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

PurposeWe 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.MethodsWe 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.ResultsHazard 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.ConclusionsGreater 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.