TY - JOUR
T1 - High-Sensitive Troponin T, Natriuretic Peptide, and Cognitive Change
AU - Pokharel, Yashashwi
AU - Mouhanna, Farah
AU - Schneider, Andrea L.C.
AU - Rawlings, Andreea M.
AU - Knopman, David S.
AU - Nambi, Vijay
AU - Virani, Salim S.
AU - Hoogeveen, Ron C.
AU - Alonso, Alvaro
AU - Heiss, Gerardo
AU - Coresh, Josef
AU - Mosley, Thomas
AU - Gottesman, Rebecca
AU - Selvin, Elizabeth
AU - Ballantyne, Christie
AU - Power, Melinda C.
N1 - Funding Information:
We thank the staff and participants of the ARIC study for their important contributions. We also thank Dr. Pamela Lutsey for providing the dietary pattern scores. Financial Disclosure: This work was supported in whole or in part with federal funds from the National Heart, Lung, and Blood Institute (NHLBI), National Institutes of Health (NIH), and Department of Health and Human Services under contracts HHSN268201700001I, HHSN268201700002I, HHSN268201700003I, HHSN268201700004I, and HHSN268201700005I. Neurocognitive data were collected with the support of NHLBI U01 HL096812, HL096814, HL096899, HL096902, and HL096917, with previous brain magnetic resonance imaging examinations funded by R01 HL70825. This research was also supported by NIH/NHLBI grant R01 HL134320 to Christie Ballantyne and Elizabeth Selvin. Yashashwi Pokharel was supported by the NHLBI of the NIH under Award Number T32HL110837 and the American Heart Association SWA Summer 2014 Postdoctoral Fellowship Award (15POST23080014).
Publisher Copyright:
© 2019 The American Geriatrics Society
PY - 2019/11/1
Y1 - 2019/11/1
N2 - OBJECTIVES: Cardiac troponin T, measured using a high-sensitive assay (hs-cTnT), and N-terminal pro-B-type natriuretic peptide (NT-proBNP) are associated with increased stroke risk and perhaps with cognitive decline. However, few well-designed prospective studies with extended follow-up have been conducted. We aimed to estimate the association of hs-cTnT and NT-proBNP with 15-year cognitive change in the Atherosclerosis Risk in Communities (ARIC) study. DESIGN: Prospective cohort study. SETTING: Four US communities. PARTICIPANTS: A total of 9114 and 9108 participants from the Atherosclerosis Risk in Communities study for analyses of hs-cTnT and NT-proBNP, respectively. MEASUREMENTS: We examined association of hs-cTnT and NT-proBNP with 15-year change (1996-1998 to 2011-2013) in three cognitive tests of executive function (Digit Symbol Substitution Test), verbal learning memory (Delayed Word Recall Test), and semantic fluency (Word Fluency Test), and an overall score combining the three tests using multivariable linear mixed effect models. We conducted several sensitivity analyses including multiple imputations to address bias due to missing data and attrition, and we compared associations within groups combining hs-cTnT and NT-proBNP into a three-level categorical variable. RESULTS: At baseline (1996-1998), mean age was 63.4 (standard deviation [SD] = 5.7) years; 56.4% were women, and 17.5% were black. The hs-cTnT at baseline was not associated with cognitive change in any measure. Some evidence indicated accelerated decline in verbal learning and memory when comparing those in the highest with the lowest NT-proBNP quintiles; however, this association was not replicated when considering clinically relevant cutoffs or deciles of exposure in survivors. Sensitivity analyses were consistent with our primary analyses. There was little evidence to support effect modification by any considered factors. People with highest levels of both biomarkers had excessive decline in global z scores vs people with lowest levels (−.34; 95% confidence interval = −.63 to −.04). CONCLUSION: Markers of myocardial injury and stretch were not associated with cognitive decline following 15 years among survivors, but when combined together they were suggestive in post hoc analysis. Whether this represents targets of intervention should be examined in the future. J Am Geriatr Soc 67:2353–2361, 2019.
AB - OBJECTIVES: Cardiac troponin T, measured using a high-sensitive assay (hs-cTnT), and N-terminal pro-B-type natriuretic peptide (NT-proBNP) are associated with increased stroke risk and perhaps with cognitive decline. However, few well-designed prospective studies with extended follow-up have been conducted. We aimed to estimate the association of hs-cTnT and NT-proBNP with 15-year cognitive change in the Atherosclerosis Risk in Communities (ARIC) study. DESIGN: Prospective cohort study. SETTING: Four US communities. PARTICIPANTS: A total of 9114 and 9108 participants from the Atherosclerosis Risk in Communities study for analyses of hs-cTnT and NT-proBNP, respectively. MEASUREMENTS: We examined association of hs-cTnT and NT-proBNP with 15-year change (1996-1998 to 2011-2013) in three cognitive tests of executive function (Digit Symbol Substitution Test), verbal learning memory (Delayed Word Recall Test), and semantic fluency (Word Fluency Test), and an overall score combining the three tests using multivariable linear mixed effect models. We conducted several sensitivity analyses including multiple imputations to address bias due to missing data and attrition, and we compared associations within groups combining hs-cTnT and NT-proBNP into a three-level categorical variable. RESULTS: At baseline (1996-1998), mean age was 63.4 (standard deviation [SD] = 5.7) years; 56.4% were women, and 17.5% were black. The hs-cTnT at baseline was not associated with cognitive change in any measure. Some evidence indicated accelerated decline in verbal learning and memory when comparing those in the highest with the lowest NT-proBNP quintiles; however, this association was not replicated when considering clinically relevant cutoffs or deciles of exposure in survivors. Sensitivity analyses were consistent with our primary analyses. There was little evidence to support effect modification by any considered factors. People with highest levels of both biomarkers had excessive decline in global z scores vs people with lowest levels (−.34; 95% confidence interval = −.63 to −.04). CONCLUSION: Markers of myocardial injury and stretch were not associated with cognitive decline following 15 years among survivors, but when combined together they were suggestive in post hoc analysis. Whether this represents targets of intervention should be examined in the future. J Am Geriatr Soc 67:2353–2361, 2019.
KW - N-terminal pro-B-type natriuretic peptide
KW - cognitive change
KW - dementia
KW - high-sensitivity troponin
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U2 - 10.1111/jgs.16092
DO - 10.1111/jgs.16092
M3 - Article
C2 - 31359423
AN - SCOPUS:85070318856
SN - 0002-8614
VL - 67
SP - 2353
EP - 2361
JO - Journal of the American Geriatrics Society
JF - Journal of the American Geriatrics Society
IS - 11
ER -