Subclinical Cardiovascular Disease and Fall Risk in Older Adults: Results From the Atherosclerosis Risk in Communities Study

J Am Geriatr Soc. 2019 Sep;67(9):1795-1802. doi: 10.1111/jgs.16041. Epub 2019 Jul 10.


Background/objectives: Falls are frequent and often devastating events among older adults. Cardiovascular disease (CVD) is associated with greater fall risk; however, it is unknown if pathways that contribute to CVD, such as subclinical myocardial damage or wall strain, are related to future falls. We hypothesized that elevations in high-sensitivity cardiac troponin T (hs-cTnT) and N-terminal pro-B-type natriuretic peptide (NT-proBNP), measured in older adults, would be associated with greater fall risk.

Design: Prospective cohort study.

Setting and participants: Atherosclerosis Risk in Communities Study participants without known coronary heart disease, heart failure, or stroke.

Measurements: We measured hs-cTnT or NT-proBNP in 2011 to 2013. Falls were identified from hospital discharge International Classification of Diseases, Ninth Revision (ICD-9), codes or Centers for Medicare and Medicaid Services claims. We used Poisson models adjusted for age, sex, and race/study center to quantify fall rates across approximate quartiles of hs-cTnT (less than 8, 8-10, 11-16, and 17 or greater ng/L) and NT-proBNP (less than 75, 75-124, 125-274, and 275 or greater pg/mL). We used Cox models to determine the association of cardiac markers with fall risk, adjusted for age, sex, race/center, and multiple fall risk factors.

Results: Among 3973 participants (mean age = 76 ± 5 years, 62% women, 22% black), 457 had a subsequent fall during a median follow-up of 4.5 years. Incidence rates across quartiles of hs-cTnT and NT-proBNP were 17.1, 20.0, 26.2, and 36.4 per 1000 person-years and 12.8, 22.2, 28.7, and 48.4 per 1000 person-years, respectively. Comparing highest vs lowest quartiles of either hs-cTnT or NT-proBNP demonstrated a greater than two-fold higher fall risk, with hazard ratios of 2.17 (95% confidence interval {CI} = 1.60-2.95) and 2.34 (95% CI = 1.73-3.16), respectively. In a joint model, the relationships of hs-cTnT and NT-proBNP with falls were significant and independent.

Conclusion: Subclinical elevations of cardiac damage and wall strain were each associated with a higher fall risk in older adults. Further research is needed to determine whether interventions that lower hs-cTnT or NT-proBNP also lower fall risk. J Am Geriatr Soc 67:1795-1802, 2019.

Keywords: N-terminal pro-B-type natriuretic peptide; cardiovascular disease; cohort; falls; high sensitivity cardiac troponin T.

MeSH terms

  • Accidental Falls / statistics & numerical data*
  • Aged
  • Aged, 80 and over
  • Atherosclerosis / blood*
  • Atherosclerosis / complications
  • Biomarkers / blood
  • Cardiovascular Diseases / blood*
  • Cardiovascular Diseases / complications
  • Female
  • Humans
  • Male
  • Medicare
  • Natriuretic Peptide, Brain / blood*
  • Peptide Fragments / blood*
  • Proportional Hazards Models
  • Prospective Studies
  • Risk Factors
  • Troponin T / blood*
  • United States


  • Biomarkers
  • Peptide Fragments
  • TNNT2 protein, human
  • Troponin T
  • pro-brain natriuretic peptide (1-76)
  • Natriuretic Peptide, Brain