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

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. ARIC study (Atherosclerosis Risk in Communities) participants aged 54 to 74 years without baseline...

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Published in:Circulation (New York, N.Y.) Vol. 139; no. 23; p. 2642
Main Authors: Jia, Xiaoming, Sun, Wensheng, Hoogeveen, Ron C, Nambi, Vijay, Matsushita, Kunihiro, Folsom, Aaron R, Heiss, Gerardo, Couper, David J, Solomon, Scott D, Boerwinkle, Eric, Shah, Amil, Selvin, Elizabeth, de Lemos, James A, Ballantyne, Christie M
Format: Journal Article
Language:English
Published: United States 04.06.2019
Subjects:
Aged
Biomarkers - blood
Cause of Death
Coronary Disease - blood
Coronary Disease - diagnosis
Coronary Disease - mortality
Coronary Disease - therapy
Female
Heart Failure - blood
Heart Failure - diagnosis
Heart Failure - mortality
Heart Failure - therapy
Hospitalization
Humans
Incidence
Male
Middle Aged
Predictive Value of Tests
Prognosis
Prospective Studies
Risk Assessment
Risk Factors
Stroke - blood
Stroke - diagnosis
Stroke - mortality
Stroke - therapy
Time Factors
Troponin I - blood
Troponin T - blood
United States - epidemiology
Up-Regulation
United States
biomarkers
troponin I
cardiovascular diseases
ISSN:1524-4539, 1524-4539
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Summary: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. 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. 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. 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.
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ISSN:1524-4539
1524-4539
DOI:10.1161/CIRCULATIONAHA.118.038772