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Feasibility and usefulness of troponin I testing in insurance medicine
Insights
Elevated Troponin I levels, a potential cardiac risk marker, were found in 1.5% of insurance applicants. Routine screening may not be cost-effective for all policies, but data collection could improve cardiovascular disease risk models.
Area of Science:
- Cardiology
- Biomarkers
- Preventive Medicine
Background:
- Elevated Troponin I levels are associated with increased mortality in patients with chest pain and in the general population.
- Asymptomatic individuals with elevated Troponin I may represent a previously unidentified cardiac risk group.
Purpose of the Study:
- To determine the prevalence of elevated Troponin I in insurance applicants.
- To assess the utility of routine Troponin I measurement in this demographic for risk stratification.
Main Methods:
- Troponin I levels were measured in blood samples from insurance applicants and health participants using the Siemens ADVIA Centaur immunoanalyzer.
- Troponin I degradation was assessed over 24 hours at room temperature to extrapolate time-zero values for stored samples.
Main Results:
- Approximately 1.5% of insurance applicants exhibited Troponin I levels above 0.04 ng/mL, a higher prevalence than expected in a healthy population.
- A smaller subset, 0.43%, had levels exceeding 0.06 ng/mL, indicative of potential myocardial injury.
Conclusions:
- Routine Troponin I measurement in all life insurance applicants may not be cost-effective due to the low prevalence of elevations.
- Targeted screening for high-value policies or continued data collection on Troponin I levels in applicants could enhance cardiovascular disease risk models.
Objective:
Ascertain the prevalence of elevated Troponin I levels in applicants for insurance to assess the utility of routine measurement of Troponin I in this population.
Background:
Patients presenting with chest pain, who are determined not to be experiencing an acute coronary event, but are noted to have increased levels of Troponin have higher mortality rates than a control population. Elevated levels of Tropoins in the general population are also associated with increase in all cause mortality. Therefore elevated Troponin levels in asymptomatic individuals could be considered a cardiac risk marker.
Methods:
Blood samples from Insurance applicants and Health & Wellness participants were analyzed for Troponin I by the Siemens ADVIA Centaur immunoanalyzer. Since such samples are in transit for a day, we determined the rate of degradation of Troponin I on 24-hour storage at room temperature and extrapolated the time-zero values.
Results:
About 1.5% (10 of 697) of the patients had Troponin levels above 0.04 ng/mL. This rate is higher than would be expected in a healthy general population. Three samples (0.43%) had levels > 0.06 ng/mL, which would be considered elevated and indicative of myocardial injury.
Conclusions:
Given the low percentage Troponin I elevations in the general population applying for life insurance, it may not be cost effective to routinely measure Troponin I levels in blood specimens submitted for insurance purposes, except for high value policies. It may be prudent collect data on Troponin I levels in Insurance applicants for better defining the risk models of cardiovascular disease.
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