Cardiac troponin T measured by a highly sensitive assay predicts coronary heart disease, heart failure, and mortality in the Atherosclerosis Risk in Communities Study

Abstract

Background: We evaluated whether cardiac troponin T (cTnT) measured with a new highly sensitive assay was associated with incident coronary heart disease (CHD), mortality, and hospitalization for heart failure (HF) in a general population of participants in the Atherosclerosis Risk in Communities (ARIC) Study.

Methods and results: Associations between increasing cTnT levels and CHD, mortality, and HF hospitalization were evaluated with Cox proportional hazards models adjusted for traditional CHD risk factors, kidney function, high-sensitivity C-reactive protein, and N-terminal pro-B-type natriuretic peptide in 9698 participants aged 54 to 74 years who at baseline were free from CHD and stroke (and HF in the HF analysis). Measurable cTnT levels (≥0.003 μg/L) were detected in 66.5% of individuals. In fully adjusted models, compared with participants with undetectable levels, those with cTnT levels in the highest category (≥0.014 μg/L; 7.4% of the ARIC population) had significantly increased risk for CHD (hazard ratio=2.29; 95% confidence interval, 1.81 to 2.89), fatal CHD (hazard ratio=7.59; 95% confidence interval, 3.78 to 15.25), total mortality (hazard ratio=3.96; 95% confidence interval, 3.21 to 4.88), and HF (hazard ratio=5.95; 95% confidence interval, 4.47 to 7.92). Even minimally elevated cTnT (≥0.003 μg/L) was associated with increased risk for mortality and HF (P<0.05). Adding cTnT to traditional risk factors improved risk prediction parameters; the improvements were similar to those with N-terminal pro-B-type natriuretic peptide and better than those with the addition of high-sensitivity C-reactive protein.

Conclusions: cTnT detectable with a highly sensitive assay was associated with incident CHD, mortality, and HF in individuals from a general population without known CHD/stroke.

Figure 1

Histogram showing gender-specific distribution of cardiac troponin T (cTnT) assay in the Atherosclerosis Risk in Communities (ARIC) sample.

Figure 2

Age-, race-, and gender-adjusted survival curves assessing the time to event across cTnT categories.

Figure 2

Age-, race-, and gender-adjusted survival curves assessing the time to event across cTnT categories.

Figure 2

Age-, race-, and gender-adjusted survival curves assessing the time to event across cTnT categories.

Figure 3

Continuous hazard functions of cTnT with total coronary heart disease, all-cause mortality, and heart failure hospitalizations for the overall group (A), in women (B), and in men (C), adjusted for age, race, gender (in the overall analyses), and traditional risk factors (total cholesterol, high-density lipoprotein cholesterol [HDL-C], systolic blood pressure, use of antihypertensive medications, smoking status, and presence of diabetes or the use of antidiabetic medications).

Figure 3

Continuous hazard functions of cTnT with total coronary heart disease, all-cause mortality, and heart failure hospitalizations for the overall group (A), in women (B), and in men (C), adjusted for age, race, gender (in the overall analyses), and traditional risk factors (total cholesterol, high-density lipoprotein cholesterol [HDL-C], systolic blood pressure, use of antihypertensive medications, smoking status, and presence of diabetes or the use of antidiabetic medications).

Figure 3

Continuous hazard functions of cTnT with total coronary heart disease, all-cause mortality, and heart failure hospitalizations for the overall group (A), in women (B), and in men (C), adjusted for age, race, gender (in the overall analyses), and traditional risk factors (total cholesterol, high-density lipoprotein cholesterol [HDL-C], systolic blood pressure, use of antihypertensive medications, smoking status, and presence of diabetes or the use of antidiabetic medications).