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CLINICAL RESEARCH: BIOMARKERS

Minimally Elevated Cardiac Troponin T and Elevated N-Terminal Pro-B-Type Natriuretic Peptide Predict Mortality in Older Adults

Results From the Rancho Bernardo Study

Lori B. Daniels, MD, MAS^_*,_*, Gail A. Laughlin, PhD, Paul Clopton, MS^_*,, Alan S. Maisel, MD, FACC^_*, and Elizabeth Barrett-Connor, MD

^_* Division of Cardiology, Department of Medicine, University of California at San Diego, San Diego, California
Department of Family and Preventive Medicine, University of California at San Diego, San Diego, California
Veteran's Affairs San Diego Healthcare System, La Jolla, California.

Manuscript received January 18, 2008; revised manuscript received April 23, 2008, accepted April 27, 2008.

^_* Reprint requests and correspondence: Dr. Lori B. Daniels, Mail Code 0986, 9350 Campus Point Drive, Suite 1D, La Jolla, California 92037-1300. (Email: lbdaniels{at}ucsd.edu).

Objectives: This study investigated the prognostic value of detectable cardiac troponin T (TnT) and elevated N-terminal pro-B-type natriuretic peptide (NT-proBNP) levels in a population of community-dwelling older adults.

Background: Minimally elevated levels of TnT, a marker of cardiomyocyte injury, have been found in small subsets of the general population, with uncertain implications. A marker of ventricular stretch, NT-proBNP has clinical utility in many venues, but its long-term prognostic value in apparently healthy older adults and in conjunction with TnT is unknown.

Methods: Participants were 957 older adults from the Rancho Bernardo Study with plasma NT-proBNP and TnT measured at baseline (1997 to 1999) and followed up for mortality through July 2006.

Results: Participants with detectable TnT (0.01 ng/ml, n = 39) had an increased risk of all-cause and cardiovascular death (adjusted hazard ratio [HR] by Cox proportional hazards analysis: 2.06; 95% confidence interval [CI]: 1.29 to 3.28, p = 0.003 for all-cause mortality; HR: 2.06, 95% CI: 1.03 to 4.12, p = 0.040 for cardiovascular mortality); elevated NT-proBNP also predicted an increased risk of all-cause and cardiovascular mortality (adjusted HR per unit-log increase in NT-proBNP: 1.85, 95% CI: 1.36 to 2.52, p < 0.001 for all-cause mortality; HR: 2.51, 95% CI: 1.55 to 4.08, p < 0.001 for cardiovascular mortality). Those with both elevated NT-proBNP and detectable TnT had poorer survival (HR for high NT-proBNP and detectable TnT vs. low NT-proBNP and any TnT: 3.20, 95% CI: 1.91 to 5.38, p < 0.001). Exclusion of the 152 participants with heart disease at baseline did not materially change the TnT mortality or NT-proBNP mortality associations.

Conclusions: Apparently healthy adults with detectable TnT or elevated NT-proBNP levels are at increased risk of death. Those with both TnT and NT-proBNP elevations are at even higher risk, and the increased risk persists for years.

Key Words: aging • cardiovascular diseases • epidemiology • natriuretic peptides • prognosis • risk factors • survival

Abbreviations and Acronyms   AUC = area under the receiver-operator characteristic curve   BMI = body mass index   BUN = blood urea nitrogen   CHD = coronary heart disease   CVD = cardiovascular disease   HR = hazard ratio   NT-proBNP = N-terminal pro-B-type natriuretic peptide   ROC = receiver-operator characteristic   TnT = troponin T

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