High‐Sensitive Troponin T, Natriuretic Peptide, and Cognitive Change

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

Circulating cardiac biomarkers, structural brain changes, and dementia: Emerging insights and perspectives

“…70 The findings summarized above are somewhat contrasted by the results of the ARIC study, which revealed no independent association of NT-proBNP with 15-year change in three cognitive tests of executive function, verbal learning memory, and semantic fluency in a cohort of > 9000 participants. 71 In this study, only in a post hoc analysis the combination of NT-proBNP and hs-cTnT was associated with cognitive decline. Regarding MR-proANP, an association of elevated plasma concentrations of MR-proANP at baseline was associated with higher risk of incident all-cause dementia and VaD, but not AD in a population-based cohort of 5347 community-dwelling older adults.…”

“…There is also evidence suggesting that the link between high BNP and dementia may be age dependent, as it was only observed in people aged <79 years in one study 70 . The findings summarized above are somewhat contrasted by the results of the ARIC study, which revealed no independent association of NT‐proBNP with 15‐year change in three cognitive tests of executive function, verbal learning memory, and semantic fluency in a cohort of > 9000 participants 71 . In this study, only in a post hoc analysis the combination of NT‐proBNP and hs‐cTnT was associated with cognitive decline.…”

“…15 As mentioned above, the ARIC study revealed no association of hs-cTnT with 15-year change in cognitive function. 71 In patients with mild-to-moderate first-ever ischemic stroke without prevalent dementia higher baseline hs-cTnT was associated with higher prevalence of cognitive impairment at baseline and during the 3-year follow-up. 28 Among participants from the ARIC study with manifest diabetes, high levels of hs-cTnI and hs-cTnT were associated with all-cause dementia.…”

Predictive ability of EuroSCORE II integrating cardiactroponin T in patients undergoing OPCABG

“…cTnT is one of the cardiac calmodulin subunits and a specific marker of myocardial injury [ 25 , 26 ]. When myocardial cells damaged, with the rupture of cell membrane structure, cTnT quickly enters circulation [ 27 , 28 ]. The continuous progress of the production technology has continuously improved the detection level of cTnT [ 29 ].…”

Are Cardiac Biomarkers to Predict Cardiovascular Outcomes in Patients with Chronic Kidney Disease Ready for Prime Time?

“…Elevated levels of 2 well-established cardiac biomarkers, highsensitivity cardiac troponin (hs-TnT) and Nterminal pro-B-type natriuretic peptide (NT-proBNP), have classically been found to be elevated in patients with cardiomyocyte damage and stretch (heart failure), respectively. 2 They are also associated with an increased risk for heart failure and mortality in the general population as well as an increased risk for mortality and heart failure hospitalization in patients with heart failure. 3 Thus, cardiac biomarkers have potential to bring a greater level of precision to the cardiac care of patients with CKD.…”