{
  "abstract": "Background NT-proBNP (N-terminal pro-B-type natriuretic peptide), high-sensitivity cardiac troponin T (hs-troponin T), and high-sensitivity cardiac troponin I (hs-troponin I) are routine biomarkers and are increasingly being recommended for early risk identification in cardiovascular high-risk populations. This study aimed to investigate the prevalence of elevated NT-proBNP and hs-cardiac troponin T/I and to examine their prognostic value, including social determinants of health (SDoH) for all-cause and CVD mortality risk.Methods Data were obtained from the 1999–2004 National Health and Nutrition Examination Survey (NHANES) and linked to mortality records. In adults aged ≥20 years with hypertension and no history of HF, we assessed the prevalence of elevated NT-proBNP, hs-cTnT, and hs-cTnI biomarkers. We investigated the prognostic value of these biomarkers and SDoH with all-cause and CVD mortality using Cox proportional hazards. Kaplan-Meier survival curves were used to display mortality over time ( figure 1).Results We analyzed data on 31,126 participants, representing an estimated 281.2M non-institutionalized U.S. civilians. Of these, 4,234 (weighted N = 55.2M) met our inclusion criteria; the majority, 53.4%, were females; the mean age was 53.8 SD 16.2 years, and 72.6% were non-Hispanic White ( Socio-demographic table 1).The prevalence of elevated NT-proBNP (>400 pg/mL) was 7.6% (95% CI 6.7%-8.6%), representing approximately 4.2M adults. Elevated hs-cTnT (>14 ng/L) and hs-cTnI (>18 ng/L) were present in 12.1% (95% CI 10.7%-13.6%; 6.6M) and 5.7% (95% CI 4.7%-6.6%; 3.0M) of the entire population, respectively.In survey-weighted Cox models adjusted for demographics and clinical covariates, elevated NT-proBNP, hs-cTnT, hs-cTnI, and social deprivation were independently associated with higher all-cause and CVD mortality (all p < 0.002). CVD mortality HRs (95% CI) were NT-proBNP 1.62 (1.46 -1.80); hs-cTnT 2.02 (1.53-2.69); hs-cTnI 1.56 (1.34-1.81); and social deprivation 1.61 (1.22 -2.14).Corresponding HRs (95% CI) for all-cause mortality were significant for each biomarker: NT-proBNP 1.35 (1.26-1.44); hs-cTnT 1.75 (1.48-2.07); hs-cTnI 1.33 (1.24-1.42); and social deprivation 1.51 (1.30-1.75); all p < 0.001.Compared to non-socially deprived individuals with normal biomarkers, those with both social deprivation and elevated biomarkers had the highest risk for all-cause mortality: For NT-proBNP (HR 2.84, 95% CI 2.10-3.84), hs-cTnT (HR 2.35, 95% CI 1.89-2.92), and hs-cTnI (HR 1.88, 95% CI 1.39-2.53). Similar association was observed for CVD mortality with NT-proBNP 4.08 (95% CI 2.69-6.18), hs-cTnT 2.06 (95% CI 3.12-4.43), and hs-cTnI 2.74 (95% CI 1.69-4.47). These were independent of age, sex, race/ethnicity, kidney function, and cardiometabolic risk factors. Subgroup analyses showed that all biomarkers retained prognostic value across age, sex, and comorbidity status (figure 2). SDoH factors, including being unmarried, lower education, unemployment, lack of insurance, food insecurity, housing instability were significantly and independently associated with premature deathConclusion Elevated cardiac biomarkers and social deprivation are independent predictors of increased all-cause and CVD mortality risk among hypertensive patients without HF. Integrating these biomarkers and SDoH factors into clinical practice could provide important information for early risk stratification and screening strategies.Abstract 318 Figure 1Survival curves showing mortality risk by social deprivation and biomarker statusAbstract 318 Figure 2Subgroup analysis showing associations between cardiac biomarkers and CVD/ all-cause mortality among Females only cohortAbstract 318 Table 1Showing sociodemographic characteristics of the study cohort (1999-2004) of patients with hypertension without history of HF",
  "authors": [
    {
      "affiliations": [
        "Liverpool Centre for Cardiovascular Science at Liverpool John Moores University (LJMU), University of Liverpool and Liverpool Heart and Chest Hospital, Liverpool, United Kingdom",
        "School of Pharmacy and Biomolecular Sciences, Liverpool John Moores University, Liverpool, United Kingdom"
      ],
      "name": "Elliot Mbeta"
    },
    {
      "affiliations": [
        "Liverpool Centre for Cardiovascular Science at Liverpool John Moores University (LJMU), University of Liverpool and Liverpool Heart and Chest Hospital, Liverpool, United Kingdom",
        "Department of Cardiology, Liverpool University Hospitals NHS Foundation Trust, Liverpool, Liverpool, United Kingdom"
      ],
      "name": "Rajiv Sankaranarayanan"
    },
    {
      "affiliations": [
        "Liverpool Centre for Cardiovascular Science at Liverpool John Moores University (LJMU), University of Liverpool and Liverpool Heart and Chest Hospital, Liverpool, United Kingdom",
        "School of Pharmacy and Biomolecular Sciences, Liverpool John Moores University, Liverpool, United Kingdom"
      ],
      "name": "Peter Penson"
    },
    {
      "affiliations": [
        "Liverpool Centre for Cardiovascular Science at Liverpool John Moores University (LJMU), University of Liverpool and Liverpool Heart and Chest Hospital, Liverpool, United Kingdom",
        "Cardiovascular and Metabolic Medicine, Institute of Life Course and Medical Sciences, University of Liverpool, Liverpool, United Kingdom",
        "Danish Centre for Health Services Research, Department of Clinical Medicine, Aalborg University, Aalborg, Denmark"
      ],
      "name": "Gregory YH Lip"
    },
    {
      "affiliations": [
        "Liverpool Centre for Cardiovascular Science at Liverpool John Moores University (LJMU), University of Liverpool and Liverpool Heart and Chest Hospital, Liverpool, United Kingdom",
        "School of Pharmacy and Biomolecular Sciences, Liverpool John Moores University, Liverpool, United Kingdom",
        "Research Laboratory, Liverpool Heart and Chest Hospital Liverpool, Liverpool, United Kingdom"
      ],
      "name": "Garry McDowell"
    }
  ],
  "title": "318 Association of cardiac biomarkers and social determinants of health with mortality in hypertensive patients without heart failure: a prospective NHANES analysis",
  "uid": "1e3cfbf7-1a81-5527-b71f-cb500c7e55cf"
}