Key result
Elevated high-sensitivity cardiac troponin T (≥14 ng/L) increased the risk of incident frailty by more than two-fold (HR 2.13) compared to lower levels in adults without known cardiovascular disease.
Why the study?
Cardiovascular disease is linked to higher frailty risk, but whether pathways contributing to CVD also associate with frailty risk remains unknown.
Do elevated levels of hs-cTnT and NT-proBNP increase the risk of incident frailty in adults without known cardiovascular disease?
Cohort (n=5,199)
Yes
Do elevated levels of hs-cTnT and NT-proBNP increase the risk of incident frailty in adults without known cardiovascular disease?
Elevated hs-cTnT should not yet change frailty screening; hypothesis-generating for biomarker-guided risk stratification in CVD-free adults.
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 .
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Jia et al. (2022) conducted a cohort in Frailty (n=5,199). Elevated high-sensitivity cardiac troponin T (hs-cTnT) ≥14 ng/L vs. hs-cTnT < 14 ng/L was evaluated on Incident frailty (HR 2.13, 95% CI 1.13-4.01, p=0.020). Elevated high-sensitivity cardiac troponin T (≥14 ng/L) increased the risk of incident frailty by more than two-fold (HR 2.13) compared to lower levels in adults without known cardiovascular disease.
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