High-Sensitivity Troponin T and Incident Heart Failure in Older Men: British Regional Heart Study

Area of Science:

• Cardiology
• Biomarkers
• Epidemiology

Background:

• Heart failure (HF) is a significant public health concern.
• Biomarkers like high-sensitivity troponin T (hsTnT) are being investigated for their role in predicting cardiovascular events.
• Understanding the predictive value of hsTnT for incident HF is crucial for refining risk assessment strategies.

Purpose of the Study:

• To investigate the association between hsTnT levels and the incidence of HF in older men.
• To evaluate the added value of hsTnT in HF prediction models, particularly when N-terminal pro-B-type natriuretic peptide (NT-proBNP) is already considered.

Main Methods:

• The British Regional Heart Study cohort, comprising 3852 men aged 60-79 years without baseline HF, was followed for a median of 12.6 years.
• Incident HF cases were identified, and the association between hsTnT and HF risk was analyzed using Cox proportional hazards models, adjusting for traditional risk factors and NT-proBNP.
• The predictive performance of risk models with and without hsTnT was assessed using the C-index.

Main Results:

• A 1-SD increase in hsTnT was associated with a 58% higher risk of incident HF (HR 1.58) after adjusting for classic risk factors, and a 34% higher risk after further adjustment for NT-proBNP (HR 1.34).
• The predictive value of hsTnT did not vary across different risk factor strata.
• While a low hsTnT (<5ng/L) showed high sensitivity for ruling out HF, adding hsTnT to a model with NT-proBNP did not significantly improve HF prediction (P = 0.28).

Conclusions:

• Elevated hsTnT is consistently associated with an increased risk of incident HF in older men.
• HF incidence was low in men with hsTnT below the limit of detection.
• hsTnT measurement does not improve HF prediction when NT-proBNP is already incorporated into the risk model.