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Researchers from the University of Murcia (UMU) detect that a protein in the blood (blood biomarker) could help predict the risk of stroke in patients with atrial fibrillation.

This finding could improve the treatments of patients suffering from this arrhythmia, by including more criteria and personalizing their treatment.

At present, a large number of patients with atrial fibrillation are forced to take medication (oral anticoagulants) according to a scale: CHA2DS2-VASc.

This scale is recommended by all atrial fibrillation management guidelines to identify those patients who should be anticoagulated because they have an increased risk of stroke.

It includes eminently clinical risk factors, characteristics of the patient as if he had suffered a previous stroke, if he has a previous cardiovascular disease or if he is male or female.

The significance of these advances, carried out by Dr. Ana Belén Arroyo Rodríguez, of the University of Murcia (UMU), together with her thesis supervisors, Rocío González-Conejero Hilla and Constantino Martínez Gómez, is that for the first time demonstrates the participation of a protein released by neutrophils, cells of the immune system, in the risk of stroke in patients with anticoagulated atrial fibrillation.

Through this research it is concluded that one of the substances released by neutrophils, elastase, could improve the prediction capacity of cardiovascular risk, in order to include it as another criterion within the mentioned scale, to identify the risk of cardiovascular diseases. patients in a more personalized way.

Blood levels of elastase, says this study, are determined by a genetic variant located in a gene of a microRNA (miR146a).

Thus, people with this variant are more susceptible to release elastase to the blood in an inflammatory context, so that this variant is also presented as a prognostic genetic marker of elastase levels.

The most frequent arrhythmia among the population

Atrial fibrillation is a disturbance of the heart rhythm that occurs when the two atria of the heart beat in a chaotic and irregular way.

People who suffer from this arrhythmia are more prone to suffer stroke.

When the atria fail, the blood does not flow properly, favoring the formation of a clot that, at a given moment, could be released and migrate to the cerebral arteries and, in the case of running aground, lead to a stroke.

This cardiac arrhythmia is the most frequent in the population with a prevalence of around 2% in the population increasing to 15% in patients older than 80 years.

According to the researchers, "one of the factors that may be involved in the formation of the clot is inflammation," as people suffering from cardiac arrhythmia have a state of chronic inflammation associated with a genetic disorder.

Elastase, a blood biomarker to predict thrombi

Those people carrying the genetic variant of miR146a have a greater inflammatory response, more possibilities of neutrophil activation and more release of components by these to the blood.

Through a series of experiments, it has been shown that one of the components released by neutrophils, elastase, can be a blood biomarker of thrombus risk.

These released substances have a positive side, protect from infection, but, on the other hand, can cause an important inflammatory and prothrombotic state if the inflammatory response persists.

This study has been conducted in 336 patients with atrial fibrillation under 76 years, who have been followed prospectively.

The research, published in the journal of high impact Arteriosclerosis, Thrombosis, and Vascular Biology (ATVB), favors that, when measuring the blood biomarker found, "it is possible to predict those patients who can do worse to identify the risk of patients" , say the experts.

The next step in the research, funded by the Carlos III Institute and the Seneca Foundation with its Excellence group, consists of the validation in other national cohorts, first, and then European cohorts, that both the genetic alteration and the substance The release of neutrophils is related to the appearance of adverse cardiovascular events, such as stroke.

The investigators point out that "these results suppose a step more in the knowledge of this disease, reason why, of being confirmed, they could help in the clinical handling of the patients"

Source: Universidad de Murcia