Physical activity, change in biomarkers of myocardial stress and injury, and subsequent heart failure risk in older adults

Abstract

Objectives: The aim of this study was to evaluate the association between physical activity and changes in levels of highly sensitive troponin T (cTnT) and N-terminal pro-B-type natriuretic peptide (NT-proBNP), and the subsequent risk of the development of heart failure (HF) in community-dwelling older adults.

Background: Higher baseline levels of cTnT and NT-proBNP and increases over time correlate with the risk of HF in older adults. Factors modifying these levels have not been identified.

Methods: NT-proBNP and cTnT were measured at baseline and 2 to 3 years later in adults 65 years of age and older free of HF participating in the Cardiovascular Health Study. Self-reported physical activity and walking pace were combined into a composite score. An increase was prespecified for NT-proBNP as a >25% increment from baseline to ≥190 pg/ml and for cTnT as a >50% increment from baseline in participants with detectable levels (≥3 pg/ml).

Results: A total of 2,933 participants free of HF had NT-proBNP and cTnT measured at both time points. The probability of an increase in biomarker concentrations between baseline and follow-up visits was inversely related to the physical activity score. Compared with participants with the lowest score, those with the highest score had an odds ratio of 0.50 (95% confidence interval: 0.33 to 0.77) for an increase in NT-proBNP and an odds ratio of 0.30 (95% confidence interval: 0.16 to 0.55) for an increase in cTnT, after adjusting for comorbidities and baseline levels. A higher activity score associated with a lower long-term incidence of HF. Moreover, at each level of activity, an increase in either biomarker still identified those at higher risk.

Conclusions: These findings suggest that moderate physical activity has protective effects on early heart failure phenotypes, preventing cardiac injury and neurohormonal activation.

Figure 1. Study Participants Included in the Analysis of Physical Activity and Change in Biomarkers

(A) Flow of study participants included in the N-terminal pro–B-type natriuretic peptide (NT-proBNP) analysis. (B) Flow of study participants included in the cardiac troponin T (TnT) analysis. HF = heart failure; hs = highly sensitive.

Figure 2. Proportion of Participants With a Significant Increase in Biomarkers by Baseline Composite Physical Activity Score

N-terminal pro–B-type natriuretic peptide (NT-proBNP) (A) or cardiac troponin T (cTnT) (B).

Figure 3. Rate of Incident HF

(A) Examined by baseline composite physical activity score and subsequent increase in NT-proBNP. Error bars represent 95% confidence intervals. Tests for trend across activity groups: p = 0.02 for a significant increase in the NT-proBNP group and p = 0.001 for no significant increase in the NT-proBNP group. (B) Examined by baseline composite activity score and subsequent increase in cTnT. Error bars represent 95% confidence intervals. Tests for trend across activity groups: p = 0.002 for a significant increase in the cTnT group and p = 0.005 for no significant increase in the cTnT group. HF = heart failure; other abbreviations as in Figure 2.