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Multicenter Study
. 2019 Jun 4;139(23):2642-2653.
doi: 10.1161/CIRCULATIONAHA.118.038772. Epub 2019 Apr 29.

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

Xiaoming Jia  1 , Wensheng Sun  1 , Ron C Hoogeveen  1 , Vijay Nambi  1   2 , Kunihiro Matsushita  3 , Aaron R Folsom  4 , Gerardo Heiss  5 , David J Couper  5 , Scott D Solomon  6 , Eric Boerwinkle  7 , Amil Shah  6 , Elizabeth Selvin  3 , James A de Lemos  8 , Christie M Ballantyne  1
Affiliations
Multicenter Study

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

Xiaoming Jia et al. Circulation. .

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: 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.

Results: 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.

Conclusions: 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.

Keywords: biomarkers; cardiovascular diseases; troponin I.

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Conflict of interest statement

Disclosures

Dr. Jia, Ms. Sun, and Drs. Folsom, Heiss, Couper, Boerwinkle, and Selvin have stated that they have no actual or potential perceived conflicts of interests.

Figures

Figure 1.
Figure 1.
Flow diagram for cohort selection. Abbreviations: ARIC, Atherosclerosis Risk in Communities; CHD, coronary heart disease; ECG, electrocardiogram; HF, heart failure; hs-TnI, high-sensitivity cardiac troponin I; MI, myocardial infarction
Figure 2.
Figure 2.
Age-, sex-, and race-adjusted survival curves assessing the time to incident cardiovascular disease (CVD) events and death across high-sensitivity troponin I (hs-TnI) quintiles: (A) coronary heart disease (CHD), (B) ischemic stroke, (C) atherosclerotic CVD (ASCVD), (D) heart failure hospitalization (HF), (E) global CVD, and (F) death from any cause. In all outcomes assessed, p<0.0001 for differences across quintiles. hs-TnI was measured with a chemiluminescent immunoassay (Architect Stat Troponin-I; Abbott, Abbott Park, IL).
Figure 2.
Figure 2.
Age-, sex-, and race-adjusted survival curves assessing the time to incident cardiovascular disease (CVD) events and death across high-sensitivity troponin I (hs-TnI) quintiles: (A) coronary heart disease (CHD), (B) ischemic stroke, (C) atherosclerotic CVD (ASCVD), (D) heart failure hospitalization (HF), (E) global CVD, and (F) death from any cause. In all outcomes assessed, p<0.0001 for differences across quintiles. hs-TnI was measured with a chemiluminescent immunoassay (Architect Stat Troponin-I; Abbott, Abbott Park, IL).
Figure 2.
Figure 2.
Age-, sex-, and race-adjusted survival curves assessing the time to incident cardiovascular disease (CVD) events and death across high-sensitivity troponin I (hs-TnI) quintiles: (A) coronary heart disease (CHD), (B) ischemic stroke, (C) atherosclerotic CVD (ASCVD), (D) heart failure hospitalization (HF), (E) global CVD, and (F) death from any cause. In all outcomes assessed, p<0.0001 for differences across quintiles. hs-TnI was measured with a chemiluminescent immunoassay (Architect Stat Troponin-I; Abbott, Abbott Park, IL).
Figure 2.
Figure 2.
Age-, sex-, and race-adjusted survival curves assessing the time to incident cardiovascular disease (CVD) events and death across high-sensitivity troponin I (hs-TnI) quintiles: (A) coronary heart disease (CHD), (B) ischemic stroke, (C) atherosclerotic CVD (ASCVD), (D) heart failure hospitalization (HF), (E) global CVD, and (F) death from any cause. In all outcomes assessed, p<0.0001 for differences across quintiles. hs-TnI was measured with a chemiluminescent immunoassay (Architect Stat Troponin-I; Abbott, Abbott Park, IL).
Figure 2.
Figure 2.
Age-, sex-, and race-adjusted survival curves assessing the time to incident cardiovascular disease (CVD) events and death across high-sensitivity troponin I (hs-TnI) quintiles: (A) coronary heart disease (CHD), (B) ischemic stroke, (C) atherosclerotic CVD (ASCVD), (D) heart failure hospitalization (HF), (E) global CVD, and (F) death from any cause. In all outcomes assessed, p<0.0001 for differences across quintiles. hs-TnI was measured with a chemiluminescent immunoassay (Architect Stat Troponin-I; Abbott, Abbott Park, IL).
Figure 2.
Figure 2.
Age-, sex-, and race-adjusted survival curves assessing the time to incident cardiovascular disease (CVD) events and death across high-sensitivity troponin I (hs-TnI) quintiles: (A) coronary heart disease (CHD), (B) ischemic stroke, (C) atherosclerotic CVD (ASCVD), (D) heart failure hospitalization (HF), (E) global CVD, and (F) death from any cause. In all outcomes assessed, p<0.0001 for differences across quintiles. hs-TnI was measured with a chemiluminescent immunoassay (Architect Stat Troponin-I; Abbott, Abbott Park, IL).
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References

    1. Saunders JT, Nambi V, de Lemos JA, Chambless LE, Virani SS, Boerwinkle E, Hoogeveen RC, Liu X, Astor BC, Mosley TH, Folsom AR, Heiss G, Coresh J, Ballantyne CM. Cardiac troponin T measured by a highly sensitive assay predicts coronary heart disease, heart failure, and mortality in the Atherosclerosis Risk in Communities Study. Circulation 2011;123:1367–1376. - PMC - PubMed
    1. deFilippi CR, de Lemos JA, Christenson RH, Gottdiener JS, Kop WJ, Zhan M, Seliger SL. Association of serial measures of cardiac troponin T using a sensitive assay with incident heart failure and cardiovascular mortality in older adults. JAMA 2010;304:2494–2502. - PMC - PubMed
    1. McEvoy JW, Chen Y, Ndumele CE, Solomon SD, Nambi V, Ballantyne CM, Blumenthal RS, Coresh J, Selvin E. Six-year change in high-sensitivity cardiac troponin T and risk of subsequent coronary heart disease, heart failure, and death. JAMA Cardiol 2016;1:519–528. - PMC - PubMed
    1. Omland T, Pfeffer MA, Solomon SD, de Lemos JA, Rosjo H, Saltyte Benth J, Maggioni A, Domanski MJ, Rouleau JL, Sabatine MS, Braunwald E, for the PEACE Investigators. Prognostic value of cardiac troponin I measured with a highly sensitive assay in patients with stable coronary artery disease. J Am Coll Cardiol 2013;61:1240–1249. - PubMed
    1. Eggers KM, Venge P, Lindahl B, Lind L. Cardiac troponin I levels measured with a high-sensitive assay increase over time and are strong predictors of mortality in an elderly population. J Am Coll Cardiol 2013;61:1906–1913. - PubMed

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