MedWire News: A high level of enhanced soluble CD40 ligand (sCD40L) independently predicts stroke among high-risk patients with nonvalvular atrial fibrillation (AF), researchers report.

Francesco Violi (Viale del Policlinico, Rome, Italy) and team say that the data from their study "cannot be extrapolated to a population at low risk [for cardiovascular events] and further study is necessary to investigate this issue."

Violi et al measured plasma levels of sCD40L in 231 patients, 177 of whom had permanent or persistent AF and 54 of whom had paroxysmal AF. The patients were then followed-up for a mean of about 28 months.

During follow-up, the 116 patients with a level of sCD40L lower than the median of 4.76 ng/ml experienced a total of six vascular events, including two nonfatal myocardial infarctions (MIs) and four nonfatal ischemic strokes. Conversely, the 115 patients with higher levels of sCD40L experienced 29 vascular events, including 11 fatal and three nonfatal MIs and three fatal and 12 nonfatal ischemic strokes.

Using the Cox proportional hazards model, the researchers calculated that patients with above median levels of sCD40L were 4.64 times more likely to experience a vascular event than patients with below median levels of sCD40L, a significant difference.

This model adjusted for age, gender, hypertension, diabetes, dyslipidemia, oral anticoagulant treatment, antiplatelet treatment, previous cerebral ischemia, previous coronary heart disease, and P-wave complexity ratio.

Looking solely at the risk for cerebrovascular events, the researchers found that patients with above median levels of sCD40L had a significant hazard ratio of 3.28 over the follow-up period, compared with other patients. Age was also a significant independent predictor of such events in this patient group.

The researchers comment in the journal Arteriosclerosis, Thrombosis, and Vascular Biology: "The AF cohort screened encompassed prevalently high-risk patients as more than 70% of patients had to be treated with oral anticoagulants."

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