High-sensitivity cardiac troponin T is associated with cognitive decline in older adults at high cardiovascular risk

Wijsman, Liselotte W.; Craen, Anton J. M. de; Trompet, Stella; Sabayan, Behnam; Muller, Majon; Stott, David J.; Ford, Ian; Welsh, Paul; Westendorp, Rudi G.J.; Jukema, J. Wouter; Sattar, Naveed; Mooijaart, Simon P.

doi:10.1177/2047487316632364

Cited by 23 publications

(31 citation statements)

References 23 publications

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“…Furthermore, impaired cardiac function, measured by NT-proBNP or Troponin, is associated with cognitive dysfunction independently from other cardiovascular risk factors [31][32][33]. As expected, also in this study, a potential predictor for worse cognitive function at baseline in multivariate analysis was a higher vascular burden, as shown before in this cohort [19,34].…”

Section: Discussionsupporting

confidence: 86%

The association of kidney function and cognitive decline in older patients at risk of cardiovascular disease: a longitudinal data analysis

et al. 2020

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Background: Chronic kidney disease (CKD) has been identified as a significant direct marker for cognitive decline, but controversy exists regarding the magnitude of the association of kidney function with cognitive decline across the different CKD stages. Therefore, the aim of this study was to investigate the association of kidney function with cognitive decline in older patients at high risk of cardiovascular disease, using data from the PROspective Study of Pravastatin in the Elderly at Risk (PROSPER). Methods: Data of 5796 patients of PROSPER were used. Strata were made according to clinical stages of CKD based on estimated glomerular filtration rate; < 30 ml/min/1.73m 2 (stage 4), 30-45 ml/min/1.73m 2 (stage 3b), 45-60 ml/min/1.73m 2 (stage 3a) and ≥ 60 ml/min/1.73m 2 (stage 1-2). Cognitive function and functional status was assessed at six different time points and means were compared at baseline and over time, adjusted for multiple prespecified variables. Stratified analyses for history of vascular disease were executed. Results: Mean age was 75.3 years and 48.3% participants were male. Mean follow-up was 3.2 years. For all cognitive function tests CKD stage 4 compared to the other stages had the worst outcome at baseline and a trend for faster cognitive decline over time. When comparing stage 4 versus stage 1-2 over time the estimates (95% CI) were 2.23 (0.60-3.85; p = 0.009) for the Stroop-Colour-Word test, − 0.33 (− 0.66-0.001; p = 0.051) for the Letter-Digit-Coding test, 0.08 (− 0.06-0.21; p = 0.275) for the Picture-Word-Learning test with immediate recall and − 0.07 (− 0.02-0.05; p = 0.509) for delayed recall. This association was most present in patients with a history of vascular disease. No differences were found in functional status. Conclusion: In older people with vascular burden, only severe kidney disease (CKD stage 4), but not mild to modest kidney disease (CKD stage 3a and b), seem to be associated with cognitive impairment at baseline and cognitive decline over time. The association of severe kidney failure with cognitive impairment and decline over time was more outspoken in patients with a history of vascular disease, possibly due to a higher probability of polyvascular damage, in both kidney and brain, in patients with proven cardiovascular disease.

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Section: Discussionsupporting

confidence: 86%

The association of kidney function and cognitive decline in older patients at risk of cardiovascular disease: a longitudinal data analysis

et al. 2020

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“…35 Most prior prospective studies did not account for selective attrition from loss to follow-up or death. 16,21,22 In a prior study, association of NT-proBNP for dementia attenuated but still remained significant and for Alzheimer's disease reversed after using competing risk analysis accounting for death as a competing risk for dementia. 39 Our results were similar after implementation of a multiple imputation approach that minimizes the likelihood that bias due to nondeath attrition can explain the lack of strong evidence of association between the cardiac biomarkers and cognitive change.…”

Section: Discussionmentioning

confidence: 95%

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

Pokharel

Mouhanna

Schneider

et al. 2019

J American Geriatrics Society

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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

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“…21 Other factors may also influence cognitive interference scores such as neural activation 26 rather than increased cerebral perfusion in low-level alcohol users when compared with non-users. 27 As alcohol use increases, the difficulty score pertaining to the STROOP-CWT increases 28 indicating that high levels of alcohol abuse 29 and neural activity 23 previously described in the Black cohort should be considered for the lower cognitive interference scores evident in the Blacks.…”

Section: Executive Cognitive Function Cardiomyocyte Injury and Glucomentioning

confidence: 84%

“…36 This results in a disrupted balance between glucose uptake and release into the circulation leading to excessive glucose accumulation in blood vessels. 2,3 Again, increased neural activity or depressed heart rate variability in the SABPA Black cohort, particularly men, 23,39 might be one mechanism to explain the chronic hyperglycaemia. Indeed, non-dipping Black men revealed higher HbA1c values, and associations were demonstrated between chronically elevated blood glucose and a blunted nocturnal blood pressure dipping.…”

Section: Dysregulated Glucose and Myocyte Stretchmentioning

confidence: 99%

Prospective associations between cardiac stress, glucose dysregulation and executive cognitive function in Black men: The Sympathetic activity and Ambulatory Blood Pressure in Africans study

Vuren

Malan

Känel

et al. 2018

Diabetes and Vascular Disease Research

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Objective: Glucose dysregulation is an independent risk factor for cardiovascular and neurodegenerative disease development through synaptic dysfunction resulting in cognitive decline. The aim of this study was to study the interplay between impaired glycaemic metabolism (hyperglycaemia and insulin resistance), cardiac stress (cardiac troponin T and N-terminal brain natriuretic peptide) and executive cognitive function prospectively, in a bi-ethnic sex cohort. Methods: Black and White teachers (N = 338, aged 20-63 years) from the Sympathetic activity and Ambulatory Blood Pressure in Africans study were monitored over a 3-year period. Fasting blood samples were obtained for cardiac troponin T, N-terminal brain natriuretic peptide, glycated haemoglobin and the homeostatic model assessment-insulin resistance for insulin resistance. The Stroop colour-word conflict test was applied to assess executive cognitive function at baseline. Results: Over the 3-year period, Black men revealed constant high levels of cardiac troponin T (⩾4.2 ng/L), prediabetes (glycated haemoglobin > 5.7%) and insulin resistance (homeostatic model assessment-insulin resistance >3). %Δ Glycated haemoglobin was associated with %Δ insulin resistance (p < 0.001) and increases in %ΔN-terminal brain natriuretic peptide (p = 0.02) in Black men only. In the latter, baseline Stroop colour-word conflict test was inversely associated with %Δ cardiac troponin T (p = 0.001) and %Δ insulin resistance levels (p = 0.01). Conclusion: Progressive myocyte stretch and chronic myocyte injury, coupled with glucose dysregulation, may interfere with processes related to interference control in Black men.

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High-sensitivity cardiac troponin T is associated with cognitive decline in older adults at high cardiovascular risk

Cited by 23 publications

References 23 publications

The association of kidney function and cognitive decline in older patients at risk of cardiovascular disease: a longitudinal data analysis

The association of kidney function and cognitive decline in older patients at risk of cardiovascular disease: a longitudinal data analysis

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

Prospective associations between cardiac stress, glucose dysregulation and executive cognitive function in Black men: The Sympathetic activity and Ambulatory Blood Pressure in Africans study

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