TY - JOUR
T1 - Atherothrombotic and thrombolytic biomarkers in incident stroke and atrial fibrillation-related stroke
T2 - The Multi-Ethnic Study of Atherosclerosis (MESA)
AU - Lidani, Karita Claudia Freitas
AU - Trainor, Patrick James
AU - Bhatia, Harpreet S.
AU - Nasir, Khurram
AU - Blaha, Michael J.
AU - Tsai, Michael Y.
AU - Gottesman, Rebecca F.
AU - Post, Wendy S.
AU - Thanassoulis, George
AU - Tsimikas, Sotirios
AU - Heckbert, Susan R.
AU - DeFilippis, Andrew Paul
N1 - Publisher Copyright:
© 2024 The Authors
PY - 2024/3
Y1 - 2024/3
N2 - Background and aims: Although several biomarkers have been studied in thromboembolic stroke, measuring the balance between thrombus formation and thrombolysis and data on its role in predicting stroke and atrial fibrillation (AF)-related stroke is limited. We sought to assess atherothrombotic biomarkers grouped into composite factors that reflect thrombotic and thrombolytic potential, and the balance between these factors as it relates to incident stroke or transient ischemic attack (TIA) and stroke/TIA in AF. Methods: A Thrombotic Factor, derived from fibrinogen, plasmin–antiplasmin complex, factor VIII, D-dimer, and lipoprotein(a); and a Thrombolytic Factor, derived from plasminogen and oxidized phospholipids on plasminogen, were evaluated at baseline in 5,764 Multi-Ethnic Study of Atherosclerosis (MESA) participants. We evaluated the association between these two factors representative of thrombotic and thrombolytic potential and incident stroke/TIA (n = 402), and AF-related stroke/TIA (n = 82) over a median of 13.9 and 3.7 years, respectively. Cox proportional hazard models adjusted for medication use, cardiovascular risk factors and CHA2DS2-VASc score were utilized. Harrell's C-index was estimated to evaluate model performance. Results: In models including both factors, Thrombotic Factor was positively while Thrombolytic Factor was inversely associated with incident stroke/TIA and AF-related stroke/TIA. Incorporating these factors along with the CHA2DS2-VASc in adjusted models resulted in a small improvement in risk prediction of incident stroke/TIA and AF-related stroke/TIA compared to models without the factors (C-index from 0.697 to 0.704, and from 0.657 to 0.675, respectively). Conclusions: Composite biomarker factors, representative of the balance between thrombotic and thrombolytic propensity, provided an improvement in predicting stroke/TIA beyond CHA2DS2-VASc score.
AB - Background and aims: Although several biomarkers have been studied in thromboembolic stroke, measuring the balance between thrombus formation and thrombolysis and data on its role in predicting stroke and atrial fibrillation (AF)-related stroke is limited. We sought to assess atherothrombotic biomarkers grouped into composite factors that reflect thrombotic and thrombolytic potential, and the balance between these factors as it relates to incident stroke or transient ischemic attack (TIA) and stroke/TIA in AF. Methods: A Thrombotic Factor, derived from fibrinogen, plasmin–antiplasmin complex, factor VIII, D-dimer, and lipoprotein(a); and a Thrombolytic Factor, derived from plasminogen and oxidized phospholipids on plasminogen, were evaluated at baseline in 5,764 Multi-Ethnic Study of Atherosclerosis (MESA) participants. We evaluated the association between these two factors representative of thrombotic and thrombolytic potential and incident stroke/TIA (n = 402), and AF-related stroke/TIA (n = 82) over a median of 13.9 and 3.7 years, respectively. Cox proportional hazard models adjusted for medication use, cardiovascular risk factors and CHA2DS2-VASc score were utilized. Harrell's C-index was estimated to evaluate model performance. Results: In models including both factors, Thrombotic Factor was positively while Thrombolytic Factor was inversely associated with incident stroke/TIA and AF-related stroke/TIA. Incorporating these factors along with the CHA2DS2-VASc in adjusted models resulted in a small improvement in risk prediction of incident stroke/TIA and AF-related stroke/TIA compared to models without the factors (C-index from 0.697 to 0.704, and from 0.657 to 0.675, respectively). Conclusions: Composite biomarker factors, representative of the balance between thrombotic and thrombolytic propensity, provided an improvement in predicting stroke/TIA beyond CHA2DS2-VASc score.
KW - Atherothrombosis
KW - Atrial fibrillation
KW - Factor analysis
KW - Stroke
KW - Thrombolysis
UR - http://www.scopus.com/inward/record.url?scp=85183006115&partnerID=8YFLogxK
UR - http://www.scopus.com/inward/citedby.url?scp=85183006115&partnerID=8YFLogxK
U2 - 10.1016/j.atherosclerosis.2024.117451
DO - 10.1016/j.atherosclerosis.2024.117451
M3 - Article
C2 - 38262276
AN - SCOPUS:85183006115
SN - 0021-9150
VL - 390
JO - Atherosclerosis
JF - Atherosclerosis
M1 - 117451
ER -