Serum Neurofilament Light Chain useful CV Risk Biomarker in AF, Suggests Research

These findings are published in JAMA Cardiology in March 2026.

Atrial fibrillation (AF) remains a significant driver of adverse cardiovascular outcomes, and while previous research linked neurofilament levels to subclinical neurological damage, a clinical gap persisted regarding its predictive value in modern populations receiving contemporary anticoagulation therapy; consequently, Geethan Baskaran and associates from the Swiss Atrial Fibrillation Cohort (SWISS-AF) aimed to determine if this biomarker could provide novel insights into systemic vascular risk beyond traditional cardiac factors.

The Swiss Atrial Fibrillation Cohort (SWISS-AF) conducted a prospective, multicenter, observational analysis of 2,311 patients across 14 Swiss secondary and tertiary care centers over a median 8-year follow-up period to evaluate how serum neurofilament light chain relates to primary outcomes like major vascular events (MVEs)—a composite of cardiovascular death, nonfatal stroke, and nonfatal myocardial infarction. The study excluded individuals lacking baseline blood samples or follow-up data and assessed secondary endpoints including heart failure hospitalizations and all-cause mortality using multivariable Cox regression models adjusted for various clinical comorbidities.

Key Clinical Findings of the Study Include:

• Primary Event Risk: The analysis demonstrated that healthcare providers should observe a 35% increase in major vascular events for each doubling of the biomarker concentration (adjusted hazard ratio [aHR], 1.35; 95% CI, 1.22-1.50).

• Stroke Risk Prediction: The investigation found that elevated baseline concentrations were associated with a 31% higher hazard of nonfatal stroke (aHR, 1.31; 95% CI, 1.09-1.57).

• Mortality Hazard Assessment: The research highlighted that increasing levels were tied to a 41% rise in all-cause mortality (aHR, 1.41; 95% CI, 1.27-1.56).

• Heart Failure Hospitalization: The study revealed that doubling the marker concentration correlated with a 25% higher risk of heart failure-related admissions (aHR, 1.25; 95% CI, 1.11-1.41).

• Cardiovascular Death Indicators: The finding indicated that every doubling of the biomarker was linked to a 36% increased risk of cardiovascular-related death (aHR, 1.36; 95% CI, 1.20-1.54).

The results suggest that increasing levels of serum neurofilament light chain are independently associated with a broad array of negative cardiovascular outcomes, including a 35% higher hazard for major vascular events per concentration doubling and significantly increased all-cause mortality in patients with atrial fibrillation.

Thus, the study concludes clinicians may find this neuronal damage marker useful for refining the identification of patients at high cardiovascular risk beyond what traditional cardiac risk factors currently provide.

While the investigation was limited by its observational nature and a lack of racial diversity within the Swiss cohort, future research could explore the underlying mechanistic pathways and the potential for biomarker-guided treatment strategies to enhance long-term patient care.

Reference

Baskaran G, Krisai P, Kühne M, et al. Serum neurofilament light chain and cardiovascular outcomes in patients with atrial fibrillation. JAMA Cardiol. Published online March 29, 2026.