Association of orthostatic hypotension with incident dementia, stroke, and cognitive decline

ObjectiveTo examine associations of orthostatic hypotension (OH) with dementia and long-term cognitive decline and to update previously published results in the same cohort for stroke with an additional 16 years of follow-up.MethodsWe analyzed data from 11,709 participants without a history of coronary heart disease or stroke who attended the baseline examination (1987–1989) of the prospective Atherosclerosis Risk in Communities (ARIC) study. OH was defined as a drop in systolic blood pressure (BP) of at least 20 mm Hg or a drop in diastolic BP of at least 10 mm Hg on standing. Dementia was ascertained via examination, contact with participants or their proxy, or medical record surveillance. Ischemic stroke was ascertained via cohort surveillance of hospitalizations, cohort follow-up, and linkage with registries. Both outcomes were adjudicated. Cognitive function was ascertained via 3 neuropsychological tests administered in 1990 to 1992 and 1996 to 1998 and a full battery of tests in 2011 to 2013. Scores were summarized and reported as SDs. We used adjusted Cox regression and linear mixed models.ResultsOver ≈25 years, 1,068 participants developed dementia and 842 had an ischemic stroke. Compared to persons without OH at baseline, those with OH had a higher risk of dementia (hazard ratio [HR] 1.54, 95% confidence interval [CI] 1.20–1.97) and ischemic stroke (HR 2.08, 95% CI 1.65–2.62). Persons with OH had greater, although nonsignificant, cognitive decline over 20 years (SD 0.09, 95% CI −0.02 to 0.21).ConclusionsOH assessed in midlife was independently associated with incident dementia and ischemic stroke. Additional studies are needed to elucidate potential mechanisms for these associations and possible applications for prevention.

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Abstract 28: Orthostatic Hypotension is Associated With 20-year Cognitive Decline and Incident Dementia: the Atherosclerosis Risk in Communities (ARIC) Study

Circulation ◽

10.1161/circ.135.suppl_1.28 ◽

2017 ◽

Vol 135 (suppl_1) ◽

Author(s):

Andreea Rawlings ◽

Stephen Juraschek ◽

Gerardo Heiss ◽

Timothy Hughes ◽

Michelle Meyer ◽

...

Keyword(s):

Cognitive Decline ◽

Orthostatic Hypotension ◽

Cox Regression ◽

Underlying Disease ◽

P Value ◽

Atherosclerosis Risk In Communities ◽

Incident Dementia ◽

History Of ◽

Aric Study

Background: Orthostatic hypotension (OH) has been associated with incident cardiovascular disease and all-cause mortality, but few studies have examined long-term associations with cognitive decline and dementia Hypothesis: OH will be associated with greater cognitive decline and risk of incident dementia Methods: We prospectively analyzed 11503 participants who attended visit 1 (1987-1989) of the ARIC study and had no history of coronary heart disease or stroke. OH was defined as a drop in systolic blood pressure (BP) >=20 mmHg or a drop in diastolic BP >=10 mmHg upon standing from a supine position. Dementia was ascertained using cohort surveillance, telephone contact with the participant or their proxy, or a comprehensive cognitive and neurologic exam in 2011-2013. Cognition was measured via three neuropsychological tests administered in 1990-1992, 1996-1998, and 2011-2013 that were summarized using a Z score. We used adjusted Cox regression and linear mixed models. Results: At visit 1 (mean age 54 years, 57% female, 27% black) 6% of participants had OH. In adjusted models, persons with OH at baseline were 40% more likely to develop dementia than those without OH (HR: 1.40, 95%CI: 1.13, 1.73; Table). Associations were significantly larger in persons with hypertension (p-value for interaction=0.023). Persons with OH compared to those without had significantly more cognitive decline over 20 years (difference: -0.12, 95% CI: -0.23, -0.02; Table). Conclusions: OH assessed in midlife was independently associated with incident dementia and cognitive decline over 20 years. Although typically considered a transient mechanism, these data suggest that OH, or the underlying disease conditions manifesting as OH, persist over time. Whether OH is a marker of vulnerability beyond that of standard hypertension measures, or whether repeated transient exposure to hypotension reduces perfusion to the brain sufficiently to lead to long-term cerebral dysfunction is an important area for further research.

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Abstract P179: Comparison of Earlier versus Later Orthostatic Hypotension Assessment Times in Middle-Age Adults of the Atherosclerosis Risk in Communities Study (ARIC)

Circulation ◽

10.1161/circ.135.suppl_1.p179 ◽

2017 ◽

Vol 135 (suppl_1) ◽

Author(s):

Stephen P Juraschek ◽

Natalie Daya ◽

Andreea M Rawlings ◽

Lawrence J Appel ◽

Edgar R Miller ◽

...

Keyword(s):

Orthostatic Hypotension ◽

Standing Position ◽

Adverse Outcomes ◽

Cox Models ◽

Atherosclerosis Risk In Communities ◽

Adverse Health Outcomes ◽

History Of ◽

Risk Of Fall

Background: Guidelines recommend assessing orthostatic hypotension (OH) 3 minutes after rising from supine to standing positions. Hypothesis: Measurements performed immediately after standing will be as informative as measurements performed closer to 3 minutes after standing with regards to symptoms of dizziness or risk of adverse outcomes. Methods: OH, defined as a drop in blood pressure (systolic ≥20 mm Hg or diastolic ≥10 mm Hg) from the supine to standing position, was measured up to five times at 25 seconds intervals in middle-aged (range 44 to 66 years) ARIC participants (1987-1989). Associations between each measurement and history of dizziness upon standing were examined via logistic regression. We used Cox models to examine the association between each of five measurements with risk of fall, fracture, syncope, and all-cause mortality over a median follow-up of 23 years. Results: In 11,449 participants (mean age 54 years, 54% women, 26% black) 10% reported a history of dizziness upon standing. OH assessed at measurement 1 (performed at a mean of 28 seconds after standing) was associated with risk of fall ( P = 0.03), fracture ( P = 0.05), syncope ( P <0.001), and mortality ( P < 0.001) ( Table ). Furthermore, measurement 1 was the only measurement associated with higher odds of dizziness upon standing (OR: 1.5; P = 0.001). Measurement 2 (performed on average 53 seconds after standing) was associated with all long-term outcomes. Measurements 4 and 5 (mean 100 and 116 seconds after standing) were generally less informative with regards to prospective outcomes than earlier measurements and were not statistically associated with history of dizziness. Conclusions: OH measurements obtained, on average, within the first 30 seconds of standing were predictive of long-term adverse health outcomes and were the most strongly related to symptoms of dizziness compared to later measurements. These findings suggest that BP measurements for determining orthostatic hypotension should be performed immediately after standing.

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Abstract MP15: Television Watching in Mid-Life and Long-Term Diabetes Risk: The Atherosclerosis Risk in Communities (ARIC) Study

Circulation ◽

10.1161/circ.141.suppl_1.mp15 ◽

2020 ◽

Vol 141 (Suppl_1) ◽

Author(s):

Michael Fang ◽

Natalie R Daya ◽

Morgan Grams ◽

Elizabeth Selvin

Keyword(s):

Physical Activity ◽

Risk Factors ◽

Weight Status ◽

Incident Diabetes ◽

Television Watching ◽

Atherosclerosis Risk In Communities ◽

History Of ◽

Aric Study

Background: Prolonged television watching is associated with numerous health problems. However, its long-term impact and its joint effect with other risk factors on the development of diabetes remains unclear. Methods: We conducted a prospective cohort analysis of television watching and incident diabetes using data from the Atherosclerosis Risk in Communities (ARIC) Study. We used Cox regression models and considered television watching independently and jointly with physical activity, weight status, and family history of diabetes. At baseline (1987-1989), participants self-reported frequency of television watching, leisure-time physical activity, and parental history of diabetes. Body mass index was calculated from measured weight and height and converted into weight status categories. Incident diabetes was defined as having a fasting glucose >126 mg/dL or non-fasting glucose >200 mg/dL, or self-report of a diagnosis of diabetes or diabetes medication with follow-up to 2017. Results: There were 13,127 participants without diabetes at baseline (mean age, 54, 23% black, 56% female). During 21 years of follow-up, there were 4,280 incident cases of diabetes. Compared to those who watched low levels of television, those who watched medium and high levels were more likely to develop diabetes (HRs 1.13 and 1.51, Figure ). Other risk factors combined with television watching jointly increased the risk of incident diabetes. That is, even within categories of physical activity, weight status, and family history, television watching was an independent risk factor for diabetes. Conclusion: Currently, there is substantial debate regarding the health effects of screen-time. Our study suggests prolonged television watching confers substantial long-term risk for diabetes, even in the setting of other major risk factors. Decreasing exposure to television and other screens may be an important target for diabetes prevention.

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Low Serum Magnesium is Associated with Incident Dementia in the ARIC-NCS Cohort

Nutrients ◽

10.3390/nu12103074 ◽

2020 ◽

Vol 12 (10) ◽

pp. 3074

Author(s):

Aniqa B. Alam ◽

Pamela L. Lutsey ◽

Rebecca F. Gottesman ◽

Adrienne Tin ◽

Alvaro Alonso

Keyword(s):

Cognitive Function ◽

Cognitive Decline ◽

Serum Magnesium ◽

Cognitive Domain ◽

Atherosclerosis Risk In Communities ◽

Incident Dementia ◽

Increased Risk ◽

Aric Study ◽

Multiple Morbidities

Higher serum magnesium is associated with lower risk of multiple morbidities, including diabetes, stroke, and atrial fibrillation, but its potential neuroprotective properties have also been gaining traction in cognitive function and decline research. We studied 12,040 participants presumed free of dementia in the Atherosclerosis Risk in Communities (ARIC) study. Serum magnesium was measured in fasting blood samples collected in 1990–1992. Dementia status was ascertained through cognitive examinations in 2011–2013, 2016–2017, and 2018–2019, along with informant interviews and indicators of dementia-related hospitalization events and death. Participants’ cognitive functioning capabilities were assessed up to five times between 1990–1992 and 2018–2019. The cognitive function of participants who did not attend follow-up study visits was imputed to account for attrition. We identified 2519 cases of dementia over a median follow-up period of 24.2 years. The lowest quintile of serum magnesium was associated with a 24% higher rate of incident dementia compared to those in the highest quintile of magnesium (HR, 1.24; 95% CI, 1.07, 1.44). No relationship was found between serum magnesium and cognitive decline in any cognitive domain. Low midlife serum magnesium is associated with increased risk of incident dementia, but does not appear to impact rates of cognitive decline.

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Abstract P116: Trait Anger Increases Short-term and Long-term Risk for Recurrent CHD: The Atherosclerosis Risk in Communities (ARIC) Study

Circulation ◽

10.1161/circ.127.suppl_12.ap116 ◽

2013 ◽

Vol 127 (suppl_12) ◽

Author(s):

Janice E Williams ◽

Sharon B Wyatt ◽

Kathryn M Rose ◽

David J Couper ◽

Anna Kucharska-Newton

Keyword(s):

Cigarette Smoking ◽

Trait Anger ◽

Middle Aged ◽

Short Term ◽

Men And Women ◽

Atherosclerosis Risk In Communities ◽

Atherosclerosis Risk ◽

Aric Study

Though several large epidemiologic studies have demonstrated the positive association of anger with coronary heart disease (CHD) onset, a dearth of population-based evidence exists regarding the relationship of anger to the clinical course of CHD among people with established disease. Trait anger is conceptualized as a stable personality trait and defined as the tendency to experience frequent and intense anger. Therefore, it is plausible that the effects of trait anger on CHD are long standing. We assessed the hypothesis that trait anger predicts short-term and long-term risk for recurrent CHD among middle-aged men and women. Participants were 611 black or white men and women, ages 48 - 67, who had a history of CHD at the second clinical examination (1990-1992) of the Atherosclerosis Risk in Communities (ARIC) Study. They were followed for the recurrence of CHD (myocardial infarction or fatal CHD) from 1990 through three different time intervals: 1995, 2003, and 2009 (maximum follow-up = 19.0 years). Trait anger (measured at Visit 2) was assessed using the Spielberger Trait Anger Scale, with scores categorized as high, moderate, and low. Cox proportional hazards regression analyses were adjusted for age, sex, race-center, educational level, waist-to-hip ratio, plasma LDL-and HDL-cholesterol levels, hypertension, diabetes, cigarette smoking status, and pack-years of cigarette smoking. After 3 - 5 years of follow-up, the risk for recurrent CHD among participants with high trait anger was more than twice that of their counterparts with low trait anger (2.24 [95% C.I: 1.14 to 4.40]). After 11 - 13 years, the risk was 80% greater (1.80 [95% C.I: 1.17 to 2.78]) and after 17 - 19 years, it was 70% greater (1.70 [95% C.I: 1.15 to 2.52]). The risk for recurrent CHD was strongest in the first time interval but remained strong and statistically significant through 19 years of follow-up. In conclusion, the experience of frequent and intense anger increases short-term and long-term risk for recurrent CHD in middle-aged men and women.

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Abstract TMP83: Long-term Risk of Venous Thromboembolism After Stroke

Stroke ◽

10.1161/str.48.suppl_1.tmp83 ◽

2017 ◽

Vol 48 (suppl_1) ◽

Author(s):

Santosh B Murthy ◽

Alexander E Merkler ◽

Gino Gialdini ◽

Abhinaba Chatterjee ◽

Costantino Iadecola ◽

...

Keyword(s):

Ischemic Stroke ◽

Venous Thromboembolism ◽

Proportional Hazards ◽

Cox Regression ◽

Multivariable Analysis ◽

First Year ◽

Cumulative Rate ◽

Incident Cases

Background: There are few data on the long-term risk of venous thromboembolism (VTE) among stroke survivors. We aimed to compare the incidence of VTE amongst patients with ischemic stroke versus those with intracerebral hemorrhage (ICH). Methods: We identified all adults discharged from nonfederal acute care hospitals in CA, NY, and FL between 2005 and 2012 with previously validated ICD-9-CM codes for ischemic stroke and ICH. Our primary outcome of VTE was defined as pulmonary embolism or deep vein thrombosis. To capture incident cases of VTE, we excluded patients with a VTE prior to or during the index stroke. Kaplan-Meier survival statistics were used to calculate the cumulative rate of incident VTE. Cox regression was used to compare the risk of VTE after stroke while adjusting for demographics, vascular risk factors, and Elixhauser comorbidity index. As there was a violation of the proportional-hazards assumption, we calculated separate hazard ratios (HR) for each year of follow-up. Results: We identified 834,660 patients with stroke, of whom 712,440 (85.3%) had ischemic stroke and 112,220 (14.7%) had ICH. Over a mean follow-up of 2.8 (+/-2.4) years, 19,937 (2.4%) developed VTE. After 7 years, the cumulative rate of VTE was 4.7% (95% confidence interval [CI], 4.5-4.9%) in patients with ICH and 4.4% (95% CI, 4.3-4.5%) in patients with ischemic stroke. In multivariable analysis, VTE risk was higher in the first year after ICH compared to ischemic stroke (HR 1.51; 95% CI, 1.43-1.58). However, following the first year, the hazard of VTE was higher among patients with ischemic stroke versus those with ICH (Figure). Conclusions: The risk of VTE after stroke varies by stroke type and time. Patients with ICH have a higher risk of VTE in the first year after stroke as compared to those with ischemic stroke while patients with ischemic stroke have a higher risk beyond 1 year.

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Predictive value of ankle–brachial index for long-term events of ischemic stroke in hemodialysis patients

Vascular ◽

10.1177/1708538120925954 ◽

2020 ◽

pp. 170853812092595

Author(s):

Kai-Ni Lee ◽

Li-Ping Chou ◽

Chi-Chu Liu ◽

Tsang-Shan Chen ◽

Eric Kim-Tai Lui ◽

...

Keyword(s):

Risk Factors ◽

Regression Analysis ◽

Ischemic Stroke ◽

Cox Regression ◽

Ankle Brachial Index ◽

Hemodialysis Patients ◽

Serum Phosphate ◽

Cox Regression Analysis

Objectives The ankle–brachial index is a noninvasive modality to evaluate atherosclerosis and is a predictive role for future cardiovascular events and mortality. However, few studies have evaluated its relation to long-term future ischemic stroke in hemodialysis patients. Therefore, we examined the relationship between ankle–brachial index and ischemic stroke events among hemodialysis patients in a seven-year follow-up. Methods A total of 84 patients were enrolled. Ankle–brachial index was assessed in January 2009. Primary outcomes included ischemic stroke. An ankle–brachial index < 0.9 was considered abnormal and 1.4 ≥ ankle–brachial index ≥ 0.9 to be normal ankle–brachial index. Results Mean values for ankle–brachial index were 0.98 ± 0.21at study entrance. In addition, 28 patients encountered ischemic stroke in the seven-year follow-up. In univariate Cox regression analysis, old age (hazard ratio (HR): 1.065, 95% confidence interval (CI): 1.030–1.102, p < 0.001), low seven-year averaged serum phosphate levels (HR: 0.473, 95% CI: 0.306–0.730, p = 0.001), and abnormal ankle–brachial index (HR: 0.035, 95% CI: 0.009–0.145, p < 0.001) were risk factors for ischemic stroke. In multivariate Cox regression analysis for significant variables in univariate analysis, abnormal ankle–brachial index (HR: 0.058, 95% CI: 0.012–0.279, p < 0.001) and low seven-year averaged serum phosphate levels (HR: 0.625, 95% CI: 0.404–0.968, p = 0.035) remained the risk factors for ischemic stroke. The risk of ischemic stroke was 3.783-fold in patients with abnormal ankle–brachial index compared with patients with normal ankle–brachial index (HR: 3.783, 95% CI: 1.731–8.269, p = 0.001). Conclusions These findings suggest that ankle–brachial index is an impressive predictor of future ischemic stroke among hemodialysis patients.

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Association of White Matter Hyperintensity Markers on MRI and Long-term Risk of Mortality and Ischemic Stroke

Neurology ◽

10.1212/wnl.0000000000011827 ◽

2021 ◽

Vol 96 (17) ◽

pp. e2172-e2183 ◽

Cited By ~ 1

Author(s):

Rashid Ghaznawi ◽

Mirjam I. Geerlings ◽

Myriam Jaarsma-Coes ◽

Jeroen Hendrikse ◽

Jeroen de Bresser ◽

...

Keyword(s):

Ischemic Stroke ◽

White Matter ◽

Cox Regression ◽

Brain Mri ◽

Arterial Disease ◽

White Matter Hyperintensity ◽

Risk Of Mortality ◽

Mri Scans

ObjectiveTo determine whether white matter hyperintensity (WMH) markers on MRI are associated with long-term risk of mortality and ischemic stroke.MethodsWe included consecutive patients with manifest arterial disease enrolled in the Second Manifestations of Arterial Disease–Magnetic Resonance (SMART-MR) study. We obtained WMH markers (volume, type, and shape) from brain MRI scans performed at baseline using an automated algorithm. During follow-up, occurrence of death and ischemic stroke was recorded. Using Cox regression, we investigated associations of WMH markers with risk of mortality and ischemic stroke, adjusting for demographics, cardiovascular risk factors, and cerebrovascular disease.ResultsWe included 999 patients (59 ± 10 years; 79% male) with a median follow-up of 12.5 years (range 0.2–16.0 years). A greater periventricular or confluent WMH volume was independently associated with a greater risk of vascular death (hazard ratio [HR] 1.29, 95% confidence interval [CI] 1.13–1.47) for a 1-unit increase in natural log-transformed WMH volume and ischemic stroke (HR 1.53, 95% CI 1.26–1.86). A confluent WMH type was independently associated with a greater risk of vascular (HR 1.89, 95% CI 1.15-3.11) and nonvascular death (HR 1.65, 95% CI 1.01–2.73) and ischemic stroke (HR 2.83, 95% CI 1.36-5.87). A more irregular shape of periventricular or confluent WMH, as expressed by an increase in concavity index, was independently associated with a greater risk of vascular (HR 1.20, 95% CI 1.05–1.38 per SD increase) and nonvascular death (HR 1.21, 95% CI 1.03–1.42) and ischemic stroke (HR 1.28, 95% CI 1.05–1.55).ConclusionsWMH volume, type, and shape are associated with long-term risk of mortality and ischemic stroke in patients with manifest arterial disease.

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Abstract P103: Kidney Function and Sudden Cardiac Death in the Community: The Atherosclerosis Risk in Communities (ARIC) Study

Circulation ◽

10.1161/circ.131.suppl_1.p103 ◽

2015 ◽

Vol 131 (suppl_1) ◽

Author(s):

Takeki Suzuki ◽

Sunil K Agarwal ◽

Rajat Deo ◽

Nona Sotoodehnia ◽

Morgan Grams ◽

...

Keyword(s):

Sudden Cardiac Death ◽

Kidney Function ◽

Cardiac Death ◽

Cox Regression ◽

Full Spectrum ◽

Atherosclerosis Risk In Communities ◽

Demographic Subgroups ◽

Aric Study

Introduction: Individuals with chronic kidney disease (CKD), particularly those requiring dialysis, are at high risk of sudden cardiac death (SCD). However, data for the full-spectrum of kidney function and SCD risk in the community are sparse. Furthermore, newly developed equations for estimated glomerular filtration rate (eGFR) and novel filtration markers might add further insight to the role of kidney function in SCD. Methods: We investigated the associations of baseline eGFRs using either serum creatinine, cystatin C (CysC), or both (eGFRcr, eGFRcr-cys, and eGFRcys), CysC itself, and β 2 -microglobulin (B2M) with SCD through 2001 among 13,070 blacks and whites participants at the second visit (1990-92) of the community-based ARIC Study. Cox regression models were used to quantify the associations of kidney function and different markers of kidney filtration with SCD after the adjustment for potential confounders. The cohort was divided into 5 groups based on clinical CKD Stages as well as quartiles. Results: Over a median of 11 years of follow-up, 205 participants developed SCD (1.4 cases per 1000 person-years). Low eGFR was independently associated with SCD risk: for example, HR for eGFR 30-44 vs ≥90 ml/min/1.73m 2 was 3.97 (95%CI 1.57-10.03) with eGFRcr; HR 6.96 (3.56-13.61) with eGFRcr-cys; and HR 5.47 (2.97-10.09) with eGFRcys. Of note, when eGFRcr and eGFRcys were included together in a single model, the association was only significant for eGFRcys. When we compared all kidney markers based on their quartiles, B2M demonstrated the strongest association with SCD ( Table ). Qualitatively consistent results were observed across clinical and demographic subgroups. Conclusion: Kidney function was independently and robustly associated with SCD in the community, particularly when CysC or B2M were taken into account as filtration markers. These results may suggest the importance of kidney function for SCD risk evaluation and the value of novel filtration markers beyond eGFRcr in association with SCD.

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Alcohol Consumption and Cardiac Biomarkers: The Atherosclerosis Risk in Communities (ARIC) Study

Clinical Chemistry ◽

10.1373/clinchem.2016.255778 ◽

2016 ◽

Vol 62 (9) ◽

pp. 1202-1210 ◽

Cited By ~ 8

Author(s):

Mariana Lazo ◽

Yuan Chen ◽

John W McEvoy ◽

Chiadi Ndumele ◽

Suma Konety ◽

...

Keyword(s):

Cardiovascular Disease ◽

Relative Risk ◽

Alcohol Consumption ◽

Wall Stress ◽

Cardiac Biomarkers ◽

Atherosclerosis Risk In Communities ◽

Atherosclerosis Risk ◽

History Of ◽

Aric Study

Abstract BACKGROUND The role of alcohol in the development of subclinical cardiovascular disease is unclear. We examined the association between alcohol consumption and markers of subclinical cardiac damage and wall stress. METHODS We studied the cross-sectional and prospective associations of alcohol consumption with high-sensitivity cardiac troponin T (hs-cTnT) and N-terminal pro B-type natriuretic peptide (NT-proBNP) measured at 2 time points, 6 years apart (baseline, 1990–1992; follow-up, 1996–1998), in over 11000 participants of the Atherosclerosis Risk in Communities (ARIC) Study with no history of cardiovascular disease. Alcohol consumption was categorized as follows: never, former, current: ≤1, 2–7, 8–14, and ≥15 drinks/week. RESULTS Compared to never drinkers, persons who consumed 2–7 drinks per week were less likely to have increased hs-cTnT (≥14 ng/L) at baseline (odds ratio = 0.67, 95% CI, 0.46–0.96), and had a lower risk of incident increases in hs-cTnT at follow-up (relative risk = 0.70, 95% CI, 0.49–1.00). Conversely, there was a positive association between alcohol intake and NT-proBNP concentrations at baseline. Consumption of ≥15 drinks/week was positively associated with incident increases in NT-proBNP (≥300 pg/mL) at the 6-year follow-up visit (relative risk = 2.38, 95% CI, 1.43–3.96). CONCLUSIONS In this community-based study of middle-aged adults without a history of cardiovascular disease, moderate drinking was associated with lower concentrations of hs-cTnT, a marker of chronic subclinical myocardial damage, and positively associated with NT-proBNP, a biomarker of cardiac wall stress. Our results suggest that the cardiac effects of alcohol are complex. Cardiac biomarkers may help improve our understanding of the full cardiovascular effects of alcohol consumption.

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