Effect modification of chronic kidney disease on the association of circulating and imaging cardiac biomarkers with outcomes

Lucile Parker Gregg, Beverley A Huet, Xilong Li, Gates Colbert, Nishank Jain, James A de Lemos, S S Hedayati

Research output: Contribution to journalArticle

10 Citations (Scopus)

Abstract

Background-Cardiac troponin T and brain natriuretic peptide (BNP) are elevated in > 50% of dialysis patients and are associated with poor outcomes. Few data investigated these associations in earlier chronic kidney disease (CKD). Methods and Results-We studied whether CKD modified associations of elevated BNP, N-terminal-pro-BNP, high-sensitivity cardiac troponin T, coronary artery calcification, and left ventricular hypertrophy with all-cause death and cardiovascular death/ events in 3218 multiethnic individuals followed for 12.5 years, and whether biomarkers added prognostic information to traditional cardiovascular risk factors in CKD. Of the cohort, 279 (9%) had CKD. There were 296 deaths and 218 cardiovascular deaths/ events. Of non-CKD individuals, 7% died and 6% had cardiovascular death/event versus 32% and 30% of CKD participants, P < 0.001 for both. The interaction between BNP and CKD on death was significant (P=0.01): the adjusted hazard ratio in CKD was 2.05, 95% CI (1.34, 3.14), but not significant in non-CKD, 1.04 (0.76, 1.41). CKD modified the association of high-sensitivity cardiac troponin T with cardiovascular death/event, adjusted hazard ratio 3.34 (1.56, 7.18) in CKD versus 1.65 (1.16, 2.35) in non-CKD, interaction P=0.09. There was an interaction between N-terminal-pro-BNP and CKD for death in those without prior cardiovascular disease. Addition of each biomarker to traditional risk factors improved risk prediction, except coronary artery calcification was not discriminatory for cardiovascular death/event in CKD. Conclusions-Cardiac biomarkers, with the exception of coronary artery calcification, prognosticated outcomes in early-stage CKD as well as, if not better than, in non-CKD individuals, even after controlling for estimated glomerular filtration rate, and added to information obtained from traditional cardiovascular risk factors alone.

Original languageEnglish (US)
Article numbere005235
JournalJournal of the American Heart Association
Volume6
Issue number7
DOIs
StatePublished - Jul 1 2017

Fingerprint

Chronic Renal Insufficiency
Biomarkers
Brain Natriuretic Peptide
Kidney Diseases
Troponin T
Coronary Vessels
Left Ventricular Hypertrophy
Glomerular Filtration Rate
Dialysis
Cause of Death
Cardiovascular Diseases

Keywords

  • Cardiac biomarkers
  • Cardiovascular outcomes
  • Chronic kidney disease
  • Coronary artery calcium
  • Mortality
  • N-terminal-pro-brain natriuretic peptide
  • Troponin T

ASJC Scopus subject areas

  • Cardiology and Cardiovascular Medicine

Cite this

Effect modification of chronic kidney disease on the association of circulating and imaging cardiac biomarkers with outcomes. / Gregg, Lucile Parker; Huet, Beverley A; Li, Xilong; Colbert, Gates; Jain, Nishank; de Lemos, James A; Hedayati, S S.

In: Journal of the American Heart Association, Vol. 6, No. 7, e005235, 01.07.2017.

Research output: Contribution to journalArticle

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abstract = "Background-Cardiac troponin T and brain natriuretic peptide (BNP) are elevated in > 50{\%} of dialysis patients and are associated with poor outcomes. Few data investigated these associations in earlier chronic kidney disease (CKD). Methods and Results-We studied whether CKD modified associations of elevated BNP, N-terminal-pro-BNP, high-sensitivity cardiac troponin T, coronary artery calcification, and left ventricular hypertrophy with all-cause death and cardiovascular death/ events in 3218 multiethnic individuals followed for 12.5 years, and whether biomarkers added prognostic information to traditional cardiovascular risk factors in CKD. Of the cohort, 279 (9{\%}) had CKD. There were 296 deaths and 218 cardiovascular deaths/ events. Of non-CKD individuals, 7{\%} died and 6{\%} had cardiovascular death/event versus 32{\%} and 30{\%} of CKD participants, P < 0.001 for both. The interaction between BNP and CKD on death was significant (P=0.01): the adjusted hazard ratio in CKD was 2.05, 95{\%} CI (1.34, 3.14), but not significant in non-CKD, 1.04 (0.76, 1.41). CKD modified the association of high-sensitivity cardiac troponin T with cardiovascular death/event, adjusted hazard ratio 3.34 (1.56, 7.18) in CKD versus 1.65 (1.16, 2.35) in non-CKD, interaction P=0.09. There was an interaction between N-terminal-pro-BNP and CKD for death in those without prior cardiovascular disease. Addition of each biomarker to traditional risk factors improved risk prediction, except coronary artery calcification was not discriminatory for cardiovascular death/event in CKD. Conclusions-Cardiac biomarkers, with the exception of coronary artery calcification, prognosticated outcomes in early-stage CKD as well as, if not better than, in non-CKD individuals, even after controlling for estimated glomerular filtration rate, and added to information obtained from traditional cardiovascular risk factors alone.",
keywords = "Cardiac biomarkers, Cardiovascular outcomes, Chronic kidney disease, Coronary artery calcium, Mortality, N-terminal-pro-brain natriuretic peptide, Troponin T",
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T1 - Effect modification of chronic kidney disease on the association of circulating and imaging cardiac biomarkers with outcomes

AU - Gregg, Lucile Parker

AU - Huet, Beverley A

AU - Li, Xilong

AU - Colbert, Gates

AU - Jain, Nishank

AU - de Lemos, James A

AU - Hedayati, S S

PY - 2017/7/1

Y1 - 2017/7/1

N2 - Background-Cardiac troponin T and brain natriuretic peptide (BNP) are elevated in > 50% of dialysis patients and are associated with poor outcomes. Few data investigated these associations in earlier chronic kidney disease (CKD). Methods and Results-We studied whether CKD modified associations of elevated BNP, N-terminal-pro-BNP, high-sensitivity cardiac troponin T, coronary artery calcification, and left ventricular hypertrophy with all-cause death and cardiovascular death/ events in 3218 multiethnic individuals followed for 12.5 years, and whether biomarkers added prognostic information to traditional cardiovascular risk factors in CKD. Of the cohort, 279 (9%) had CKD. There were 296 deaths and 218 cardiovascular deaths/ events. Of non-CKD individuals, 7% died and 6% had cardiovascular death/event versus 32% and 30% of CKD participants, P < 0.001 for both. The interaction between BNP and CKD on death was significant (P=0.01): the adjusted hazard ratio in CKD was 2.05, 95% CI (1.34, 3.14), but not significant in non-CKD, 1.04 (0.76, 1.41). CKD modified the association of high-sensitivity cardiac troponin T with cardiovascular death/event, adjusted hazard ratio 3.34 (1.56, 7.18) in CKD versus 1.65 (1.16, 2.35) in non-CKD, interaction P=0.09. There was an interaction between N-terminal-pro-BNP and CKD for death in those without prior cardiovascular disease. Addition of each biomarker to traditional risk factors improved risk prediction, except coronary artery calcification was not discriminatory for cardiovascular death/event in CKD. Conclusions-Cardiac biomarkers, with the exception of coronary artery calcification, prognosticated outcomes in early-stage CKD as well as, if not better than, in non-CKD individuals, even after controlling for estimated glomerular filtration rate, and added to information obtained from traditional cardiovascular risk factors alone.

AB - Background-Cardiac troponin T and brain natriuretic peptide (BNP) are elevated in > 50% of dialysis patients and are associated with poor outcomes. Few data investigated these associations in earlier chronic kidney disease (CKD). Methods and Results-We studied whether CKD modified associations of elevated BNP, N-terminal-pro-BNP, high-sensitivity cardiac troponin T, coronary artery calcification, and left ventricular hypertrophy with all-cause death and cardiovascular death/ events in 3218 multiethnic individuals followed for 12.5 years, and whether biomarkers added prognostic information to traditional cardiovascular risk factors in CKD. Of the cohort, 279 (9%) had CKD. There were 296 deaths and 218 cardiovascular deaths/ events. Of non-CKD individuals, 7% died and 6% had cardiovascular death/event versus 32% and 30% of CKD participants, P < 0.001 for both. The interaction between BNP and CKD on death was significant (P=0.01): the adjusted hazard ratio in CKD was 2.05, 95% CI (1.34, 3.14), but not significant in non-CKD, 1.04 (0.76, 1.41). CKD modified the association of high-sensitivity cardiac troponin T with cardiovascular death/event, adjusted hazard ratio 3.34 (1.56, 7.18) in CKD versus 1.65 (1.16, 2.35) in non-CKD, interaction P=0.09. There was an interaction between N-terminal-pro-BNP and CKD for death in those without prior cardiovascular disease. Addition of each biomarker to traditional risk factors improved risk prediction, except coronary artery calcification was not discriminatory for cardiovascular death/event in CKD. Conclusions-Cardiac biomarkers, with the exception of coronary artery calcification, prognosticated outcomes in early-stage CKD as well as, if not better than, in non-CKD individuals, even after controlling for estimated glomerular filtration rate, and added to information obtained from traditional cardiovascular risk factors alone.

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KW - Cardiovascular outcomes

KW - Chronic kidney disease

KW - Coronary artery calcium

KW - Mortality

KW - N-terminal-pro-brain natriuretic peptide

KW - Troponin T

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