Troponin T, B-type natriuretic peptide, C-reactive protein, and cause-specific mortality

Ann Epidemiol. 2013 Feb;23(2):66-73. doi: 10.1016/j.annepidem.2012.11.004. Epub 2012 Dec 8.

Abstract

Purpose: We sought to evaluate the associations of high-sensitivity troponin T (Hs-TnT), N-terminal pro-brain natriuretic peptide (NT-proBNP), and high sensitivity C-reactive protein (Hs-CRP) with mortality from any cause, cardiovascular disease (CVD), coronary heart disease (CHD), stroke, cancer, and respiratory disease in the Atherosclerosis Risk in Communities cohort.

Methods: We included 11,193 participants aged 54 to 74 years, initially free of the conditions being studied, and who had biomarkers measured. Participants were followed for a mean of 9.9 years.

Results: Hazard ratios (HR), adjusted for multiple risk factors, for mortality in participants in the highest Hs-TnT category compared with those with undetectable levels were: Total 3.42 (95% confidence interval [CI], 2.75-4.26); CVD, 7.34 (95% CI, 4.64-11.6); CHD, 6.06 (95% CI, 2.91-12.6); stroke, 3.31 (95% CI, 1.26-8.66); cancer, 1.60 (95% CI, 1.08-2.38); and respiratory, 3.85 (95% CI, 1.39-10.7). Comparing the highest NT-proBNP quintile with those in the lowest quintile, the adjusted HRs for mortality were: Total, 3.05 (95% CI, 2.46-3.77); CVD, 7.48 (95% CI, 4.67-12.0); CHD, 4.07 (95% CI, 2.07-7.98); and stroke, 10.4 (95% CI, 2.26-47.7). Comparing extreme Hs-CRP quintiles, the adjusted HRs for mortality were: Total, 1.61 (95% CI, 1.32-1.97); CVD, 1.76 (95% CI, 1.19-2.62); and respiratory, 3.36 (95% CI, 1.34-8.45). Having multiple markers elevated simultaneously greatly increased cause-specific mortality risks.

Conclusions: Greater levels of Hs-TnT, NT-proBNP and Hs-CRP are associated with increased risk of death, not just from CVD, but also from some noncardiovascular causes.

Publication types

  • Research Support, N.I.H., Extramural

MeSH terms

  • Aged
  • Biomarkers / blood
  • C-Reactive Protein / metabolism*
  • Cardiovascular Diseases / blood*
  • Cardiovascular Diseases / diagnosis
  • Cardiovascular Diseases / mortality
  • Female
  • Humans
  • Male
  • Middle Aged
  • Mortality*
  • Natriuretic Peptide, Brain / blood*
  • Neoplasms / blood
  • Neoplasms / mortality
  • Population Surveillance
  • Predictive Value of Tests
  • Prevalence
  • Proportional Hazards Models
  • Prospective Studies
  • Respiration Disorders / blood
  • Respiration Disorders / mortality
  • Risk Factors
  • Surveys and Questionnaires
  • Troponin T / blood*

Substances

  • Biomarkers
  • Troponin T
  • Natriuretic Peptide, Brain
  • C-Reactive Protein