Inclusion of Risk Biomarkers Improves Stroke Prediction Interview with:
Dr. Ashkan Shoamanesh MD FRCPC
Assistant Professor
Division of Neurology, Department of Medicine
McMaster University and
Dr. Jose Rafael Romero, MD
Associate Professor of Neurology
Boston University School of Medicine What is the background for this study? What are the main findings?

Response: The Framingham Heart Study is a population-based study of individuals residing in the community. Identifying people who are at risk for stroke can help us determine who would benefit most from existing or new therapies to prevent stroke. As inflammatory pathways are believed to contribute to vascular disease and stroke, we tested whether circulating biomarkers of inflammation and endothelial dysfunction could improve the predictive ability of the Framingham Stroke Risk Profile score, a model that contains classical vascular risk factors such as high blood pressure and diabetes.

Our main observation was that inclusion of 4 biomarkers (C-reactive protein, tumor necrosis factor receptor-2, total homocysteine, and vascular endothelial growth factor) in the Framingham Stroke Risk Profile improved its ability to predict a stroke (net reclassification improvement of 0.34 [0.12–0.57]). What should readers take away from your report?

Response: Circulating biomarkers of inflammation and endothelial dysfunction are associated with an increased risk of first stroke in persons living within the community and can be used to improve stroke prediction models. What recommendations do you have for future research as a result of this study?

Response: These results require validation in separate populations. If replicated, research could then begin investigating clinically relevant thresholds for these biomarkers and whether lowering their levels or blocking their action could be a way to prevent strokes. Is there anything else you would like to add?

Response: Our study does not provide evidence that these markers are validated well enough to be implemented in clinical practice at this time. Thank you for your contribution to the community.


Circulating biomarkers and incident ischemic stroke in the Framingham Offspring Study
Ashkan Shoamanesh, MD,Sarah R. Preis, ScD,Alexa S. Beiser, PhD. ,Carlos S. Kase, MD, Philip A. Wolf, MD,Ramachandran S. Vasan, MD, Emelia J. Benjamin, MD, ScM,Sudha Seshadri, MD* and Jose R. Romero, MD*
Published online before print August 24, 2016, doi:
Neurology 10.1212/WNL.0000000000003115

Note: Content is Not intended as medical advice. Please consult your health care provider regarding your specific medical condition and questions.

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