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.

Role of Biomarkers for the Prevention, Assessment, and Management of Heart Failure: A Scientific Statement From the American Heart Association

“…49 Furthermore, in the CHS (Cardiovascular Health Study), it was shown that physical activity decreased the likelihood for an increase in NT-proBNP and hs-troponin over time, and this was associated with a lower risk of new-onset HF. 50 …”

Effects of Physical Activity and Sedentary Time on the Risk of Heart Failure

“…39 Physical activity may prevent cardiac injury and neurohormonal activation and thereby decrease the risk of HF. 40 Excessive sedentary behavior is also associated with unfavorable cardiovascular risk factors. 17 Animal and prolonged human bed rest studies suggest that inadequate muscle contraction may suppress skeletal muscle lipoprotein lipase.…”

Dose–Response Relationship Between Physical Activity and Risk of Heart Failure

“…[15][16][17] In contrast, the role of PA in reducing risk of HF has not been emphasized in existing guidelines and public health recommendations. 15 Although observational cohort studies have reported an inverse association between higher levels of PA and HF risk, [18][19][20][21][22][23][24][25][26][27][28][29][30][31][32] a comprehensive assessment of the quantitative dose-response association between PA and HF risk has not been previously reported. Understanding this relationship is important because recent studies suggest that there may be important differences in the mechanisms through which PA modifies HF risk and CHD risk, 20 and the dose of PA needed to significantly lower HF risk may differ from that currently recommended to reduce CHD risk.…”