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Subclinical cardiovascular disease and frailty risk: the atherosclerosis risk in communities study

Yu Jia^1,2, Dongze Li¹, Jing Yu²

¹Department of Emergency Medicine and National Clinical Research Center for Geriatrics, Disaster Medicine Center, West China Hospital, Sichuan University West China School of Medicine, Chengdu, China.

|April 13, 2022

Insights

Elevated cardiac biomarkers, high-sensitivity cardiac troponin T (hs-cTnT) and N-terminal pro-B-type natriuretic peptide (NT-proBNP), are linked to increased frailty risk in individuals without known cardiovascular disease (CVD). Early detection may aid in identifying those at high risk for frailty.

Area of Science:

Gerontology and Cardiovascular Medicine
Biomarker Discovery and Clinical Application

Background:

Cardiovascular disease (CVD) is a known risk factor for frailty.
The specific pathways linking CVD to frailty risk remain unclear.
This study investigates cardiac biomarkers as potential indicators of frailty risk.

Purpose of the Study:

To determine if elevated levels of high-sensitivity cardiac troponin T (hs-cTnT) and N-terminal pro-B-type natriuretic peptide (NT-proBNP) are associated with an increased risk of developing frailty.
To explore the role of subclinical cardiac damage and strain in the development of frailty.

Main Methods:

Utilized data from the Atherosclerosis Risk in Communities (ARIC) study.
Measured hs-cTnT and NT-proBNP levels from plasma samples collected between 1991-1993.
Assessed frailty status in 2011-2013 and analyzed associations using Cox regression models.

Main Results:

A significant association was found between elevated hs-cTnT (≥14 ng/L) or NT-proBNP (≥300 pg/mL) and a higher incidence of frailty (17.9% vs. 6.7% and 19.7% vs. 6.8%, respectively).
Elevated levels of either biomarker more than doubled the risk of frailty (HRs 2.13 and 2.61).
Individuals with both elevated hs-cTnT and NT-proBNP exhibited a substantially higher frailty risk (HR 4.15).

Conclusions:

High levels of hs-cTnT and NT-proBNP are strongly associated with incident frailty in a community-dwelling population without diagnosed CVD.
Subclinical cardiac damage and/or wall strain indicated by these biomarkers may be key pathways contributing to frailty.
Measuring hs-cTnT and NT-proBNP could facilitate early screening and personalized interventions for frailty.

Read full analysis

Abstract

Background:

Cardiovascular disease (CVD) is associated with a greater frailty risk, but it remains unknown if pathways that contribute to CVD are associated with the frailty risk. Thus, we aimed to investigate whether elevations in high-sensitivity cardiac troponin T (hs-cTnT) and N-terminal pro-B-type natriuretic peptide (NT-proBNP) for those without known CVD at baseline are associated with a higher frailty risk.

Methods:

This study used data from the Atherosclerosis Risk in Communities study. Cardiac biomarkers were measured from stored plasma samples collected at Visit 2 (1991-1993). Frailty was recorded at Visit 5 (2011-2013). Cox regression models were used to determine the association of cardiac biomarkers with frailty risk.

Results:

Overall, 360/5199 (6.9%) participants aged 55.1 ± 5.1 years developed frailty during a median follow-up of 21.7 years. The incidence of frailty was significantly higher in participants with hs-cTnT ≥14 ng/L (vs. < 14 ng/L: 17.9% vs. 6.7%) or NT-proBNP ≥300 pg/ml (vs. < 300 pg/ml: 19.7% vs. 6.8%) (all P < 0.001). Comparing higher vs. lower cut-off levels of either hs-cTnT (14 ng/l) or NT-proBNP (300 pg/ml) demonstrated a greater than two-fold higher frailty risk, with hazard ratios (HRs) of 2.13 (95% confidence interval (CI): 1.130-4.01, P = 0.020) and 2.61 (95% CI: 1.28-5.33, P = 0.008), respectively. Individuals with both elevated hs-cTnT and NT-proBNP had a higher frailty risk than those without it (HR: 4.15; 95% CI: 1.50-11.48, P = 0.006).

Conclusions:

High hs-cTnT and NT-proBNP levels are strongly associated with incident frailty in the community-dwelling population without known CVD. Subclinical cardiac damage (hs-cTnT) and/or wall strain (NT-proBNP) may be the key pathway of CVD patients developing frailty. Detection of hs-cTnT and NT-proBNP may help for early screening of high-risk frailty and providing individualised intervention.

Trial Registration:

URL: https://www.

Clinicaltrials:

gov ; Unique identifier: NCT00005131 .

Keywords:

Cardiovascular disease Frailty High sensitivity cardiac troponin T N-terminal pro-B-type natriuretic peptide

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