Biomarkers identified that could predict the risk of stroke

By Dr. Ananya Mandal, MDJan 7 2019

Researchers have successfully developed two biomarkers that could help predict the risk of a heart condition and stroke.

The study titled, “Data-driven discovery and validation of circulating blood-based biomarkers associated with prevalent atrial fibrillation,” was published in the latest issue of the European Heart Journal. The study came from researchers at the Institute of Cardiovascular Sciences and the Institute of Cancer and Genomic Sciences at the University of Birmingham's College of Medical and Dental Sciences.

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Atrial fibrillation (AF) remains one of the commonest causes of arrhythmia or disturbance of the heart rhythm. It affects around 1.6 million people in the United Kingdom and is often the underlying cause for a stroke. According to the British Heart Foundation, this is an important study as it can help detect AF early and predict the risk of stroke in thousands of individuals. At present ECG or EKG (Electrocardiogram) remains the only method to detct AF in a person.

According to the researchers at the University of Birmingham, there are three clinical risk factors and two biomarkers that have an association with AF. The team looked at 638 hospital patients between 2014 and 2016. The blood samples from these patients were analyzed for 40 cardiovascular biomarkers and the patients were assessed for seven clinical risk factors –

• Age
• Sex
• Hypertension
• Heart failure
• History of stroke or transient ischaemic attack (TIA)
• Kidney function and
• Body mass index (BMI).

All participants underwent an ECG. They pinpointed that older, males with a high Body Mass Index or BMI were at the greatest risk of strokes. Of all the biomarkers, two seemed most relevant for strokes. These were brain natriuretic peptide (BNP) and fibroblast growth factor-23 (FGF-23). BNP is a hormone that is secreted by the heart and FGF-23 is a protein that takes part in phosphate regulation. If the levels of these markers are elevated, a person can be considered to be at risk.

According to lead author of the study, “The biomarkers we have identified have the potential to be used in a blood test in community settings such as in GP practices to simplify patient selection for ECG screening.” Co-author Dr Winnie Chua said, “: People with atrial fibrillation are much more likely to develop blood clots and suffer from strokes. To avoid strokes it is important for them to take anticoagulant drugs to prevent blood clotting. However, atrial fibrillation is often only diagnosed after a patient has suffered a stroke. Therefore it is important that patients at risk are screened so that they can begin taking anticoagulants to prevent potentially life-threatening complications.”

The BHF that support the study lauded its findings. Professor Metin Avkiran, associate medical director at the BHF said in a statement, “Atrial fibrillation increases the risk of stroke, a serious condition that causes over 36,000 deaths in the UK each year, but is often detected too late. This research has used sophisticated statistical and machine learning methods to analyse patient data and provides encouraging evidence that a combination of easy-to-measure indices may be used to predict atrial fibrillation. The study may pave the way towards better detection of people with AF and their targeted treatment with blood-thinning medicines for the prevention of stroke and its devastating consequences.”

Authors of the study concluded in their study, “A simple assessment of age, sex, BMI, BNP, and FGF-23 can identify patients with AF, e.g. to enrich populations undergoing ECG screening. Brain natriuretic peptide and FGF-23 may also be useful to stratify patients with AF.” They write, “Three simple clinical risk factors (age, sex, and BMI) and two biomarkers (elevated BNP and elevated FGF-23) identify patients with AF. Further research is warranted to elucidate FGF-23 dependent mechanisms of AF.”