High-Sensitivity Cardiac Troponins I and T and Cardiovascular Outcomes: Findings from the Systolic Blood Pressure
Xiaoming Jia1, Vijay Nambi1,2, Jarett D Berry3
1Department of Medicine, Baylor College of Medicine, Houston, TX, United States.
Insights
High-sensitivity cardiac troponin I (hs-cTnI) helps identify individuals at high cardiovascular disease risk. Combining hs-cTnI with hs-cTnT offers complementary value for risk assessment and hypertension management.
Area of Science:
- Cardiology
- Biomarkers
- Hypertension Management
Background:
- Cardiac troponins are established predictors of adverse cardiovascular disease (CVD) outcomes.
- The role of high-sensitivity cardiac troponin I (hs-cTnI), alone and with high-sensitivity cardiac troponin T (hs-cTnT), in hypertension management requires further investigation.
Purpose of the Study:
- To evaluate the utility of hs-cTnI, independently and with hs-cTnT, in identifying high-risk individuals within the Systolic Blood Pressure Intervention Trial (SPRINT).
- To assess the association of baseline hs-cTnI levels and 1-year changes with CVD events and all-cause mortality.
- To determine the complementary value of hs-cTnI and hs-cTnT in CVD risk stratification.
Main Methods:
- Analysis of 8796 SPRINT participants with baseline and 1-year hs-cTnI measurements.
- Utilized adjusted Cox regression models to evaluate associations between hs-cTnI and outcomes.
- Assessed complementary value by analyzing concordant and discordant hs-cTnI and hs-cTnT categories.
Main Results:
- Baseline hs-cTnI was independently associated with composite CVD risk (HR 1.23 per log-unit increase).
- Intensive blood pressure lowering showed greater CVD risk reduction in individuals with higher hs-cTnI.
- Elevated hs-cTnI at baseline and 1-year change were linked to increased CVD risk; hs-cTnI and hs-cTnT showed complementary risk assessment value.
Conclusions:
- Baseline hs-cTnI levels and 1-year changes identify high-risk individuals who may benefit from intensive blood pressure treatment.
- hs-cTnI and hs-cTnT provide complementary information for comprehensive CVD risk assessment.
Background:
Cardiac troponins are associated with adverse cardiovascular disease (CVD) outcomes. The value of high-sensitivity cardiac troponin I (hs-cTnI) independently and in concert with troponin T (hs-cTnT) in the management of hypertension has not been well studied.
Methods:
We assessed the utility of hs-cTnI independently and with hs-cTnT in identifying the highest risk individuals in the Systolic Blood Pressure Intervention Trial (SPRINT). Among 8796 eligible SPRINT participants, hs-cTnI was measured at baseline and 1 year. The association of baseline level and 1-year change in hs-cTnI with CVD events and all-cause death was evaluated using adjusted Cox regression models. We further assessed the complementary value of hs-cTnI and hs-cTnT by identifying concordant and discordant categories and assessing their association with outcomes.
Results:
hs-cTnI was positively associated with composite CVD risk [myocardial infarction, other acute coronary syndrome, stroke, or cardiovascular death: hazard ratio 1.23, 95% confidence interval 1.08-1.39 per 1-unit increase in log(troponin I)] independent of traditional risk factors, N-terminal pro-B-type natriuretic peptide, and hs-cTnT. Intensive blood pressure lowering was associated with greater absolute risk reduction (4.5% vs 1.7%) and lower number needed to treat (23 vs 59) for CVD events among those with higher baseline hs-cTnI (≥6 ng/L in men, ≥4 ng/L in women). hs-cTnI increase at 1 year was also associated with increased CVD risk. hs-cTnI and hs-cTnT were complementary, and elevations in both identified individuals with the highest risk for CVD and death.
Conclusions:
Baseline levels and change in hs-cTnI over 1 year identified higher-risk individuals who may derive greater cardiovascular benefit with intensive blood pressure treatment. hs-TnI and hs-TnT have complementary value in CVD risk assessment. ClinicalTrials.gov Registration Number: NCT01206062.
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