Hassanain Toma, MD

Cushman M, Judd SE, Howard VJ, Kissela B, Gutiérrez OM, Jenny NS, et al. N-Terminal Pro–B-type Natriuretic Peptide and Stroke Risk: The Reasons for Geographic and Racial Differences in Stroke Cohort. Stroke. 2014

The REasons for Geographic And Racial Differences in Stroke (REGARDS) cohort is a national population-based cohort study evaluating racial and geographic disparities in stroke incidence and mortality. Using this cohort, Cushman et al. evaluated the association of the cardiac function biomarker N-terminal pro-B-type natriuretic peptide (NT-proBNP) with first time strokes in whites and blacks over 5.4 years. They showed that NT-proBNP levels were similar in whites and blacks, and did not differ by region. In addition, participants in the top quartile had 2.9 times the risk of stroke and 9.1 times the risk of cardioembolic stroke, when compared to the bottom quartile. Finally in 27% of participants, NT-proBNP levels accurately predicted stroke risk.

Although NT-proBNP failed to shed light on the racial and geographic disparities in stroke incidence and mortality, its utility in predicting stroke risk appears to be promising. The diagnostic utility for NT-proBNP is probably too early for primetime, but I can see its utility in cryptogenic strokes. Imagine an elderly stroke patient whose NT-proBNP falls within the top quartile of this study, and whose ASCOD phenotyping grade is A3,S0,C3,O0,D0, and is pending a prolonged 30-day loop monitoring. Would you anticoagulate?