TY - JOUR
T1 - Sex-specific associations of established and emerging cardiac biomarkers with all-cause mortality in older adults
T2 - The ActiFE study
AU - Dallmeier, Dhayana
AU - Denkinger, Michael
AU - Peter, Richard
AU - Rapp, Kilian
AU - Jaffe, Allan S.
AU - Koenig, Wolfgang
AU - Rothenbacher, Dietrich
N1 - Publisher Copyright:
© 2014 American Association for Clinical Chemistry.
PY - 2015/2/1
Y1 - 2015/2/1
N2 - 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.
AB - 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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U2 - 10.1373/clinchem.2014.230839
DO - 10.1373/clinchem.2014.230839
M3 - Article
C2 - 25501933
AN - SCOPUS:84921843030
SN - 0009-9147
VL - 61
SP - 389
EP - 399
JO - Clinical chemistry
JF - Clinical chemistry
IS - 2
ER -