Performance of High-Sensitivity Cardiac Troponin Assays to Reflect Comorbidity Burden and Improve Mortality Risk
Olive Tang1, Natalie Daya1, Kunihiro Matsushita1
1Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD.
Insights
High-sensitivity cardiac troponins (hs-cTnI and hs-cTnT) identify older adults with diabetes at high mortality risk, even with low comorbidity burden. These biomarkers improve risk stratification beyond existing comorbidity assessments.
Area of Science:
- Cardiology
- Geriatrics
- Biomarkers
Background:
- Managing diabetes in older adults is complex due to comorbidities.
- High-sensitivity cardiac troponins (hs-cTnI, hs-cTnT) are quantifiable biomarkers for risk monitoring.
- Assessing troponin elevation's link to comorbidities and mortality is crucial.
Purpose of the Study:
- To evaluate associations between hs-cTnI/hs-cTnT elevations and comorbidities in older adults with diabetes.
- To determine if hs-cTnI/hs-cTnT improve mortality risk stratification beyond comorbidity burden.
Main Methods:
- Logistic regression analyzed troponin levels (≥85th percentile) against comorbidities in 1,835 Atherosclerosis Risk in Communities (ARIC) Study participants with diabetes.
- Cox models assessed troponin's association with mortality across different comorbidity levels.
Main Results:
- Troponin elevations correlated with prevalent coronary heart disease, heart failure, chronic kidney disease, pulmonary disease, hypoglycemia, hypertension, dementia, and frailty.
- Both hs-cTnI and hs-cTnT further stratified mortality risk beyond comorbidity levels.
- Individuals with low comorbidity but high troponin levels faced significantly elevated mortality risk.
Conclusions:
- hs-cTnI and hs-cTnT reflect numerous comorbidities in older adults with diabetes.
- Elevated troponin levels independently predict higher mortality risk.
- High-sensitivity cardiac troponins can aid in identifying high-risk individuals and guiding clinical care for older adults with diabetes.
Objective:
Incorporation of comorbidity burden to inform diabetes management in older adults remains challenging. High-sensitivity cardiac troponins are objective, quantifiable biomarkers that may improve risk monitoring in older adults. We assessed the associations of elevations in high-sensitivity cardiac troponin I (hs-cTnI) and T (hs-cTnT) with comorbidities and improvements in mortality risk stratification.
Research Design And Methods:
We used logistic regression to examine associations of comorbidities with elevations in either troponin (≥85th percentile) among 1,835 participants in the Atherosclerosis Risk in Communities (ARIC) Study with diabetes (ages 67-89 years, 43% male, 31% black) at visit 5 (2011-2013). We used Cox models to compare associations of high cardiac troponins with mortality across comorbidity levels.
Results:
Elevations in either troponin (≥9.4 ng/L for hs-cTnI, ≥25 ng/L for hs-cTnT) were associated with prevalent coronary heart disease, heart failure, chronic kidney disease, pulmonary disease, hypoglycemia, hypertension, dementia, and frailty. Over a median follow-up of 6.2 years (418 deaths), both high hs-cTnI and high hs-cTnT further stratified mortality risk beyond comorbidity levels; those with a high hs-cTnI or hs-cTnT and high comorbidity were at highest mortality risk. Even among those with low comorbidity, a high hs-cTnI (hazard ratio 3.0 [95% CI 1.7, 5.4]) or hs-cTnT (hazard ratio 3.3 [95% CI 1.8, 6.2]) was associated with elevated mortality.
Conclusions:
Many comorbidities were reflected by both hs-cTnI and hs-cTnT; elevations in either of the troponins were associated with higher mortality risk beyond comorbidity burden. High-sensitivity cardiac troponins may identify older adults at high mortality risk and be useful in guiding clinical care of older adults with diabetes.
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