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A prospective assessment of cardiac biomarkers for hemodynamic stress and necrosis and the risk of falls among older people: the ActiFE study

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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.

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Acknowledgments

The authors would like to thank Mrs. Gerlinde Trischler for expert technical assistance. The study was supported by grants from the Ministry of Science, Research and Arts, state of Baden-Wuerttemberg, Germany, as part of the Geriatric Competence Center, Ulm University, and the Hertha-Nathorff-Program for the professional development of female academic physicians to Dr D. Dallmeier, and by additional funds from the Department of Internal Medicine II-Cardiology, Ulm University.

Conflict of interest

The ARCHITECT STAT hs-cTnI assay was provided for free by Abbott. No funding organization had any role in the study design, data collection and analysis, decision to publish, or preparation of the manuscript.

Author information

Authors and Affiliations

  1. Department of Internal Medicine II-Cardiology, University of Ulm Medical Center, Albert-Einstein Allee 23, 89081, Ulm, Germany

    Dhayana Dallmeier & Wolfgang Koenig

  2. Department of Epidemiology, Boston University School of Public Health, 715 Albany St, Boston, MA, 02118, USA

    Dhayana Dallmeier

  3. Institute of Epidemiology and Medical Biometry, Ulm University, Helmholtzstr. 22, Ulm, Germany

    Jochen Klenk, Raphael S. Peter, Richard Peter & Dietrich Rothenbacher

  4. Agaplesion Bethesda Clinic Ulm, Zollernring 26, 890873, Ulm, Germany

    Michael Denkinger

  5. Institute of the History, Philosophy and Ethics of Medicine, Ulm University, Frauensteige 6, 89081, Ulm, Germany

    Richard Peter

  6. Clinic for Geriatric Rehabilitation, Robert-Bosch Hospital, Auerbachstr. 110, 70376, Stuttgart, Germany

    Kilian Rapp

  7. Klinik für Herz- & Kreislauferkrankungen, Deutsches Herzzentrum München, Technische Universität München, Lazarettstr. 36, 80636, Munich, Germany

    Wolfgang Koenig

  8. DZHK (German Centre for Cardiovascular Research), Partner Site Munich Heart Alliance, Munich, Germany

    Wolfgang Koenig

Authors
  1. Dhayana Dallmeier
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  2. Jochen Klenk
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  3. Raphael S. Peter
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  4. Michael Denkinger
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  5. Richard Peter
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  6. Kilian Rapp
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  7. Wolfgang Koenig
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  8. Dietrich Rothenbacher
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Corresponding author

Correspondence to Wolfgang Koenig.

Additional information

The ActiFE study group consists further of: K. Scharffetter-Kochanek, Department of Dermatology and Allergology; H. Geiger, Institute Molecular Medicine and Stem Cell Research; A. Lukas, Agaplesion Bethesda Clinic, M. Riepe, Division of Gerontopsychiatry, Department of Psychiatry and Psychotherapy II; J.M. Steinacker, Department of Sports- and Rehabilitation Medicine; A. Ludolph, C. von Arnim, Department of Neurology; G. Nagel, G. Weinmayr, Institute of Epidemiology and Medical Biometry. All Institutes are located at Ulm University.

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Dallmeier, D., Klenk, J., Peter, R.S. et al. A prospective assessment of cardiac biomarkers for hemodynamic stress and necrosis and the risk of falls among older people: the ActiFE study. Eur J Epidemiol 31, 427–435 (2016). https://doi.org/10.1007/s10654-015-0059-9

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  • DOI: https://doi.org/10.1007/s10654-015-0059-9

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