title: Highly sensitive cardiac troponin T and long-term mortality in a population of community-derived perimenopausal women: nested case-control study.
abstract: OBJECTIVE
  To assess the association between baseline levels of highly sensitive cardiac troponin T (hs-cTnT) and long-term mortality in perimenopausal women of the general community using a gender specific 99th percentile reference limit.
  
  
  METHODS
  Nested case control.
  
  
  METHODS
  The present study was conducted within the Eindhoven Perimenopausal Osteoporosis Study which is a large prospective cohort of 8503 community-derived women of the city of Eindhoven, The Netherlands.
  
  
  METHODS
  Cases were defined as Eindhoven Perimenopausal Osteoporosis Study participants who provided an adequate baseline blood sample and subsequently experienced death during follow-up between 1994 and 2003. In total, 123 cases were identified. For each case two matched controls were selected using age, body mass index and hypertension as matching factors. The gender specific 99th percentile reference limit determined in the 246 controls was 8.0 ng/l.
  
  
  METHODS
  All cause mortality.
  
  
  RESULTS
  Hs-cTnT was significantly higher in the cases: 3.0 ng/l versus 2.3 ng/l (p=0.04). After adjustment for matching and clinical risk factors, each 1 SD increase of the level of hs-cTnT was significantly associated with mortality (OR 1.3, 95% CI 1.1 to 1.7, p=0.018). With amino-terminal pro-B-type natriuretic peptide (NT-proBNP) in the multivariable model as a continuous variable the association of hs-cTnT with mortality was lost. With both hs-cTnT and NT-proBNP as dichotomous variables, the gender specific 99th percentile reference limit (8.0 ng/l) was associated with mortality, independent of NT-proBNP (OR 3.7, 95% CI 1.0 to 13.2, p=0.048).
  
  
  CONCLUSIONS
  In this study of community-derived perimenopausal women, hs-cTnT was associated with long-term mortality, independent of clinical risk factors. With the use of easily applicable cut-off levels, the gender specific reference limit of hs-cTnT had a prognostic impact that was independent of NT-proBNP.
authors: Department of Cardiology 670, Radboud University Nijmegen Medical Centre, Nijmegen, The Netherlands. e.cramer@cardio.umcn.nl
authors: G Etienne
authors: GE
authors: Cramer
authors: Marc A
authors: MA
authors: Brouwer
authors: Huib L
authors: HL
authors: Vader
authors: Menko Jan
authors: MJ
authors: de Boer
authors: Gheorghe A M
authors: GA
authors: Pop
authors: Victor J M
authors: VJ
authors: Pop
authors: Freek W A
authors: FW
authors: Verheugt
mesh_terms: D015415:Biomarkers / Q000097:blood; D002318:Cardiovascular Diseases / Q000097:blood* / Q000401:mortality*; D016022:Case-Control Studies; D002423:Cause of Death; D016009:Chi-Square Distribution; D005260:Female; D006801:Humans; D016015:Logistic Models; D008875:Middle Aged; D015999:Multivariate Analysis; D020097:Natriuretic Peptide, Brain / Q000097:blood; D009426:Netherlands; D016017:Odds Ratio; D010446:Peptide Fragments / Q000097:blood; D047648:Perimenopause / Q000097:blood*; D011379:Prognosis; D011446:Prospective Studies; D018570:Risk Assessment; D012307:Risk Factors; D013997:Time Factors; D020107:Troponin T / Q000097:blood*; D015854:Up-Regulation
chemical_list: D015415:Biomarkers; D010446:Peptide Fragments; C545568:TNNT2 protein, human; D020107:Troponin T; C109794:pro-brain natriuretic peptide (1-76); D020097:Natriuretic Peptide, Brain