Title | High-Sensitive Troponin T, Natriuretic Peptide, and Cognitive Change. |
Publication Type | Journal Article |
Year of Publication | 2019 |
Authors | Pokharel Y, Mouhanna F, Schneider ALC, Rawlings AM, Knopman DS, Nambi V, Virani SS, Hoogeveen RC, Alonso A, Heiss G, Coresh JJ, Mosley T, Gottesman R, Selvin E, Ballantyne CM |
Secondary Authors | Power MC |
Journal | J Am Geriatr Soc |
Volume | 67 |
Issue | 11 |
Pagination | 2353-2361 |
Date Published | 2019 11 |
ISSN | 1532-5415 |
Keywords | Atherosclerosis, Biomarkers, Cognition, Cognition Disorders, Female, Follow-Up Studies, Humans, Incidence, Male, Middle Aged, Natriuretic Peptide, Brain, Peptide Fragments, Prospective Studies, Protein Precursors, Risk Assessment, Troponin T, United States |
Abstract | 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. |
DOI | 10.1111/jgs.16092 |
Alternate Journal | J Am Geriatr Soc |
PubMed ID | 31359423 |
PubMed Central ID | PMC6861618 |
Grant List | U01 HL096812 / HL / NHLBI NIH HHS / United States R01-HL70825 / HL / NHLBI NIH HHS / United States U01 HL096917 / HL / NHLBI NIH HHS / United States R01 DK089174 / DK / NIDDK NIH HHS / United States HL096899 / HL / NHLBI NIH HHS / United States HHSN268201700002I / HH / HHS / United States U01 HL096902 / HL / NHLBI NIH HHS / United States HHSN268201700001I / HL / NHLBI NIH HHS / United States U01 HL096814 / HL / NHLBI NIH HHS / United States HHSN268201700003I / HH / HHS / United States R01 HL134320 / HL / NHLBI NIH HHS / United States HHSN268201700003I / HL / NHLBI NIH HHS / United States HL096902 / HL / NHLBI NIH HHS / United States T32HL110837 / HL / NHLBI NIH HHS / United States HL096814 / HL / NHLBI NIH HHS / United States HL096917 / HL / NHLBI NIH HHS / United States R03 AG055485 / AG / NIA NIH HHS / United States HHSN268201700005I / HH / HHS / United States HHSN268201700001I / HH / HHS / United States R25 NS065729 / NS / NINDS NIH HHS / United States HHSN268201700002C / HL / NHLBI NIH HHS / United States K24 DK106414 / DK / NIDDK NIH HHS / United States HHSN268201700004I / HL / NHLBI NIH HHS / United States T32 HL110837 / HL / NHLBI NIH HHS / United States HHSN268201700005C / HL / NHLBI NIH HHS / United States HHSN268201700003C / HL / NHLBI NIH HHS / United States / NH / NIH HHS / United States HHSN268201700001C / HL / NHLBI NIH HHS / United States HHSN268201700004I / HH / HHS / United States R01 HL070825 / HL / NHLBI NIH HHS / United States R03AG055485 / / National Institute of Aging / International U01 HL096899 / HL / NHLBI NIH HHS / United States HHSN268201700004C / HL / NHLBI NIH HHS / United States HHSN268201700002I / HL / NHLBI NIH HHS / United States HHSN268201700005I / HL / NHLBI NIH HHS / United States |