Associations of high-sensitivity cardiac troponin and natriuretic peptide with subsequent risk of infection in persons without cardiovascular disease: The atherosclerosis risk in communities study

Junichi Ishigami, Ron C. Hoogeveen, Christie M. Ballantyne, Aaron R. Folsom, Josef Coresh, Elizabeth Selvin, Kunihiro Matsushita

Research output: Contribution to journalArticlepeer-review

Abstract

Whether persons without prevalent cardiovascular disease (CVD) but elevated levels of high-sensitivity cardiac troponin T (hs-cTnT) or N-terminal pro-B-type natriuretic peptide (NT-proBNP) are at high risk of infection is unknown. Using 1996-2013 data from the Atherosclerosis Risk in Communities Study, we estimated hazard ratios for incident hospitalization with infection in relation to plasma hs-cTnT and NT-proBNP concentrations among participants without prevalent CVD and contrasted them with hazard ratios for persons with prevalent CVD (coronary heart disease, heart failure, or stroke). In a multivariable Cox model, prevalent CVD was significantly associated with risk of hospitalization with infection (hazard ratio (HR) = 1.31, 95% confidence interval (CI): 1.19, 1.45). Among participants without prevalent CVD, hs-cTnT and NT-proBNP were independently associated with infection risk in a graded fashion (e.g., HR = 1.44 (95% CI: 1.24, 1.69) for hs-cTnT ≥14 ng/L and HR = 1.28 (95% CI: 1.14, 1.44) for hs-cTnT 9-13 ng/L vs. <3 ng/L; HR = 1.57 (95% CI: 1.35, 1.81) for NT-proBNP ≥248.1 pg/mL and HR = 1.19 (95% CI: 1.06, 1.34) for NT-proBNP 137.2-248.0 pg/mL vs. <48.1 pg/mL). The 15-year cumulative incidences of hospitalization with infection were similar for participants with prevalent CVD and participants who did not have prevalent CVD but had hs-cTnT ≥14 ng/L or NT-proBNP ≥248.1 pg/mL. Thus, hs-cTnT and NT-proBNP were independently associated with infection risk. Persons without CVD but with elevated hs-cTnT or NT-proBNP levels should be recognized to have similar infection risks as persons with prevalent CVD.

Original languageEnglish (US)
Pages (from-to)2146-2155
Number of pages10
JournalAmerican journal of epidemiology
Volume188
Issue number12
DOIs
StatePublished - Dec 31 2019

Bibliographical note

Funding Information:
J.I. was supported by National Institutes of Health (NIH) grant T32HL007024 from the National Heart, Lung, and Blood Institute (NHLBI). E.S. was supported by NIH grants K24DK106414 and R01DK089174 from the National Institute of Diabetes and Digestive and Kidney Diseases. This research was also supported by NIH grant R01HL134320 awarded to C.M.B. and E.S. by the NHLBI. The Atherosclerosis Risk in Communities Study is performed as a collaborative study supported by NHLBI contracts HHSN268201100005C, HHSN268201100006C, HHSN268201100007C, HHSN268201100008C, HHSN268201100009C, HHSN268201100010C, HHSN268201100011C, and HHSN268201100012C.

Keywords

  • N-terminal pro-B-type natriuretic peptide
  • cardiovascular disease
  • high-sensitivity cardiac troponin T
  • hospitalization
  • infection

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