Longitudinal Changes in Cardiac Troponin and Risk of Heart Failure Among Black Adults
Amit Saha1, Kershaw V Patel2, Colby Ayers1
1Division of Cardiology, Department of Internal Medicine, University of Texas Southwestern Medical Center, Dallas, Texas.
Insights
Among Black adults, rising levels of high-sensitivity cardiac troponin I (hs-cTnI) indicate increased heart failure risk. Persistent or worsening hs-cTnI elevation is linked to a greater chance of developing heart failure.
Area of Science:
- Cardiology
- Biomarkers
- Public Health
Background:
- High-sensitivity cardiac troponin I (hs-cTnI) is linked to heart failure (HF) risk in Black adults.
- Longitudinal changes in hs-cTnI and their association with incident HF, HFrEF, and HFpEF in this population are not well-established.
Purpose of the Study:
- To investigate the association between longitudinal changes in hs-cTnI levels and the risk of incident heart failure among Black adults.
- To examine the relationship between hs-cTnI changes and specific HF subtypes (HFrEF and HFpEF).
Main Methods:
- The study analyzed data from 2423 Black participants in the Jackson Heart Study with hs-cTnI measurements at two visits.
- Cox models assessed the association of hs-cTnI change categories (incident elevation, stable/improved, worsened) with incident HF risk.
- Follow-up averaged 12.0 years, during which 139 HF hospitalizations occurred.
Main Results:
- 11.6% of participants showed incident hs-cTnI elevation, 16.9% had stable/improved elevation, and 4.0% had worsened elevation.
- Compared to no elevation, incident, stable/improved, and worsened hs-cTnI elevation were associated with significantly higher HF risk (aHR 3.20, 2.40, and 8.10, respectively).
- Similar associations were observed for both HFrEF and HFpEF risk.
Conclusions:
- In Black adults, an increase in hs-cTnI levels over time is associated with an elevated risk of developing heart failure.
- Persistent or worsening subclinical myocardial injury, indicated by hs-cTnI, is a significant predictor of future HF events.
Background:
Among Black adults, high-sensitivity cardiac troponin I (hs-cTnI) is associated with heart failure (HF) risk. The association of longitudinal changes in hs-cTnI with risk of incident HF, HF with reduced and preserved ejection fraction (HFrEF and HFpEF, respectively), among Black adults is not well-established.
Methods And Results:
This study included Black participants from the Jackson Heart Study with available hs-cTnI data at visits 1 (2000-2004) and 2 (2005-2008) and no history of cardiovascular disease. Cox models were used to evaluate associations of categories of longitudinal change in hs-cTnI with incident HF risk. Among 2423 participants, 11.6% had incident elevation in hs-cTnI at visit 2, and 16.9% had stable or improved elevation (≤50% increase in hs-cTnI), and 4.0% had worsened hs-cTnI elevation (>50% increase). Over a median follow-up of 12.0 years, there were 139 incident HF hospitalizations (64 HFrEF, 58 HFpEF). Compared with participants without an elevated hs-cTnI, those with incident, stable or improved, or worsened hs-cTnI elevation had higher HF risk (adjusted hazard ratio 3.20 [95% confidence interval, 1.92-5.33]; adjusted hazard ratio 2.40, [95% confidence interval, 1.47-3.92]; and adjusted hazard ratio 8.10, [95% confidence interval, 4.74-13.83], respectively). Similar patterns of association were observed for risk of HFrEF and HFpEF.
Conclusions:
Among Black adults, an increase in hs-cTnI levels on follow-up was associated with a higher HF risk.
Lay Summary:
The present study included 2423 Black adults from the Jackson Heart Study with available biomarkers of cardiac injury and no history of cardiovascular disease at visits 1 and 2. The majority of participants did not have evidence of cardiac injury at both visits (67.5%), 11.6% had evidence of cardiac injury only on follow-up, 14.5% had stable elevations, 4.0% had worsened elevations, and 2.4% had improved elevations of cardiac injury biomarkers during follow-up. Compared with participants without evidence of cardiac injury, those with new, stable, and worsened levels of cardiac injury had a higher risk of developing heart failure.
Tweet:
Among Black adults, persistent or worsening subclinical myocardial injury is associated with an elevated risk of HF.
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