Preclinical screening for cardiovascular disease with high-sensitivity cardiac troponins: ready, set, go?
Aya Awwad1, Yashika Parashar1, Soahum Bagchi1
1Postgraduate Research Program, Harvard Medical School, Boston, MA, United States.
Insights
High-sensitivity troponin assays can detect occult cardiovascular disease (CVD) and identify individuals at high risk for future events. Measuring cardiac troponins (cTnT and cTnI) may enable earlier, aggressive risk factor management to prevent myocardial infarction and cardiovascular death.
Area of Science:
- Cardiology
- Biomarker Discovery
- Preventive Medicine
Background:
- Cardiovascular disease (CVD) often remains asymptomatic for years, posing a diagnostic challenge.
- Current preventive treatments can mitigate risks like myocardial infarction (MI) and heart failure.
- Cardiac troponins (cTnT, cTnI) are established MI biomarkers, with recent high-sensitivity (hs) assays enhancing detection capabilities.
Purpose of the Study:
- To review the evidence supporting the use of hs-cTnT and hs-cTnI for cardiovascular risk screening.
- To explore the association between elevated hs-cTn levels and occult CVD.
- To illustrate how hs-cTn screening can guide aggressive risk factor management.
Main Methods:
- Review of existing literature on cardiac troponin assays and CVD.
- Analysis of cross-sectional imaging studies correlating hs-cTn levels with CVD.
- Examination of clinical scenarios demonstrating the impact of hs-cTn screening on patient outcomes.
Main Results:
- High-sensitivity troponin assays can now measure cTnT and cTnI in over 50% of the general population.
- Elevated hs-cTn levels are clearly associated with an increased risk of future cardiovascular events.
- hs-cTn levels correlate with subclinical CVD, including coronary artery disease and myocardial fibrosis.
Conclusions:
- Measuring hs-cTnT and hs-cTnI represents a promising strategy for screening individuals at risk for CVD.
- Early identification of elevated troponin levels can facilitate timely and aggressive management of modifiable risk factors.
- This approach holds potential for improving patient outcomes by preventing major cardiovascular events.
Abstract:
Cardiovascular disease (CVD), including atherosclerosis, valvular etiologies, or myocardial disorders, is typically asymptomatic for several years, representing an occult phase of illness. Readily available preventive treatments to reduce cholesterol and blood pressure, among other risk factors, have the potential to reduce and delay incident myocardial infarction (MI), heart failure, and cardiovascular (CV) deaths. Measurement of circulating levels of cardiac troponin T (cTnT) and troponin I (cTnI) released from cardiomyocytes, as a result of injury, has been the biochemical standard for the diagnosis of MI for more than 20 years. The recent adoption of high-sensitivity (hs) assays, which are capable of measuring cTnT and I levels in more than 50% of the general population, has revealed a clear association between progressively higher biomarker levels and future CV events. In cross-sectional imaging studies, cTn levels measured by hs assays have also demonstrated correlations between elevated biomarker levels and occult CVD such as coronary artery disease and myocardial fibrosis. In this review, we provide evidence to consider measuring hs-cTnT and hs-cTnI to screen for patient CV risk and provide an example of a scenario in which such screening may improve outcomes through decision support for aggressive management of blood pressure.
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