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

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: Atherosclerosis Risk in Communities study participants aged 54-74 years without baseline CVD were included in this study (n=8121). Cox proportional hazard models were constructed to determine associations between hs-TnI and incident coronary heart disease (CHD; myocardial infarction and fatal CHD), ischemic stroke, atherosclerotic CVD (ASCVD; CHD and stroke), HF hospitalization, global CVD (ASCVD and HF), and all-cause mortality. The comparative association of hs-TnI and hs-TnT 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 (PCE).

Sex‐related differences in contemporary biomarkers for heart failure: a review

“…Strong evidence 53,60,70,89 • HR comparable in men and women: including stable HF patients, median cTnT levels were 23 ng/L in men and 18 ng/L in women. 67 Several mechanisms have been proposed to explain raised cTns in HF, 131,132 but the exact pathophysiology of sex-related differences remains to be elucidated.…”

“…The value of cTns in HF diagnosis is limited. However, cTns strongly predict incident HF in the general population 53,60,89,126 , and in a meta-analysis of 16 studies (67 063 individuals and 4165 HF events), the predictive value of cTns for incident HF was comparable in men and women ( Table 2). 70 cTns can also potentially be used to risk-stratify HF patients, although the level of evidence for this is currently lower than for NPs.…”

“…127,128 For instance, median values were ∼53% higher in men using the Roche Diagnostics cTnT assay [pooled median values ± standard deviation (SD): 5.5 ± 2.2 ng/L in men vs. 3.6 ± 1.3 ng/L in women], [60][61][62][63][64] and ∼44% higher in men with the Abbott cTnI assay (2.6 ± 1.1 ng/L in men vs. 1.8 ± 1.0 ng/L in women). 60,62,65 An illustrative overview of sex-related differences in the 99th percentile values for cTnT assay (Roche Diagnostics) and cTnI assays (Abbott Diagnostics, Beckman Coulter, Singulex and Siemens) using data from over 30 population-based studies was recently provided by Romiti and colleagues. 128 In HF patients, plasma cTn levels rise several fold ( Figure 3A), 66,129,130 and on average, men have higher cTn levels compared with women ( Figure 3B).…”

Biomarker-defined pathways for incident type 2 diabetes and coronary heart disease—a comparison in the MONICA/KORA study

“…The myocardial injury pathway was represented by ultrasensitive troponin I, a marker of myocardial injury. Troponin I is used to diagnose acute MI in clinical practice and has also been shown to be predictive for incident CHD in individuals of the general population without prior CHD [17,61].…”

Adverse Cardiac Remodelling after Acute Myocardial Infarction: Old and New Biomarkers

“…Cell-free pool of cardiac troponins was reported having a tendency to decrease after AMI, while peak concentrations of both hs-TnT and hs-TnI have strongly predicted major cardiovascular events including death, recurrent MI, need of PCI, and subsequent HF hospitalization [96,97]. Moreover, elevated concentrations of circulating cardiac troponins remain useful independent predictive biomarkers of newly post-AMI HF [98,99]. Interestingly, elevated levels of hs-TnI were associated with CV death, whereas hs-TnT has more strongly predicted the risk of non-CV death [100].…”