Physicians' Academy for Cardiovascular Education

Increase in hs-troponin I associated with higher risk of CVD in individuals without CVD history

High-Sensitivity Troponin I and Incident Coronary Events, Stroke, Heart Failure Hospitalization, and Mortality in the ARIC Study

Literature - Jia X, Sun W, Hoogeveen RC, et al. - Circulation 2019; DOI: 10.1161/CIRCULATIONAHA.118.038772

Introduction and methods

Individuals with cardiac conditions and risk factors without established CVD often have low levels of cardiac troponin I (TnI) and T (TnT), which can now be detected with high sensitivity assays (hs-TnI and hs-TnT). Lower detection threshold for cardiac troponins has resulted in potential use as a biomarker in subjects without CVD. In previous community-based studies, detectable levels of cardiac troponins have been associated with incidence of coronary heart disease [CHD], heart failure [HF] and CV mortality [1-3].

In this study, the association between baseline hs-TnI and risk of incident CVD was examined in individuals without history of CVD in the ARIC study (Atherosclerosis Risk in Communities). Furthermore, it was assessed whether hs-TnI and hs-TnT were independent risk markers for incident CVD and whether adding hs-TnI and hs-TnT to the Pooled Cohort Equation (PCE) model improved risk prediction.

The ARIC study is a large, predominantly biracial prospective cohort of middle-aged and older individuals, recruited from 4 US communities in 1987-1989. In this study, 8121 participants were included from ARIC visit 4 (1996-1998). Outcomes were total incident CHD (including fatal CHD, definite or probable MI and silent MI), incident stroke, incident HF hospitalization, all-cause mortality, incident ASCVD, and incident global CVD. Median follow-up was ~15 years for all end points.

Main results


Measurements of hs-TnI in a population of individuals without history of CVD in the ARIC study showed that higher hs-TnI levels were associated with increased risk of ASCVD, global CVD, incident CHD, ischemic stroke, HF hospitalization and all-cause mortality, with significant interactions by race and sex. There was a modest correlation between hs-TnI and hs-TnT and association with outcomes was strongest when both hs-TnI and hs-TnT were highest. Addition of hs-TnI and hs-TnT to the PCE model improved risk prediction for both ASCVD and global CVD events.


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