title: A prospective assessment of cardiac biomarkers for hemodynamic stress and necrosis and the risk of falls among older people: the ActiFE study.
abstract: Falls are related to a complex interaction of risk factors. We examined if cardiac biomarkers for hemodynamic stress (N-terminal pro Brain Natriuretic Peptide-NT-proBNP), and for necrosis [high sensitive (hs) cardiac troponins T (cTnT) and I (cTnI)] are associated with falls in older people. Biomarkers were measured at baseline in a cohort of 1506 community-dwelling adults ≥65 years. Falls were assessed prospectively in a falls calendar (median 370 days). Cox-proportional hazards models evaluated the association of each biomarker with the incidence of the first fall accounting for established confounders. We observed 430 incident falls among 1327 participants and an effect modification by sex for all biomarkers. In multivariable analyses among men a one unit increment of log-transformed hs-cTnI was associated with a hazard ratio (HR) of 1.26 (95 % CI 1.04, 1.53). Men with hs-cTnT ≥ 14 ng/L had a HR of 1.74 (95 % CI 1.15, 2.61) compared to those with undetectable hs-cTnT levels. In women cTn were not associated with falls. We did not detect an association between NT-proBNP and the risk of fall. Our results suggest that cardiac troponins may not only identify subjects at risk for cardiovascular diseases, but also help to understand the underlying complex pathophysiology of falls.
authors.affiliation: Department of Internal Medicine II-Cardiology, University of Ulm Medical Center, Albert-Einstein Allee 23, 89081, Ulm, Germany.|Department of Epidemiology, Boston University School of Public Health, 715 Albany St, Boston, MA, 02118, USA.
authors.forename: Dhayana
authors.initials: D
authors.lastname: Dallmeier
authors.affiliation: Institute of Epidemiology and Medical Biometry, Ulm University, Helmholtzstr. 22, Ulm, Germany.
authors.forename: Jochen
authors.initials: J
authors.lastname: Klenk
authors.affiliation: Institute of Epidemiology and Medical Biometry, Ulm University, Helmholtzstr. 22, Ulm, Germany.
authors.forename: Raphael S
authors.initials: RS
authors.lastname: Peter
authors.affiliation: Agaplesion Bethesda Clinic Ulm, Zollernring 26, 890873, Ulm, Germany.
authors.forename: Michael
authors.initials: M
authors.lastname: Denkinger
authors.affiliation: Institute of Epidemiology and Medical Biometry, Ulm University, Helmholtzstr. 22, Ulm, Germany.|Institute of the History, Philosophy and Ethics of Medicine, Ulm University, Frauensteige 6, 89081, Ulm, Germany.
authors.forename: Richard
authors.initials: R
authors.lastname: Peter
authors.affiliation: Clinic for Geriatric Rehabilitation, Robert-Bosch Hospital, Auerbachstr. 110, 70376, Stuttgart, Germany.
authors.forename: Kilian
authors.initials: K
authors.lastname: Rapp
authors.affiliation: Department of Internal Medicine II-Cardiology, University of Ulm Medical Center, Albert-Einstein Allee 23, 89081, Ulm, Germany. koenig@dhm.mhn.de.|Klinik für Herz- & Kreislauferkrankungen, Deutsches Herzzentrum München, Technische Universität München, Lazarettstr. 36, 80636, Munich, Germany. koenig@dhm.mhn.de.|DZHK (German Centre for Cardiovascular Research), Partner Site Munich Heart Alliance, Munich, Germany. koenig@dhm.mhn.de.
authors.forename: Wolfgang
authors.initials: W
authors.lastname: Koenig
authors.affiliation: Institute of Epidemiology and Medical Biometry, Ulm University, Helmholtzstr. 22, Ulm, Germany.
authors.forename: Dietrich
authors.initials: D
authors.lastname: Rothenbacher
mesh_terms: D000058:Accidental Falls; D000368:Aged; D000369:Aged, 80 and over; D015415:Biomarkers / Q000097:blood; D005260:Female; D006439:Hemodynamics / Q000502:physiology*; D006801:Humans; D008297:Male; D020097:Natriuretic Peptide, Brain / Q000097:blood*; D010446:Peptide Fragments / Q000097:blood*; D011159:Population Surveillance; D016016:Proportional Hazards Models; D011446:Prospective Studies; D012307:Risk Factors; D014336:Troponin / Q000097:blood*
chemical_list: D015415:Biomarkers; D010446:Peptide Fragments; D014336:Troponin; C109794:pro-brain natriuretic peptide (1-76); D020097:Natriuretic Peptide, Brain
keywords: Elderly; Falls; High-sensitive troponin I; High-sensitive troponin T; N-terminal pro Brain Natriuretic Peptide