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Blood‐based cardiac biomarkers and the risk of cognitive decline, vascular events and mortality
Author(s) -
Gyanwali Bibek,
Liu Benedict,
Lai Mitchell KP,
Richards Arthur Mark,
Chen Christopher,
Hilal Saima
Publication year - 2020
Publication title -
alzheimer's and dementia
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 6.713
H-Index - 118
eISSN - 1552-5279
pISSN - 1552-5260
DOI - 10.1002/alz.041689
Subject(s) - medicine , troponin complex , cognitive decline , cardiology , brain natriuretic peptide , biomarker , neuropsychology , context (archaeology) , gdf15 , natriuretic peptide , stroke (engine) , troponin , cognition , heart failure , myocardial infarction , psychiatry , dementia , biology , paleontology , biochemistry , mechanical engineering , disease , engineering
Background Vascular pathology plays an important role in the development of cognitive decline, stroke and mortality. In this context, amino terminal pro‐brain natriuretic peptide (NTpro‐BNP), high sensitivity cardiac troponin T (hs‐cTnT) and growth differentiation factor‐15 (GDF‐15) have been proposed as important biomarkers of early vascular pathology due to their up‐regulation in inflammatory and trophic responses during tissue injury. However, little is known on the longitudinal effects of these cardiac biomarkers and their potential clinical implications. We examine the association of blood‐based cardiac biomarkers (NTpro‐BNP, hs‐cTnT and GDF‐15) with cognitive decline and risk of vascular events and mortality in a memory clinic study. Method A total of 414 (mean age:72.7± 9.1years, 56% women) patients with blood samples, neuropsychological assessment (baseline and at least two neuropsychological assessments obtained a minimum of one year apart), 3T neuroimaging and detailed clinical assessment were recruited. NTpro‐BNP and hs‐cTnT concentrations were measured by electrochemiluminescence immunoassay and GDF‐15 by quantitative sandwich immunoassay technique. Data on incident clinical outcomes and mortality were obtained until June 2018. Result Patients with higher levels of NTpro‐BNP, hs‐cTnT and GDF‐15 showed a greater decline in memory domain per year with a stronger decline observed for hs‐cTnT (p for interaction, <0.001) followed by NTpro‐BNP (p for interaction, 0.001) and GDF‐15 (p for interaction, 0.006). Additionally, hs‐cTnT was associated with accelerated decline in global cognition, executive function and visuomotor speed. During a mean follow‐up of 3 years, 26 (6.2%) patients died and 43 (10.4%) developed vascular events (heart disease and stroke). Patients with higher levels of NTpro‐BNP and hs‐cTnT were at increased risk of vascular events (OR for NTpro‐BNP:2.40, 95%CI: 1.15‐4.98 and OR for hs‐cTnT:5.59, 95%CI: 1.38‐22.72) whereas those with higher levels of NTpro‐BNP and GDF‐15 were at risk of mortality (OR for NTpro‐BNP: 4.48, 95%CI:1.59‐12.58 and OR for GDF‐15: 44.27, 95%CI:5.36‐363.46). Conclusion We showed that the higher levels of blood‐based cardiac biomarkers were associated with worse decline in memory. This suggests that cardiac biomarkers may be useful indicators of vascular brain damage and to identify patients at risk of adverse vascular events and death and could warrant consideration of treatment trials.