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Circulation. 2019 Jun 4;139(23):2642-2653. doi: 10.1161/CIRCULATIONAHA.118.038772. Epub 2019 Apr 29.

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

Author information

1
Baylor College of Medicine, Houston, TX (X.J., W.S., R.C.H., V.N., C.M.B.).
2
Michael E. DeBakey Veterans Affairs Medical Center, Houston, TX (V.N.).
3
Johns Hopkins University, Baltimore, MD (K.M., E.S.).
4
University of Minnesota, Minneapolis (A.R.F.).
5
University of North Carolina at Chapel Hill (G.H., D.J.C.).
6
Brigham and Women's Hospital, Boston, MA (S.D.S., A.S.).
7
University of Texas Health Science Center at Houston (E.B.).
8
University of Texas-Southwestern Medical Center, Dallas (J.A.d.L.).

Abstract

BACKGROUND:

We assessed whether plasma troponin I measured by a high-sensitivity assay (hs-TnI) is associated with incident cardiovascular disease (CVD) and mortality in a community-based sample without prior CVD.

METHODS:

ARIC study (Atherosclerosis Risk in Communities) participants aged 54 to 74 years without baseline CVD were included in this study (n=8121). Cox proportional hazards models were constructed to determine associations between hs-TnI and incident coronary heart disease (CHD; myocardial infarction and fatal CHD), ischemic stroke, atherosclerotic CVD (CHD and stroke), heart failure hospitalization, global CVD (atherosclerotic CVD and heart failure), and all-cause mortality. The comparative association of hs-TnI and high-sensitivity troponin T with incident CVD events was also evaluated. Risk prediction models were constructed to assess prediction improvement when hs-TnI was added to traditional risk factors used in the Pooled Cohort Equation.

RESULTS:

The median follow-up period was ≈15 years. Detectable hs-TnI levels were observed in 85% of the study population. In adjusted models, in comparison to low hs-TnI (lowest quintile, hs-TnI ≤1.3 ng/L), elevated hs-TnI (highest quintile, hs-TnI ≥3.8 ng/L) was associated with greater incident CHD (hazard ratio [HR], 2.20; 95% CI, 1.64-2.95), ischemic stroke (HR, 2.99; 95% CI, 2.01-4.46), atherosclerotic CVD (HR, 2.36; 95% CI, 1.86-3.00), heart failure hospitalization (HR, 4.20; 95% CI, 3.28-5.37), global CVD (HR, 3.01; 95% CI, 2.50-3.63), and all-cause mortality (HR, 1.83; 95% CI, 1.56-2.14). hs-TnI was observed to have a stronger association with incident global CVD events in white than in black individuals and a stronger association with incident CHD in women than in men. hs-TnI and high-sensitivity troponin T were only modestly correlated ( r=0.47) and were complementary in prediction of incident CVD events, with elevation of both troponins conferring the highest risk in comparison with elevation in either one alone. The addition of hs-TnI to the Pooled Cohort Equation model improved risk prediction for atherosclerotic CVD, heart failure, and global CVD.

CONCLUSIONS:

Elevated hs-TnI is strongly associated with increased global CVD incidence in the general population independent of traditional risk factors. hs-TnI and high-sensitivity troponin T provide complementary rather than redundant information.

KEYWORDS:

biomarkers; cardiovascular diseases; troponin I

PMID:
31030544
PMCID:
PMC6546524
[Available on 2020-06-04]
DOI:
10.1161/CIRCULATIONAHA.118.038772

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