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Temporal rise in high-sensitivity cardiac troponin T linked to CHD, HF, mortality risk
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Increases in levels of high-sensitivity cardiac troponin T during 6 years are associated with risk for CHD, mortality and, particularly, HF, researchers reported in JAMA Cardiology.
Researchers analyzed data from 8,838 participants from the ARIC study (mean age, 56 years; 59% women; 21.4% black). Data on high-sensitivity cardiac troponin T and incidences of CHD, HF and mortality were collected between Oct. 28, 2014, and March 9, 2016. High-sensitivity cardiac troponin T measurements were taken two times, 6 years apart.
Poor outcomes seen
During a median follow-up of 14 years, John W. McEvoy, MB, BCh, MHS, and colleagues recorded 1,157 CHD events, 965 HF events and 1,813 deaths.
John W. McEvoy
Incident detectable high-sensitivity cardiac troponin T (baseline, < 0.005 ng/mL; follow-up, 0.005 ng/mL) was associated with CHD (HR = 1.4; 95% CI, 1.2-1.6), HF (HR = 2; 95% CI, 1.6-2.4) and death (HR = 1.5; 95% CI, 1.3-1.7). The highest HRs (4 for CHD, 8 for HF) were found in patients with the largest increase in high-sensitivity cardiac troponin T, McEvoy, from Johns Hopkins University, and colleagues reported.
Participants whose cardiac troponin decreased by more than 50% during the study had lower risk for the outcomes.
A secondary analysis evaluating the association between the 6-year change in high-sensitivity cardiac troponin T and HF hospitalization revealed that increased troponin levels were associated with events related to HF with reduced and preserved ejection fraction.
“Together with the wealth of data supporting single baseline [high-sensitivity cardiac troponin T] measurements, we found improved prognostic performance for serial measurement of [high-sensitivity cardiac troponin T] and add to a compelling argument that serial [high-sensitivity cardiac troponin T] monitoring, alone or with other biomarkers, may identify high-risk individuals and guide the prevention of CHD or HF,” the researchers wrote.
How to reduce risk
In an accompanying editorial, James L. Januzzi Jr., MD, of Massachusetts General Hospital and Harvard Clinical Research Institute, wrote that this study raised the question of how doctors can intervene to reduce these risks associated with elevated high-sensitivity cardiac troponin T.
James L. Januzzi
“Given multiple causes of incident [high-sensitivity cardiac troponin T] , this is not likely to be a one-size-fits-all approach, but to the extent that recent randomized data from HF clinical trials suggest that it is possible to reduce [high-sensitivity cardiac troponin T ] concentrations with drug therapies, the logical approach would be to optimize treatment for medical conditions associated with [high-sensitivity cardiac troponin T] elevation, while applying therapies that may provide cardioprotection,” Januzzi wrote.
“What is needed now are efforts toward developing strategies to upwardly bend the survival curves of those with a biomarker signature of risk, leveraging the knowledge gained from studies such as the report by McEvoy et al to improve public health,” Januzzi concluded. – by Tracey Romero
Disclosure : Roche Diagnostics donated reagents for the high-sensitivity cardiac troponin T and C-reactive protein assays. McEvoy reports no relevant financial disclosures. Please see full study for a list of all other researchers’ relevant financial disclosures. Januzzi reports receiving grants from Prevencio, Siemens and Singulex; partial support from the Hutter Family Professorship at the Harvard Medical School; consulting fees from Critical Diagnostics, Novartis, Phillips, Roche Diagnostics and Sphingotec; and fees for participating in clinical endpoint committees for Amgen, Boehringer Ingelheim, Janssen and Novartis.
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