Dhayana Dallmeier1, Michael Denkinger2, Richard Peter3, Kilian Rapp4, Allan S Jaffe5, Wolfgang Koenig6, Dietrich Rothenbacher7. 1. Department of Internal Medicine II-Cardiology, University of Ulm Medical Center, Ulm, Germany; Department of Epidemiology, Boston University School of Public Health, Boston, MA; 2. Agaplesion Bethesda Clinic Ulm, Geriatric Center Ulm/Alb-Donau, Ulm, Germany; Institute of Molecular Medicine and Stem Cell Research. 3. Institute of Epidemiology and Medical Biometry, and Institute of the History, Philosophy, and Ethics of Medicine, Ulm University, Ulm, Germany; 4. Clinic for Geriatric Rehabilitation, Robert-Bosch Hospital, Stuttgart, Germany; 5. Mayo Clinic College of Medicine, Division of Cardiovascular Diseases, Rochester, MN. 6. Department of Internal Medicine II-Cardiology, University of Ulm Medical Center, Ulm, Germany; wolfgang.koenig@uniklinik-ulm.de. 7. Institute of Epidemiology and Medical Biometry, and.
Abstract
BACKGROUND: N-terminal pro B-type natriuretic peptide (NT-proBNP) has strong prognostic value for all-cause mortality in the general population. High-sensitivity assays now allow detection of cardiac troponins even in asymptomatic populations. We examined the association between NT-proBNP, high-sensitivity cardiac troponin T (hs-cTnT), and hs-cTnI and all-cause mortality in older adults. METHODS: We conducted a longitudinal cohort study [Activity and Function in the Elderly in Ulm (ActiFE Ulm)] including 1506 community-dwelling adults ≥65 years old with NT-proBNP, hs-cTnT, and hs-cTnI measured at baseline. We evaluated the associations between log-transformed biomarker concentrations and 4-year total mortality, accounting for possible confounders, with Cox proportional hazards models. RESULTS: We observed 125 deaths among 1422 participants (median follow-up 4 years). We detected effect modification by sex for all biomarkers (all P values <0.05) expressed as hazard ratio (HR) for death per 1-unit increment of ln(biomarker concentration) in women (n = 618, 37 deaths) compared with men (n = 804, 88 deaths): HR 2.97 (95% CI 2.04-4.33) vs 1.73 (1.40-2.13) for NT-proBNP; 3.67 (2.31-5.81) vs 2.15 (1.61-2.87) for hs-cTnT; and 3.32 (2.13-5.18) vs 1.92 (1.55-2.38) for hs-cTnI. Among 777 participants with undetectable hs-cTnT (<5 ng/L), hs-cTnI remained associated with all-cause mortality in age- and sex-adjusted analysis. CONCLUSIONS: NT-proBNP, hs-cTnT, and hs-cTnI were independently associated with all-cause mortality in older adults. The strength of these associations varied between men and women, emphasizing the need for additional sex-specific research among older people.
BACKGROUND: N-terminal pro B-type natriuretic peptide (NT-proBNP) has strong prognostic value for all-cause mortality in the general population. High-sensitivity assays now allow detection of cardiac troponins even in asymptomatic populations. We examined the association between NT-proBNP, high-sensitivity cardiac troponin T (hs-cTnT), and hs-cTnI and all-cause mortality in older adults. METHODS: We conducted a longitudinal cohort study [Activity and Function in the Elderly in Ulm (ActiFE Ulm)] including 1506 community-dwelling adults ≥65 years old with NT-proBNP, hs-cTnT, and hs-cTnI measured at baseline. We evaluated the associations between log-transformed biomarker concentrations and 4-year total mortality, accounting for possible confounders, with Cox proportional hazards models. RESULTS: We observed 125 deaths among 1422 participants (median follow-up 4 years). We detected effect modification by sex for all biomarkers (all P values <0.05) expressed as hazard ratio (HR) for death per 1-unit increment of ln(biomarker concentration) in women (n = 618, 37 deaths) compared with men (n = 804, 88 deaths): HR 2.97 (95% CI 2.04-4.33) vs 1.73 (1.40-2.13) for NT-proBNP; 3.67 (2.31-5.81) vs 2.15 (1.61-2.87) for hs-cTnT; and 3.32 (2.13-5.18) vs 1.92 (1.55-2.38) for hs-cTnI. Among 777 participants with undetectable hs-cTnT (<5 ng/L), hs-cTnI remained associated with all-cause mortality in age- and sex-adjusted analysis. CONCLUSIONS: NT-proBNP, hs-cTnT, and hs-cTnI were independently associated with all-cause mortality in older adults. The strength of these associations varied between men and women, emphasizing the need for additional sex-specific research among older people.
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