ASSOCIATION OF N-TERMINAL PRO-B-TYPE NATRIURETIC PEPTIDE AND HIGH-SENSITIVITY TROPONIN WITH MORTALITY IN THE GENERAL POPULATION

Abstract

Objective: High-sensitivity troponin T (Hs-cTnT) and N-terminal pro-B-type Natriuretic Peptide (NT-proBNP) are clinically useful markers of myocardial injury and ventricular function. Whether their elevation in the general population predicts poor prognosis and increased mortality is unclear. Design and method: Serum concentrations of Hs-cTnT and NT-proBNP in participants of the US National Health And Nutrition Examination Survey (NHANES) 1999-2004 were used. Elevated Hs-cTnT and NT-proBNP were defined as 14 ng/L and 125 pg/mL, respectively. Participants were classified according to whether none, one or both of the markers were elevated. The weighted-Cox model was used to estimate the hazard ratios (HRs) for cardiovascular and all-cause mortality. Results: 13,680 patients (mean age 46.7 years, 52.1% female) with a median follow-up of 17 years were included. Compared to the both-not-elevated group, the adjusted HRs [95% confidence interval (CI)] of one and both elevated groups were 1.57 (1.40-1.76) and 2.70 (2.33-3.11), respectively, for all-cause mortality. The corresponding HRs for cardiovascular mortality were 1.58 (1.31-1.92) and 3.36 (2.63-4.30). There was an interaction with age (P-interaction = 0.006) and diabetes status (P-interaction = 0.03) in the association between Hs-cTnT and NT-proBNP categories and cardiovascular mortality. The HR in the both-elevated group was 7.23 (3.79-13.81) in participants <60 years and 2.89 (2.16-3.88) in older participants. The HRs for cardiovascular mortality in participants with and without diabetes were 2.31 (1.48-3.60) and 4.04 (2.87-5.68), respectively. Conclusions: In the general population, elevated Hs-cTnT and NT-proBNP are associated with increased mortality, especially in non-elderly and people without diabetes. These tests may be useful for screening.