Circulating troponin as measured by a sensitive assay for cardiovascular risk assessment in primary prevention
David M Leistner1, Jens Klotsche, Lars Pieper
1Department of Medicine III, Cardiology, Goethe-University Frankfurt, Germany.
Insights
Minute elevations in cardiac troponin I (cTnI) predict mortality and major adverse cardiovascular events (MACE) in primary prevention. Sensitive cTnI assays enhance cardiovascular risk assessment beyond traditional factors.
Area of Science:
- Cardiology
- Preventive Medicine
- Biomarker Research
Background:
- Novel sensitive assays detect minute cardiac troponin elevations, linking them to mortality in various populations.
- The prognostic value of sensitive cardiac troponin I (cTnI) assays for primary prevention risk assessment remains less defined.
Purpose of the Study:
- To evaluate the incremental value of sensitive cardiac troponin I (cTnI) measurement for cardiovascular risk assessment in primary prevention.
Main Methods:
- Measured circulating cTnI, NT-proBNP, and hsCRP in 5388 individuals without known cardiovascular disease (DETECT study).
- Assessed prognostic implications for incident major adverse cardiovascular events (MACE) over 5 years.
Main Results:
- Circulating cTnI was detectable in 19% of subjects and associated with atherosclerosis risk factors.
- Increased cTnI showed a graded relationship with all-cause mortality and incident MACE.
- A single cTnI measurement significantly improved risk prediction, adding prognostic information beyond NT-proBNP and hsCRP.
Conclusions:
- Minute cTnI increases identify individuals at higher risk for mortality and MACE in primary prevention.
- Sensitive cTnI assays capture cardiovascular risk not fully addressed by traditional risk factors.
Background:
Measuring circulating cardiac troponin using novel sensitive assays has revealed that even minute elevations are associated with increased mortality in patients with coronary artery disease or even in the general population. Less well defined, however, is the incremental value of measuring circulating cardiac troponin I (cTnI) by a sensitive assay for risk assessment in primary prevention.
Methods:
We measured circulating concentrations of cTnI, N-terminal pro-B-type natriuretic peptide (NT-proBNP), and high-sensitivity C-reactive protein (hsCRP) in 5388 individuals free of known cardiovascular disease recruited into the DETECT study, a prospective longitudinal population-based cohort study. We determined the prognostic implications for incident major adverse cardiovascular events (MACE) during 5 years of follow-up.
Results:
Circulating cTnI was detectable in 19% of the subjects. Increased cTnI concentrations were associated with established risk factors for atherosclerosis and demonstrated a graded relationship with all-cause mortality and incident MACE during 5-year follow-up. A single measurement of cTnI significantly improved risk prediction over established risk factors, and also added prognostic information, when adjusted for serum concentrations of NT-proBNP and hsCRP.
Conclusions:
Minute increases in cTnI are associated with increased mortality and incident MACE in a large primary prevention cohort and, thus, identify contributors to cardiovascular risk not fully captured by traditional risk factor assessment.
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