Cardiac Biomarkers in a Brazilian Indigenous Population Exposed to Arboviruses: A Cross-Sectional Study

Abstract

Arthropod-borne viral diseases are acute febrile illnesses, sometimes with chronic effects, that can be debilitating and even fatal worldwide, affecting particularly vulnerable populations. Indigenous communities face not only the burden of these acute febrile illnesses, but also the cardiovascular complications that are worsened by urbanization. A cross-sectional study was conducted in an Indigenous population in the Northeast Region of Brazil to explore the association between arboviral infections (dengue, chikungunya, and Zika) and cardiac biomarkers, including cardiotrophin 1, growth differentiation factor 15, lactate dehydrogenase B, fatty-acid-binding protein 3, myoglobin, N-terminal pro-B-type natriuretic peptide, cardiac troponin I, big endothelin 1, and creatine kinase-MB, along with clinical and anthropometric factors. The study included 174 individuals from the Fulni-ô community, with a median age of 47 years (interquartile range 39.0 to 56.0). High rates of previous exposure to dengue, chikungunya, and Zika were observed (92.5%, 78.2%, and 95.4% anti-IgG, respectively), while acute exposure (anti-IgM) remained low. The biomarkers were linked to age (especially in the elderly), obesity, chronic kidney disease, and previous or recent exposure to chikungunya. This study pioneers the use of Luminex xMAP technology to reveal the association between cardiac inflammatory biomarkers and exposure to classical arboviruses in an Indigenous population undergoing urbanization.

Keywords: Zika; arboviruses; cardiac biomarkers; cardiac involvement; chikungunya; dengue.

Figure 1

Location of the study area. Fulni-ô ethnic group, Águas Belas, Pernambuco, Brazil.

Figure 2

Distribution and comparison of cardiac and inflammatory biomarkers in relation to demographic, anthropometric, and clinical variables with statistical significance. Legend—BMI: body mass index; CKMB: creatine kinase MB; big ET-1: big endothelin 1; FABP-3: fatty-acid-binding protein 3; GDF-15: growth differentiation factor 15; LDH-B: lactate dehydrogenase B; MFI: mean fluorescence intensity; NT-proBNP: N-terminal pro-B-type natriuretic peptide. Comparisons include (a,b) sex-specific differences in myoglobin and NT-proBNP; (c,d) age-related changes in GDF-15 and big ET-1; (e,f) biomarkers associated with obesity (NT-proBNP and CKMB); (g) glomerular filtration rate and big ET-1; (h–k) associations of diabetes mellitus; and (l–o) CHIKV serology (IgM and IgG) with biomarkers such as cardiotrophin 1, LDH-B, and FABP-3. Statistically significant p-values (<0.05) are indicated above the corresponding panels.