Relationship between cardiac biomarker concentrations and long-term mortality in subjects with osteoarthritis.

Martin Rehm,Klaus-Peter Günther,Dietrich Rothenbacher,Raphael Simon Peter,Gisela Büchele,Hermann Brenner,Wolfgang Koenig,Rolf Erwin Brenner,Claudio Passino

doi:10.1371/journal.pone.0242814

Abstract

Osteoarthritis (OA) is associated with adverse cardio-metabolic features. N-terminal pro-B-type natriuretic peptide (NT-proBNP) and high-sensitivity troponins T and I (hs-cTnT and hs-cTnI) are well-characterized cardiac markers and provide prognostic information. The objective was to assess the association of cardiac biomarker concentrations with long-term mortality in subjects with OA. In a cohort of 679 OA subjects, undergoing hip or knee replacement during 1995/1996, cardiac biomarkers were measured and subjects were followed over 20 years. During a median follow-up of 18.4 years, 332 (48.9%) subjects died. Median of hs-cTnT, hs-cTnI, and NT-proBNP at baseline was 3.2 ng/L, 3.9 ng/L, and 96.8 ng/L. The top quartile of NT-proBNP was associated with increased risk of mortality (Hazard Ratio (HR) 1.79, 95% confidence interval (CI) 1.17–2.73) after adjustment for covariates including troponins (hs-cTnT HR 1.30 (95% CI 0.90–1.89), hs-cTnI HR 1.32 (95% CI 0.87–2.00) for top category). When biomarker associations were evaluated as continuous variables, only NT-proBNP (HR per log-unit increment 1.34, 95% CI 1.16–1.54) and hs-cTnI (HR 1.38, 95% CI 1.11–1.72) showed robust results. Elevated cardiac biomarker concentrations predicted an increased risk of long-term mortality and strongest for NT-proBNP and hs-cTnI. These results might help to identify subjects at risk and target preventive efforts early.

Highlights

Cardiac troponins are established biomarkers for the diagnosis of myocardial infarction (MI) [1]
A history of diabetes mellitus, hypertension, myocardial infarction, and heart failure was reported by 8.7%, 50.5%, 4%, and 18.7% of subjects, respectively
Subjects with diabetes had higher levels of High-sensitivity cardiac troponin T (hs-cTnT) and High-sensitivity cardiac troponin I (hs-cTnI) compared to non-diabetics

Summary

Introduction

Cardiac troponins are established biomarkers for the diagnosis of myocardial infarction (MI) [1]. Serum levels in asymptomatic populations are associated with an increased risk of subsequent cardiovascular and total mortality [2, 3]. Osteoarthritis (OA) is a common age-related degenerative disease of the musculoskeletal system that causes severe joint pain and loss of function [4]. In addition to determinants such as genetic predisposition, advanced age, female sex, joint injury, and increased body mass, various systemic etiological conditions such as inflammation, inflamed adipose tissue, and dyslipidemia are known to be risk factors for OA [5,6,7,8,9]. It has been shown that the presence of metabolic syndrome determines the overall risk for the development and progression of OA. The role of well-established cardiovascular biomarkers in a population with OA has not been evaluated

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