High-Sensitivity Troponins and Subclinical Coronary Atherosclerosis Evaluated by Coronary Calcium Score Among Older Asians Living With Well-Controlled Human Immunodeficiency Virus

Abstract

Background: Elevated levels of high-sensitivity cardiac troponin (hs-cTn) are suggestive of myocardial cell injury and coronary artery disease. We explored the association between hs-cTn and subclinical arteriosclerosis using coronary artery calcification (CAC) scoring among 337 virally suppressed patients with human immunodeficiency virus (HIV) who were ≥50 years old and without evidence of known coronary artery disease.

Methods: Noncontrast cardiac computed tomography and blood sampling for hs-cTn, both subunit I (hs-cTnI) and subunit T (hs-cTnT), were performed. The relationship between CAC (Agatston score) and serum hs-cTn levels was analyzed using Spearman correlation and logistic regression models.

Results: The patients, of whom 62% were male, had a median age of 54 years and had been on antiretroviral therapy for a median of 16 years; the CAC score was >0 in 50% of patients and ≥100 in 16%. Both hs-cTn concentrations were positively correlated with the Agatston score, with correlation coefficients of 0.28 and 0.27 (P < .001) for hs-cTnI and hs-cTnT, respectively. hs-cTnI and hs-cTnT concentrations of ≥4 and ≥5.3 pg/mL, respectively, provided the best performance for discriminating patients with Agatston scores ≥100, with a sensitivity and specificity of 76% and 60%, respectively, for hs-cTnI and 70% and 50% for hs-cTnT. In multivariable logistic regression analysis, each log unit increase in hs-cTnI level was independently associated with increased odds of having an Agatston score ≥100 (odds ratio, 2.83 [95% confidence interval, 1.69-4.75]; P <.001). Although not an independent predictor, hs-cTnT was also associated with an increased odds of having an Agatston score ≥100 (odds ratio, 1.58 [95% confidence interval, .92-2.73]; P = .10).

Conclusions: Among Asians aged ≥50 years with well-controlled HIV infection and without established cardiovascular disease, 50% had subclinical arteriosclerosis. Increasing hs-cTnI and hs-cTnT concentrations were associated with an increased risk of severe subclinical arteriosclerosis, and hs-cTn may be a potential biomarker to detect severe subclinical arteriosclerosis.

Keywords: PLWH; coronary artery calcification; high-sensitivity cardiac troponin; subclinical atherosclerosis.

Figure 1.

Distribution of Agatston score expressed as percentages across high-sensitivity cardiac troponin (hs-cTn) quartiles, for hs-cTn subunit I (hs-cTnI) (left) and subunit T (hs-cTnT) (right).

Figure 2.

Box-and-whisker plots for high-sensitivity cardiac troponin subunit I (hs-cTnI) (left) and subunit T (hs-cTnT) (right) concentrations by Agatston score category. Lower edges of boxes represent the 25th percentile; upper edges, the 75th percentile; line within boxes, median values; whiskers, range of data, including outliers. P < .001 for both hs-cTnI and hs-cTnT, across score categories.

Figure 3.

Receiver operating characteristic (ROC) curves to detect the presence of Agatston score ≥100 and atherosclerotic cardiovascular disease (ASCVD) risk score only or ASCVD risk score combined with high-sensitivity cardiac troponin subunit I (hs-cTnI) or subunit T (hs-cTnT) levels and multivariable (MV) models for hs-cTnI or hs-cTnT. Abbreviation: AUROC, area under the ROC curve.