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Subclinical Cardiovascular Disease and Fall Risk in Older Adults: Results From the Atherosclerosis Risk in Communities Study.

TitleSubclinical Cardiovascular Disease and Fall Risk in Older Adults: Results From the Atherosclerosis Risk in Communities Study.
Publication TypeJournal Article
Year of Publication2019
AuthorsJuraschek SP, Daya N, Appel LJ, Miller ER, Matsushita K, Michos ED, B Windham G, Ballantyne CM
Secondary AuthorsSelvin E
JournalJ Am Geriatr Soc
Volume67
Issue9
Pagination1795-1802
Date Published2019 09
ISSN1532-5415
KeywordsAccidental Falls, Aged, Aged, 80 and over, Atherosclerosis, Biomarkers, Cardiovascular Diseases, Female, Humans, Male, Medicare, Natriuretic Peptide, Brain, Peptide Fragments, Proportional Hazards Models, Prospective Studies, Risk Factors, Troponin T, United States
Abstract

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.

DESIGN: Prospective cohort study.

SETTING AND PARTICIPANTS: Atherosclerosis Risk in Communities Study participants without known coronary heart disease, heart failure, or stroke.

MEASUREMENTS: 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.

RESULTS: 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.

CONCLUSION: 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.

DOI10.1111/jgs.16041
Alternate JournalJ Am Geriatr Soc
PubMed ID31493355
PubMed Central IDPMC6733582
Grant ListU01 HL096812 / HL / NHLBI NIH HHS / United States
R01 DK089174 / DK / NIDDK NIH HHS / United States
R01DK089174 / / NIH/National Institute of Diabetes and Digestive and Kidney Diseases / International
R01HL134320 / / National Institutes of Health (NIH)/National Heart, Lung, and Blood Institute (NHLBI) / International
7K23HL135273-02 / / National Institutes of Health (NIH)/National Heart, Lung, and Blood Institute (NHLBI) / International
L30 AG051250 / AG / NIA NIH HHS / United States
K24 DK106414 / DK / NIDDK NIH HHS / United States
K24DK106414 / / NIH/National Institute of Diabetes and Digestive and Kidney Diseases / International
K23 HL135273 / HL / NHLBI NIH HHS / United States
HHSN268201700002I / HL / NHLBI NIH HHS / United States