hs-cTnT (high-sensitivity cardiac troponin T), but not NT-proBNP (N-terminal pro-B natriuretic peptide), has been shown to predict bleeding in patients with atrial fibrillation. Whether these biomarkers are independently associated with bleeding in the general population is unknown.
Methods and Results
We used Cox proportional hazards models to examine the association of hs‐cTnT and NT‐proBNP with incident bleeding (defined by International Classification of Diseases, Ninth Revision [ICD‐9] codes) among 9550 middle‐aged men and women without a history of cardiovascular disease or bleeding. There were 847 hospitalizations with bleeding (92% from gastrointestinal bleeding) during a median follow‐up of 9.0 years. Serum levels of hs‐cTnT were associated with bleeding in a graded fashion, with a hazard ratio of 1.28 (95% CI, 1.06–1.59) for 6 to < 9 ng/L, 1.52 (1.21–1.91) for 9 to < 14, and 2.05 (1.56–2.69) for ≥14 versus < 3 ng/L. For NT‐proBNP, the highest category (≥264 versus < 42 pg/mL) showed a hazard ratio of 2.00 (1.59–2.61), and the remaining 3 categories had hazard ratios ranging from 1.2 to 1.3. Individuals in the highest category of both hs‐cTnT and NT‐proBNP had a hazard ratio of 3.03 (1.97–4.68) compared with those in the lowest categories.
In a community‐based population, elevated hs‐cTnT and NT‐proBNP were associated with bleeding‐related hospitalizations. These biomarkers may have a high utility in identifying people at high risk for bleeding. There is a need for research on the underlying mechanisms linking subclinical cardiac abnormalities and bleeding.
Digital Object Identifier (DOI)
The Atherosclerosis Risk in Communities study has been funded in whole or in part with Federal funds from the National Heart, Lung, and Blood Institute, National Institutes of Health, Department of Health and Human Services, under Contract nos. (HHSN268201700001I, HHSN268201700002I, HHSN268201700003I, HHSN268201700005I, HHSN268201700004I). Dr. Mathews is supported by a training grant (grant Number T32 HL007024) from the National Heart, Lung, and Blood Institute, National Institutes of Health. Dr. Selvin was supported by National Institutes of Health, National Institute of Diabetes and Digestive and Kidney Diseases, National Institute of Health grants (grant numbers K24DK106414, R01DK089174). Roche Diagnostics provided a grant to Baylor College of Medicine for supplies to perform all the assays.
Mathews, Lena; Ishigami, Junichi; Ding, Ning; Hoogeveen, Ron C.; Kucharska-Newton, Anna; Ballantyne, Christie M.; Gottesman, Rebecca; Selvin, Elizabeth; and Matsushita, Kunihiro, "Cardiac Biomarkers and Subsequent Risk of Hospitalization With Bleeding in the Community: Atherosclerosis Risk in Communities Study" (2020). Epidemiology and Environmental Health Faculty Publications. 68.