Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Massachusetts.
The Johns Hopkins School of Medicine Department of Medicine, The Johns Hopkins Bloomberg School of Public Health Department of Epidemiology, The Welch Center for Prevention, Epidemiology and Clinical Research, and Johns Hopkins Medical Institutions, Baltimore, Maryland.
J Am Geriatr Soc. 2019 Sep;67(9):1795-1802. doi: 10.1111/jgs.16041. Epub 2019 Jul 10.
BACKGROUND/OBJECTIVES: Falls are frequent and often devastating events among older adults. Cardiovascular disease (CVD) is associated with greater fall risk; however, it is unknown if pathways that contribute to CVD, such as subclinical myocardial damage or wall strain, are related to future falls. We hypothesized that elevations in high-sensitivity cardiac troponin T (hs-cTnT) and N-terminal pro-B-type natriuretic peptide (NT-proBNP), measured in older adults, would be associated with greater fall risk.
Prospective cohort study.
Atherosclerosis Risk in Communities Study participants without known coronary heart disease, heart failure, or stroke.
We measured hs-cTnT or NT-proBNP in 2011 to 2013. Falls were identified from hospital discharge International Classification of Diseases, Ninth Revision (ICD-9), codes or Centers for Medicare and Medicaid Services claims. We used Poisson models adjusted for age, sex, and race/study center to quantify fall rates across approximate quartiles of hs-cTnT (less than 8, 8-10, 11-16, and 17 or greater ng/L) and NT-proBNP (less than 75, 75-124, 125-274, and 275 or greater pg/mL). We used Cox models to determine the association of cardiac markers with fall risk, adjusted for age, sex, race/center, and multiple fall risk factors.
Among 3973 participants (mean age = 76 ± 5 years, 62% women, 22% black), 457 had a subsequent fall during a median follow-up of 4.5 years. Incidence rates across quartiles of hs-cTnT and NT-proBNP were 17.1, 20.0, 26.2, and 36.4 per 1000 person-years and 12.8, 22.2, 28.7, and 48.4 per 1000 person-years, respectively. Comparing highest vs lowest quartiles of either hs-cTnT or NT-proBNP demonstrated a greater than two-fold higher fall risk, with hazard ratios of 2.17 (95% confidence interval {CI} = 1.60-2.95) and 2.34 (95% CI = 1.73-3.16), respectively. In a joint model, the relationships of hs-cTnT and NT-proBNP with falls were significant and independent.
Subclinical elevations of cardiac damage and wall strain were each associated with a higher fall risk in older adults. Further research is needed to determine whether interventions that lower hs-cTnT or NT-proBNP also lower fall risk. J Am Geriatr Soc 67:1795-1802, 2019.
背景/目的：老年人经常发生跌倒，且跌倒通常会造成严重后果。心血管疾病（CVD）与更大的跌倒风险相关；然而，导致 CVD 的途径（如亚临床心肌损伤或壁应变）是否与未来的跌倒有关尚不清楚。我们假设在老年人中测量到的高敏心肌肌钙蛋白 T（hs-cTnT）和 N 末端 B 型利钠肽原（NT-proBNP）升高与更大的跌倒风险相关。
前瞻性队列研究。
无已知冠心病、心力衰竭或中风的动脉粥样硬化风险社区研究参与者。
我们于 2011 年至 2013 年期间测量了 hs-cTnT 或 NT-proBNP。通过医院出院国际疾病分类（ICD-9）代码或医疗保险和医疗补助服务索赔确定跌倒情况。我们使用泊松模型，根据年龄、性别和种族/研究中心进行调整，以量化 hs-cTnT（<8、8-10、11-16 和 17 或更高 ng/L）和 NT-proBNP（<75、75-124、125-274 和 275 或更高 pg/mL）的近似四分位数的跌倒率。我们使用 Cox 模型来确定心脏标志物与跌倒风险的关联，该模型根据年龄、性别、种族/中心和多个跌倒风险因素进行了调整。
在 3973 名参与者（平均年龄=76±5 岁，62%为女性，22%为黑人）中，457 人在中位随访 4.5 年后发生了后续跌倒。hs-cTnT 和 NT-proBNP 的四分位区间的发生率分别为 17.1、20.0、26.2 和 36.4/1000 人年和 12.8、22.2、28.7 和 48.4/1000 人年。比较 hs-cTnT 或 NT-proBNP 的最高和最低四分位数显示，跌倒风险增加了两倍以上，风险比分别为 2.17（95%置信区间[CI] = 1.60-2.95）和 2.34（95% CI = 1.73-3.16）。在联合模型中，hs-cTnT 和 NT-proBNP 与跌倒的关系均显著且独立。
亚临床心肌损伤和壁应变升高均与老年人更高的跌倒风险相关。需要进一步研究以确定降低 hs-cTnT 或 NT-proBNP 是否也能降低跌倒风险。美国老年医学会 67:1795-1802,2019。
