High-Sensitivity Cardiac Troponin Concentration and Risk of First-Ever Cardiovascular Outcomes in 154,052 Participants

Abstract

BackgroundHigh-sensitivity assays can quantify cardiac troponins I and T (hs-cTnI, hs-cTnT) in individuals with no clinically manifest myocardial injury.ObjectivesThe goal of this study was to assess associations of cardiac troponin concentration with cardiovascular disease (CVD) outcomes in primary prevention studies.MethodsA search was conducted of PubMed, Web of Science, and EMBASE for prospective studies published up to September 2016, reporting on associations of cardiac troponin concentration with first-ever CVD outcomes (i.e., coronary heart disease [CHD], stroke, or the combination of both). Study-specific estimates, adjusted for conventional risk factors, were extracted by 2 independent reviewers, supplemented with de novo data from PROSPER (Pravastatin in Elderly Individuals at Risk of Vascular Disease Study), then pooled by using random effects meta-analysis.ResultsA total of 28 relevant studies were identified involving 154,052 participants. Cardiac troponin was detectable in 80.0% (hs-cTnI: 82.6%; hs-cTnT: 69.7%). In PROSPER, positive associations of log-linear shape were observed between hs-cTnT and CVD outcomes. In the meta-analysis, the relative risks comparing the top versus the bottom troponin third were 1.43 (95% confidence interval [CI]: 1.31 to 1.56) for CVD (11,763 events), 1.67 (95% CI: 1.50 to 1.86) for fatal CVD (7,775 events), 1.59 (95% CI: 1.38 to 1.83) for CHD (7,061 events), and 1.35 (95% CI: 1.23 to 1.48) for stroke (2,526 events). For fatal CVD, associations were stronger in North American studies (p = 0.010) and those measuring hs-cTnT rather than hs-cTnI (p = 0.027).ConclusionsIn the general population, high cardiac troponin concentration within the normal range is associated with increased CVD risk. This association is independent of conventional risk factors, strongest for fatal CVD, and applies to both CHD and stroke.

Stable atypical chest pain with negative anatomical or functional diagnostic test: Diagnosis no matter what or prevention at any cost?

“…In particular, cigarette smoking is associated with a very high risk of sudden death, so much so that in the US guidelines, cigarette smoking abstention is placed first in the recommendations for preventing this mode of death . Worldwide, 25% of men and 5% of women are smokers (in Italy, 23% and 17%, respectively) . In our study, the majority of patients who experienced events were current smokers.…”

“…26 Worldwide, 25% of men and 5% of women are smokers (in Italy, 23% and 17%, respectively). 24 In our study, the majority of patients who experienced events were current smokers. Even in those with diagnosed (revascularized or non-revascularized) coronary artery disease, the persistence of smoking habits is the most important lifestyle-related risk factor for future coronary events and is associated with a lower efficacy of statin therapy.…”

“…Methods of reducing the residual risk in these patients remain challenging. It has recently been found that in the general population, high cardiac troponin concentrations within the normal range are associated with a higher incidence of cardiovascular events . Whether this can improve the prognostic prediction in these patients remains to be established.…”

Elevated high‐sensitive troponin T in negative stress test individuals

“…18,[24][25][26][27][28] Concordant with this concept are also the findings in the Multi-Ethnic Study of Atherosclerosis 29 that hs-cTnT levels were linked to structural myocardial changes (eg, replacement fibrosis and progressive changes in left ventricular physiology) in CVD-free adults. 18,[24][25][26][27][28] Concordant with this concept are also the findings in the Multi-Ethnic Study of Atherosclerosis 29 that hs-cTnT levels were linked to structural myocardial changes (eg, replacement fibrosis and progressive changes in left ventricular physiology) in CVD-free adults.…”

“…These results are in line with the concept that increased hs-cTnT may not only reflect myocardial necrosis but also serve as a marker of subclinical myocardial injury and future CVD risk in the general population as well as in patients with existing CVD. 18,[24][25][26][27][28] Concordant with this concept are also the findings in the Multi-Ethnic Study of Atherosclerosis 29 that hs-cTnT levels were linked to structural myocardial changes (eg, replacement fibrosis and progressive changes in left ventricular physiology) in CVD-free adults.…”