Cardiac Troponin I and T Ratio and Risk of Cardiovascular or Non-Cardiovascular Events in a General Population
Marie de Bakker1, Paul Welsh2, Naveed Sattar2
1British Heart Foundation Centre for Cardiovascular Science, University of Edinburgh, Edinburgh, United Kingdom.
Insights
The cardiac troponin I/T ratio predicts cardiovascular death risk in the general population. A higher ratio indicates increased cardiovascular mortality, while a lower ratio suggests higher non-cardiovascular mortality risk.
Area of Science:
- Biomarkers
- Cardiovascular Disease
- Prognostics
Background:
- Cardiac troponin (cTn) I/T ratio may predict adverse outcomes in cardiovascular disease patients.
- Prognostic value of cTn I/T ratio in the general population is unknown.
Purpose of the Study:
- To investigate the association between the cTn I/T ratio and mortality outcomes in the general population.
Main Methods:
- Calculated cTn I/T ratio in 8855 participants from the Generation Scotland Study.
- Used multivariable cause-specific Cox proportional hazard models to assess associations with cardiovascular and non-cardiovascular death.
Main Results:
- Higher cTn I/T ratio tertile associated with male sex, higher BMI, systolic blood pressure, and cardiovascular disease history.
- Lower cTn I/T ratio tertile associated with smoking and diabetes.
- Adjusted analysis showed cTn I/T ratio positively associated with cardiovascular death (aHR 1.16) and inversely with non-cardiovascular death (aHR 0.89).
Conclusions:
- The cTn I/T ratio is associated with cardiovascular and non-cardiovascular death in the general population.
- Further research is needed to understand mechanisms and clinical utility for guiding management.
Background:
Emerging evidence suggests that the ratio between cardiac troponin (cTn) I and T may provide information on the risk of adverse outcomes in individuals with cardiovascular disease. Whether the cTn I/T ratio provides prognostic insights in the general population is unknown.
Methods:
The cTn I/T ratio was calculated in 8855 participants (43% female, median age 56 years) from the Generation Scotland Study where both cTnI and cTnT concentrations were above the limit of blank. Multivariable cause-specific Cox proportional hazard models were used to estimate the associations between cTn I/T ratio and the primary outcome of cardiovascular or non-cardiovascular death.
Results:
The median cTn I/T ratio was 0.5 (25th-75th percentile, 0.3-0.8) and median follow-up was 11.4 (10.8-12.7) years. Individuals in the highest ratio tertile (≥0.64) were more likely to be male, have a higher body mass index and systolic blood pressure, and a history of cardiovascular disease. Those in the lowest ratio tertile (<0.38) were more likely to be smokers or have diabetes. After adjustment for cardiovascular risk factors, the cTn I/T ratio was positively associated with cardiovascular death (per doubling increase, adjusted hazard ratio [HR] 1.16 [95% CI, 1.05-1.28]), while an inverse association was observed for non-cardiovascular death (HR 0.89 [95% CI, 0.81-0.99]).
Conclusions:
The cTn I/T ratio is positively associated with cardiovascular death in the general population, while inversely associated with non-cardiovascular death. Future research is needed to unravel underlying mechanisms and determine whether the cTn I/T ratio provides valuable information regarding risk of cardiovascular and non-cardiovascular mortality to guide further management.
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