Background and Purpose-
NT-proBNP (N-terminal pro-
B-type natriuretic peptide) is a risk factor for
atrial fibrillation and a marker of cardiac function used in the detection of
heart failure. Given the link between cardiac dysfunction and
stroke,
NT-proBNP is a candidate marker of
stroke risk. Our aim was to evaluate the association of
NT-proBNP with
stroke and to determine the predictive value beyond a panel of established risk factors. Methods- Based on the
Biomarkers for Cardiovascular Risk Assessment in Europe-Consortium, we analyzed data of 58 173 participants (50% men; mean age 52 y) free of
stroke from 6 community-based cohorts.
NT-proBNP measurements were performed in the central
Biomarkers for Cardiovascular Risk Assessment in Europe laboratory. The outcomes considered were total
stroke and subtypes of
stroke (ischemic/hemorrhagic). Results- During a median follow-up time of 7.9 years, we observed 1550
stroke events (1176 ischemic). Increasing quarters of the
NT-proBNP distribution were associated with increasing risk of
stroke ( P for trend <0.0001; multivariable Cox regression analysis adjusted for risk factors and
cardiac diseases). Individuals in the highest
NT-proBNP quarter (
NT-proBNP >82.2 pg/mL) had 2-fold (95% CI, 75%-151%) greater risk of
stroke than individuals in the lowest quarter (
NT-proBNP <20.4 pg/mL). The association remained unchanged when adjusted for interim coronary events during follow-up, and though it was somewhat heterogeneous across cohorts, it was highly homogenous according to cardiovascular risk profile or subtypes of
stroke. The addition of
NT-proBNP to a reference model increased the C-index discrimination measure by 0.006 ( P=0.0005), yielded a categorical net reclassification improvement of 2.0% in events and 1.4% in nonevents and an integrated discrimination improvement of 0.007. Conclusions- In European individuals free of
stroke, levels of
NT-proBNP are positively associated with risk of ischemic and
hemorrhagic stroke, independently from several other risk factors and conditions. The addition of
NT-proBNP to variables of established risk scores improves prediction of
stroke, with a medium effect size.