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

Xiaoming Jia, Wensheng Sun, Ron C. Hoogeveen, Vijay Nambi, Kunihiro Matsushita, Aaron R. Folsom, Gerardo Heiss, David J. Couper, Scott D. Solomon, Eric Boerwinkle, Amil Shah, Elizabeth Selvin, James A. De Lemos, Christie M. Ballantyne

Research output: Contribution to journalReview article

27 Scopus citations

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.

Original languageEnglish (US)
Pages (from-to)2642-2653
Number of pages12
JournalCirculation
Volume139
Issue number23
DOIs
StatePublished - Jun 4 2019

Keywords

  • biomarkers
  • cardiovascular diseases
  • troponin I

ASJC Scopus subject areas

  • Cardiology and Cardiovascular Medicine
  • Physiology (medical)

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    Jia, X., Sun, W., Hoogeveen, R. C., Nambi, V., Matsushita, K., Folsom, A. R., Heiss, G., Couper, D. J., Solomon, S. D., Boerwinkle, E., Shah, A., Selvin, E., De Lemos, J. A., & Ballantyne, C. M. (2019). High-Sensitivity Troponin i and Incident Coronary Events, Stroke, Heart Failure Hospitalization, and Mortality in the ARIC Study. Circulation, 139(23), 2642-2653. https://doi.org/10.1161/CIRCULATIONAHA.118.038772