Association Between High-Sensitivity Cardiac Troponin and Risk of Stroke in 96 702 Individuals: A Meta-Analysis
Leonie H A Broersen1,2, Helena Stengl1,2, Christian H Nolte1,2,3,4,5
1From the Klinik für Neurologie mit Experimenteller Neurologie (L.H.A.B., H.S., C.H.N., M.E., J.F.S.), Charité-Universitätsmedizin Berlin, Germany.
Insights
High-sensitivity cardiac troponin (hs-cTn) indicates myocardial injury and is a risk marker for incident stroke in the general population and patients with atrial fibrillation. Further research is needed for high-risk populations, particularly those with a history of ischemic stroke.
Area of Science:
- Cardiology
- Neurology
- Biomarker Research
Background:
- Myocardial injury, indicated by high-sensitivity cardiac troponin (hs-cTn), is a known risk factor for cardiovascular events.
- The association between hs-cTn levels and incident stroke risk requires further elucidation across diverse populations.
Purpose of the Study:
- To estimate the risk of incident stroke associated with varying levels of hs-cTn.
- To analyze this risk in the general population, patients with atrial fibrillation, and patients with a history of stroke.
Main Methods:
- A systematic meta-analysis of randomized controlled trials and cohort studies was conducted.
- Searches were performed in Embase, PubMed, and Web of Science up to March 14, 2019.
- Pooled adjusted hazard ratios were calculated using a random-effects model, accounting for heterogeneity and stroke classification.
Main Results:
- In the general population (77,978 participants), high hs-cTn levels were associated with a 1.25-fold increased risk of incident stroke (CI, 1.10-1.40).
- When using categorical data, the risk increased to 1.58 (CI, 1.26-1.90).
- In patients with atrial fibrillation (18,725 participants), high hs-cTn levels showed a 1.95-fold increased risk of incident stroke (CI, 1.29-2.62).
Conclusions:
- High-sensitivity cardiac troponin is a significant risk marker for incident stroke across different populations.
- The effect size of hs-cTn as a stroke risk marker varies among subgroups.
- Further research is warranted to investigate the hs-cTn-stroke association in high-risk groups, especially those with prior ischemic stroke.
Abstract:
Background and Purpose- Our study aim was to estimate risk of incident stroke based on levels of hs-cTn (high-sensitivity cardiac troponin), a specific biomarker indicating myocardial injury, in the general population, patients with atrial fibrillation, and patients with previous stroke. Methods- Embase, PubMed, and Web of Science were searched until March 14, 2019 to identify relevant articles. Randomized controlled trials and cohort studies assessing the risk of incident stroke based on hs-cTn were eligible. Pooled adjusted hazard ratios including 95% CI were calculated using a random-effects model due to study heterogeneity per population, coding of hs-cTn (categorical/continuous data), per hs-cTn subunit (T or I), for low risk of bias, and for all-cause and ischemic stroke separately. Results- We included 17 articles with 96 702 participants. In studies conducted in the general population (n=12; 77 780 participants), the pooled adjusted hazard ratio for incident stroke was 1.25 (CI, 1.10-1.40) for high versus low hs-cTn (as defined by included studies) during an average follow-up of 1 to 20 years (median 10). When categorical data were used, this was increased to 1.58 (CI, 1.26-1.90). The results were robust when accounting for stroke classification (all-cause stroke/ischemic stroke), hs-cTn subunit, risk of bias, and coding of hs-cTn. In patients with atrial fibrillation (4 studies; 18 725 participants), the pooled adjusted hazard ratio for incident stroke was 1.95 (CI, 1.29-2.62) for high versus low hs-cTn. Due to lack of data (one study, 197 participants), no meta-analysis could be performed in patients with previous stroke. Conclusions- This meta-analysis suggests that hs-cTn can be regarded as a risk marker for incident stroke, with different effect size in different subgroups. More research about the association between hs-cTn and incident stroke in high-risk populations is needed, especially in patients with history of ischemic stroke.
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