Sex-specific associations of established and emerging cardiac biomarkers with all-cause mortality in older adults

The ActiFE study

Dhayana Dallmeier, Michael Denkinger, Richard Peter, Kilian Rapp, Allan S Jaffe, Wolfgang Koenig, Dietrich Rothenbacher

Research output: Contribution to journalArticle

19 Citations (Scopus)

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.

Original languageEnglish (US)
Pages (from-to)389-399
Number of pages11
JournalClinical Chemistry
Volume61
Issue number2
DOIs
StatePublished - Feb 1 2015

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Troponin T
Brain Natriuretic Peptide
Biomarkers
Mortality
Hazards
Independent Living
Troponin
Proportional Hazards Models
Population
Longitudinal Studies
Assays
Cohort Studies
Association reactions
Research

ASJC Scopus subject areas

  • Clinical Biochemistry
  • Biochemistry, medical

Cite this

Sex-specific associations of established and emerging cardiac biomarkers with all-cause mortality in older adults : The ActiFE study. / Dallmeier, Dhayana; Denkinger, Michael; Peter, Richard; Rapp, Kilian; Jaffe, Allan S; Koenig, Wolfgang; Rothenbacher, Dietrich.

In: Clinical Chemistry, Vol. 61, No. 2, 01.02.2015, p. 389-399.

Research output: Contribution to journalArticle

Dallmeier, Dhayana ; Denkinger, Michael ; Peter, Richard ; Rapp, Kilian ; Jaffe, Allan S ; Koenig, Wolfgang ; Rothenbacher, Dietrich. / Sex-specific associations of established and emerging cardiac biomarkers with all-cause mortality in older adults : The ActiFE study. In: Clinical Chemistry. 2015 ; Vol. 61, No. 2. pp. 389-399.
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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

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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