M.P., J.S.F., S.R.H., J.A.C.D., W.T.L.), and Health Services (B.M.P.), University of Washington, Seattle; Department of Neurology (M.S.V.E.), Vagelos College of Physicians and Surgeons, and Department of Epidemiology (M.S.V.E.), Mailman School of Public Health, Columbia University, New York, NY; Division of Cardiovascular Medicine (R.E.G.), Department of Medicine, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA; and College of Pharmacy (J.A.C.D.), University of Manitoba, Winnipeg, Canada
| | - Joshua C Bis
- From the Departments of Neurology (R.K., D.L.T., W.T.L.), Biostatistics (T.M.B., A.S.), Cardiovascular Health Research Unit (B.M.P., J.S.F., S.R.H., J.C.B., T.R.A.), Medicine, Epidemiology (B.M.P., J.S.F., S.R.H., J.A.C.D., W.T.L.), and Health Services (B.M.P.), University of Washington, Seattle; Department of Neurology (M.S.V.E.), Vagelos College of Physicians and Surgeons, and Department of Epidemiology (M.S.V.E.), Mailman School of Public Health, Columbia University, New York, NY; Division of Cardiovascular Medicine (R.E.G.), Department of Medicine, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA; and College of Pharmacy (J.A.C.D.), University of Manitoba, Winnipeg, Canada
| | - Thomas R Austin
- From the Departments of Neurology (R.K., D.L.T., W.T.L.), Biostatistics (T.M.B., A.S.), Cardiovascular Health Research Unit (B.M.P., J.S.F., S.R.H., J.C.B., T.R.A.), Medicine, Epidemiology (B.M.P., J.S.F., S.R.H., J.A.C.D., W.T.L.), and Health Services (B.M.P.), University of Washington, Seattle; Department of Neurology (M.S.V.E.), Vagelos College of Physicians and Surgeons, and Department of Epidemiology (M.S.V.E.), Mailman School of Public Health, Columbia University, New York, NY; Division of Cardiovascular Medicine (R.E.G.), Department of Medicine, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA; and College of Pharmacy (J.A.C.D.), University of Manitoba, Winnipeg, Canada
| | - David L Tirschwell
- From the Departments of Neurology (R.K., D.L.T., W.T.L.), Biostatistics (T.M.B., A.S.), Cardiovascular Health Research Unit (B.M.P., J.S.F., S.R.H., J.C.B., T.R.A.), Medicine, Epidemiology (B.M.P., J.S.F., S.R.H., J.A.C.D., W.T.L.), and Health Services (B.M.P.), University of Washington, Seattle; Department of Neurology (M.S.V.E.), Vagelos College of Physicians and Surgeons, and Department of Epidemiology (M.S.V.E.), Mailman School of Public Health, Columbia University, New York, NY; Division of Cardiovascular Medicine (R.E.G.), Department of Medicine, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA; and College of Pharmacy (J.A.C.D.), University of Manitoba, Winnipeg, Canada
| | - Joseph A C Delaney
- From the Departments of Neurology (R.K., D.L.T., W.T.L.), Biostatistics (T.M.B., A.S.), Cardiovascular Health Research Unit (B.M.P., J.S.F., S.R.H., J.C.B., T.R.A.), Medicine, Epidemiology (B.M.P., J.S.F., S.R.H., J.A.C.D., W.T.L.), and Health Services (B.M.P.), University of Washington, Seattle; Department of Neurology (M.S.V.E.), Vagelos College of Physicians and Surgeons, and Department of Epidemiology (M.S.V.E.), Mailman School of Public Health, Columbia University, New York, NY; Division of Cardiovascular Medicine (R.E.G.), Department of Medicine, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA; and College of Pharmacy (J.A.C.D.), University of Manitoba, Winnipeg, Canada
| | - W T Longstreth
- From the Departments of Neurology (R.K., D.L.T., W.T.L.), Biostatistics (T.M.B., A.S.), Cardiovascular Health Research Unit (B.M.P., J.S.F., S.R.H., J.C.B., T.R.A.), Medicine, Epidemiology (B.M.P., J.S.F., S.R.H., J.A.C.D., W.T.L.), and Health Services (B.M.P.), University of Washington, Seattle; Department of Neurology (M.S.V.E.), Vagelos College of Physicians and Surgeons, and Department of Epidemiology (M.S.V.E.), Mailman School of Public Health, Columbia University, New York, NY; Division of Cardiovascular Medicine (R.E.G.), Department of Medicine, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA; and College of Pharmacy (J.A.C.D.), University of Manitoba, Winnipeg, Canada
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Shen X, Liao J, Jiang Y, Xu Y, Liu M, Zhang X, Dong N, Yu L, Chen Q, Fang Q. Elevated NT-proBNP levels are associated with CTP ischemic volume and 90-day functional outcomes in acute ischemic stroke: a retrospective cohort study. BMC Cardiovasc Disord 2022; 22:431. [PMID: 36180827 PMCID: PMC9524121 DOI: 10.1186/s12872-022-02861-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/02/2022] [Accepted: 09/14/2022] [Indexed: 11/21/2022] Open
Abstract
Objective To investigate the impact of N-terminal pro-B-type natriuretic peptide (NT-proBNP) on CTP infarct core volume and poor 90-day functional outcomes in acute ischemic stroke (AIS). Methods A total of 403 hospitalized patients with AIS in the Stroke Center of the First Hospital Affiliated to Soochow University were enrolled from March 2018 to January 2021. The association between NT-proBNP and clinical outcomes in acute ischemic patients was assessed by logistic regression and adjusted for confounding factors. Also, subgroup analyses were conducted based on treatment decisions. Results NT-proBNP was positively correlated with CTP ischemic volume (p < 0.001), infarct core volume (p < 0.001), and ischemic penumbra volume (p < 0.001). Univariate analysis showed that the influence of NT-proBNP and functional outcomes were statistically significant in model 1 (p = 0.002). This phenomenon was persistent after adjusted for age, sex, and body mass index in model 2 (p = 0.011), adjusted for SBP, current smoking, family history of stroke, hypertension, and diabetes mellitus in model 3 (p < 0.001), and adjusted for TnI, D-dimer, PLT, Cr, TC, TG, HDL-C, treatment decisions, and NIHSS score in model 4 (p = 0.027). A high NT-proBNP was associated with a high 90-days mRS score among the total population, IV rt-PA, and standardized treatment groups, but not in IV rt-PA + EVT, EVT, and EVT/IV rt-PA + EVT groups. Conclusion Elevated NT-proBNP levels reveal large CTP infarct core volume and poor 90-day functional outcome in AIS. NT-pro BNP is an independent risk factor for functional outcomes.
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Affiliation(s)
- Xiaozhu Shen
- Department of Neurology, The First Affiliated Hospital of Soochow University, Suzhou, 215000, China.,Department of Geriatrics, Lianyungang Second People's Hospital, Lianyungang, China
| | - Juan Liao
- Department of Neurology, The First Affiliated Hospital of Soochow University, Suzhou, 215000, China
| | - Yi Jiang
- Department of Geriatrics, Lianyungang Second People's Hospital, Lianyungang, China
| | - Yiwen Xu
- Department of Geriatrics, Lianyungang Second People's Hospital, Lianyungang, China
| | - Mengqian Liu
- Department of Geriatrics, Lianyungang Second People's Hospital, Lianyungang, China
| | - Xianxian Zhang
- Department of Neurology, The First Affiliated Hospital of Soochow University, Suzhou, 215000, China. .,Department of Neurology, Yancheng Third People's Hospital, Yancheng, China.
| | - Nan Dong
- Department of Neurology, The First Affiliated Hospital of Soochow University, Suzhou, 215000, China.,Department of Neurology, Suzhou Industrial Park Xinghai Hospital, Suzhou, China
| | - Liqiang Yu
- Department of Neurology, The First Affiliated Hospital of Soochow University, Suzhou, 215000, China
| | - Qingmei Chen
- Department of Neurology, The First Affiliated Hospital of Soochow University, Suzhou, 215000, China
| | - Qi Fang
- Department of Neurology, The First Affiliated Hospital of Soochow University, Suzhou, 215000, China.
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Hervella P, Alonso-Alonso ML, Pérez-Mato M, Rodríguez-Yáñez M, Arias-Rivas S, López-Dequidt I, Pumar JM, Sobrino T, Campos F, Castillo J, Iglesias-Rey R. Surrogate biomarkers of outcome for wake-up ischemic stroke. BMC Neurol 2022; 22:215. [PMID: 35681147 PMCID: PMC9178818 DOI: 10.1186/s12883-022-02740-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/13/2022] [Accepted: 05/31/2022] [Indexed: 11/24/2022] Open
Abstract
Background Wake-up ischemic stroke (IS) has been usually excluded from acute stroke therapy options for being outside of the safe treatment window. We identified risk factors, and clinical or molecular biomarkers that could be therapeutic targets for wake-up stroke prevention, thus hopefully leading to a decrease in its mortality and disability in medium to long-term outcome. Methods 4251 ischemic stroke (IS) patients from a prospectively registered database were recruited; 3838 (90.3%) had known onset-symptom time, and 413 (9.7%) were wake-up strokes. The main endpoint was to analyze the association between different serum biomarkers with wake-up IS episodes and their progression. Leukocytes count, serum levels of C-reactive protein, fibrinogen, interleukin 6 (IL-6), and vitamin D were analyzed as inflammation biomarkers; N-terminal pro-B-type Natriuretic-Peptide and microalbuminuria, used as atrial/endothelial dysfunction biomarkers; finally, glutamate levels as excitotoxicity biomarker. In addition, demographic, clinical and neuroimaging variables associated with the time-evolution of wake-up IS patients and functional outcome at 3 months were evaluated. Good and poor functional outcome were defined as mRS ≤2 and mRS > 2 at 3 months, respectively. Results Wake-up IS showed a poorer outcome at 3-months than in patients with known on-set-symptom time (59.1% vs. 48.1%; p < 0.0001). Patients with wake-up IS had higher levels of inflammation biomarkers; IL-6 levels at admission (51.5 ± 15.1 vs. 27.8 ± 18.6 pg/ml; p < 0.0001), and low vitamin D levels at 24 h (5.6 ± 5.8 vs. 19.2 ± 9.4 ng/ml; p < 0.0001) are worthy of attention. In a logistic regression model adjusted for vitamin D, OR was 15.1; CI 95%: 8.6–26.3, p < 0.0001. However, we found no difference in vitamin D levels between patients with or without clinical-DWI mismatch (no: 18.95 ± 9.66; yes: 17.84 ± 11.77 ng/mL, p = 0.394). No difference in DWI volume at admission was found (49.3 ± 96.9 ml in wake-up IS patients vs. 51.7 ± 98.2 ml in awake IS patients; p = 0.895). Conclusions Inflammatory biomarkers are the main factors that are strongly associated with wake-up IS episodes. Wake-up IS is associated with lower vitamin D levels. These data indicate that vitamin D deficiency could become a therapeutic target to reduce wake-up IS events.
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Affiliation(s)
- Pablo Hervella
- Neuroimaging and Biotechnology Laboratory (NOBEL), Clinical Neurosciences Research Laboratory (LINC), Health Research Institute of Santiago de Compostela (IDIS), Santiago de Compostela, Spain. .,Hospital Clínico Universitario, Rúa Travesa da Choupana, s/n, 15706, Santiago de Compostela, Spain.
| | - María Luz Alonso-Alonso
- Neuroimaging and Biotechnology Laboratory (NOBEL), Clinical Neurosciences Research Laboratory (LINC), Health Research Institute of Santiago de Compostela (IDIS), Santiago de Compostela, Spain
| | - María Pérez-Mato
- Neuroscience and Cerebrovascular Research Laboratory, Department of Neurology and Stroke Center, La Paz University Hospital, Neuroscience Area of IdiPAZ Health Research Institute, Universidad Autónoma de Madrid, Madrid, Spain
| | - Manuel Rodríguez-Yáñez
- Stroke Unit, Department of Neurology, Hospital Clínico Universitario, Santiago de Compostela, Spain
| | - Susana Arias-Rivas
- Stroke Unit, Department of Neurology, Hospital Clínico Universitario, Santiago de Compostela, Spain
| | - Iria López-Dequidt
- Stroke Unit, Department of Neurology, Hospital Clínico Universitario, Santiago de Compostela, Spain
| | - José M Pumar
- Neuroimaging and Biotechnology Laboratory (NOBEL), Clinical Neurosciences Research Laboratory (LINC), Health Research Institute of Santiago de Compostela (IDIS), Santiago de Compostela, Spain.,Department of Neuroradiology, Hospital Clínico Universitario, Health Research Institute of Santiago de Compostela (IDIS), Santiago de Compostela, Spain
| | - Tomás Sobrino
- Neuroaging Laboratory (NEURAL), Clinical Neurosciences Research Laboratory (LINC), Health Research Institute of Santiago de Compostela (IDIS), Santiago de Compostela, Spain
| | - Francisco Campos
- Translational Stroke Laboratory (TREAT), Clinical Neurosciences Research Laboratory (LINC), Health Research Institute of Santiago de Compostela (IDIS), Santiago de Compostela, Spain
| | - José Castillo
- Neuroimaging and Biotechnology Laboratory (NOBEL), Clinical Neurosciences Research Laboratory (LINC), Health Research Institute of Santiago de Compostela (IDIS), Santiago de Compostela, Spain
| | - Ramón Iglesias-Rey
- Neuroimaging and Biotechnology Laboratory (NOBEL), Clinical Neurosciences Research Laboratory (LINC), Health Research Institute of Santiago de Compostela (IDIS), Santiago de Compostela, Spain. .,Hospital Clínico Universitario, Rúa Travesa da Choupana, s/n, 15706, Santiago de Compostela, Spain.
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