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High-Sensitive Troponin T, Natriuretic Peptide, and Cognitive Change.

TitleHigh-Sensitive Troponin T, Natriuretic Peptide, and Cognitive Change.
Publication TypeJournal Article
Year of Publication2019
AuthorsPokharel 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 AuthorsPower MC
JournalJ Am Geriatr Soc
Volume67
Issue11
Pagination2353-2361
Date Published2019 11
ISSN1532-5415
KeywordsAtherosclerosis, 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.

DOI10.1111/jgs.16092
Alternate JournalJ Am Geriatr Soc
PubMed ID31359423
PubMed Central IDPMC6861618
Grant ListU01 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