Department of Internal Medicine II-Cardiology, University of Ulm Medical Center, Ulm, Germany; Department of Epidemiology, Boston University School of Public Health, Boston, MA;
Agaplesion Bethesda Clinic Ulm, Geriatric Center Ulm/Alb-Donau, Ulm, Germany; Institute of Molecular Medicine and Stem Cell Research.
Clin Chem. 2015 Feb;61(2):389-99. doi: 10.1373/clinchem.2014.230839. Epub 2014 Dec 10.
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.
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.
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.
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.
N 端脑利钠肽前体（NT-proBNP）对全因死亡率具有很强的预后价值，适用于普通人群。高敏检测方法现在甚至可以在无症状人群中检测到心脏肌钙蛋白。我们研究了 NT-proBNP、高敏心肌肌钙蛋白 T（hs-cTnT）和 hs-cTnI 与老年人全因死亡率之间的关系。
我们进行了一项纵向队列研究[乌尔姆老年人活动和功能研究（ActiFE Ulm）]，纳入了 1506 名年龄在 65 岁及以上、基线时检测 NT-proBNP、hs-cTnT 和 hs-cTnI 的社区居住成年人。我们使用 Cox 比例风险模型评估了经对数转换的生物标志物浓度与 4 年总死亡率之间的关联，同时考虑了可能的混杂因素。
在 1422 名参与者中（中位随访时间为 4 年）观察到 125 例死亡。我们发现所有生物标志物的性别存在效应修饰（所有 P 值均<0.05），表现为女性（n=618，37 例死亡）与男性（n=804，88 例死亡）相比，ln（生物标志物浓度）每增加 1 个单位的死亡风险比（HR）：NT-proBNP：2.97（95%CI 2.04-4.33）比 1.73（1.40-2.13）；hs-cTnT：3.67（2.31-5.81）比 2.15（1.61-2.87）；hs-cTnI：3.32（2.13-5.18）比 1.92（1.55-2.38）。在 777 名 hs-cTnT 未检测到（<5ng/L）的参与者中，hs-cTnI 在年龄和性别调整分析中仍与全因死亡率相关。
NT-proBNP、hs-cTnT 和 hs-cTnI 与老年人全因死亡率独立相关。这些关联在男性和女性之间的强度不同，这强调了在老年人中需要进行更多的性别特异性研究。
