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High cardiac troponin concentration linked to heightened CVD risk
Patients with a high cardiac troponin concentration within the normal range may have an increased risk for CVD, researchers reported in the Journal of the American College of Cardiology.
The current research was conducted “to clarify associations of cardiac troponins with incident CVD,” according to Peter Willeit, MD, MPhil, PhD, associate professor of clinical epidemiology at Medical University of Innsbruck in Austria, and colleagues.
The meta-analysis included 154,052 patients (mean age, 56 years; 53% men) from 28 prospective studies that evaluated the association between cardiac troponin concentration and incident CVD outcomes. Patients were free from previous CVD and were followed for more than 1 year. Researchers also reviewed de novo data from the PROSPER study, a randomized, double-blind, placebo-controlled trial of pravastatin (n = 4,402). Eighteen studies were conducted in Europe, seven in North America, two multinational and one in Asia. Eleven studies measured high-sensitivity cardiac troponin T and 17 measured high-sensitivity cardiac troponin I.
The combined CVD endpoint was nonfatal MI, fatal CHD and fatal and nonfatal stroke, including hemorrhagic, ischemic or unclassified stroke.
Overall, 80% of patients had detectable cardiac troponin concentrations (82.6% high-sensitivity cardiac troponin I studies; 69.7% high-sensitivity cardiac troponin T studies).
The median troponin T value was 7 ng/l; 85% of values were within the normal range of 14 ng/l or lower.
Overall, 694 fatal CVD events occurred during follow-up out to 11 years (mean, 8.3 years).
The relative risk for events in patients with cardiac troponin levels in the top third vs. bottom third was 1.43 for CVD (11,763 events; 95% CI, 1.31-1.56), 1.67 for fatal CVD (7,775 events; 95% CI, 1.5-1.86), 1.56 for CHD (7,061 events; 95% CI, 1.38-1.83) and 1.35 for stroke (2,526 events; 95% CI, 1.23-1.48). The association between cardiac troponin and fatal CVD was stronger in studies conducted in North America (P = .01) and those that measured high-sensitivity cardiac troponin T vs. high-sensitivity cardiac troponin I (P = .027).
“It is striking that we observed significant positive associations with CVD outcomes even though 85% of the study population had [high-sensitivity cardiac troponin T] values within the normal range ( 14 ng/l) at baseline,” Willeit and colleagues wrote.
The researchers called for additional research on cardiac troponin as a marker of risk prediction.
In this study, “the addition of high-sensitivity cardiac troponin T concentration to a prediction model containing information on conventional risk factors improved the prediction of fatal CVD,” the researchers wrote.
Jennifer E. Ho, MD, cardiologist in the heart failure and transplant section of the cardiology division at Massachusetts General Hospital, discussed high-sensitivity cardiac troponin in the general population in a related editorial.
“Although high-sensitivity troponin assays have been used in Europe and Canada for some time, the recent [FDA] 501(k) clearance for the first high-sensitivity troponin assay (Elecsys Troponin T Gen 5 Stat, Roche Diagnostics Corp.) promises to transform the use of cardiac troponins in the United States. With this in mind, redefining a new normal will be paramount to how we will practice CV medicine,” she wrote. – by Darlene Dobkowski
Disclosures: Willeit reports receiving support by an Erwin-Schrodinger-Fellowship sponsored by the Austrian Science Fund and by the excellence initiative of the Austrian Research Promotion Agency. Ho reports receiving support by a grant from the NIH and a Massachusetts General Hospital Hassenfeld Scholar Award. Please see the full study for a list of the other authors’ relevant financial disclosures.