Impact of age on cardiac troponin concentration among healthy individuals
Rasmus Bo Hasselbalch1, Nina Strandkjær1, Jonas Kristensen2
1Department of Emergency Medicine, Copenhagen University Hospital - Herlev and Gentofte, Copenhagen, Denmark; Department of Cardiology, Copenhagen University Hospital - Herlev and Gentofte, Copenhagen, Denmark.
Insights
Cardiac troponin (cTn) levels increase with age in healthy individuals. The 99th percentile, a key marker for myocardial infarction, is significantly affected by age, especially for hs-cTnT assays.
Area of Science:
- Cardiology
- Biomarkers
- Clinical Chemistry
Background:
- The 99th percentile of cardiac troponin (cTn) defines the diagnostic threshold for myocardial infarction in healthy populations.
- Understanding age-related variations in cTn is crucial for accurate diagnosis.
Purpose of the Study:
- To investigate the impact of age on the 99th percentile of cTn across various high-sensitivity assays.
- To determine if age influences the diagnostic cutoff for myocardial infarction.
Main Methods:
- Analysis of healthy Danish blood donors (n=2169) screened for cardiovascular risk factors.
- Measurement of cTn using Siemens, Abbott, Vitros (hs-cTnI), and Roche (hs-cTnT) assays.
- Calculation of 99th percentiles using non-parametric methods and quantile regression adjusted for sex and creatinine.
Main Results:
- Cardiac troponin concentrations increased with age for all tested assays (p < 0.001).
- The 99th percentile of Roche hs-cTnT showed a significant age association (0.42 ng/L increase/year).
- For hs-cTnT, individuals >70 years had a 99th percentile more than double that of individuals <50 years, with 22.2% exceeding the manufacturer's cutoff.
Conclusions:
- Age is a significant factor associated with elevated cTn concentrations across multiple assays.
- The strongest age-related correlation was observed with hs-cTnT, impacting its diagnostic utility in older populations.
- A substantial proportion of individuals >70 years exceeded the manufacturer's 99th percentile for hs-cTnT.
Background:
The 99th percentile of cardiac troponin (cTn) among healthy individuals is the diagnostic cutoff for myocardial infarction. This study investigates the effect of age on the 99th percentile of cTn among healthy individuals.
Methods:
We sampled healthy Danish blood donors, screened using hemoglobin A1c, N-terminal pro-brain natriuretic peptide, and creatinine. The cTn assays investigated were Siemens Atellica and Dimension Vista hs-cTnI, Abbott hs-cTnI, Vitros hs-cTnI, and Roche hs-cTnT. The 99th percentiles were calculated using the non-parametric method and modeled using quantile regressions adjusted for sex and creatinine concentration.
Results:
We included 2287 participants, excluding 118 due to a history of heart disease, insufficient plasma, or biomarker screening, leaving 2169 participants with a median age of 58 years (IQR 49-69 years), and 1152 (53 %) were female. Concentrations increased with age for all assays (p < 0.001). Only the 99th percentile of hs-cTnT was significantly associated with age (0.42 ng/L increase/year, p < 0.001); for participants >70 years, the 99th percentile was 36.8 ng/L (90 % CI 33.8-40.7 ng/L), with 22.2 % above the manufacturer's 99th percentile. The difference in the 99th percentile between age groups was less clear for cTnI, except for the Vitros assay: <50 years 6.5 ng/L (90 % CI 5.0-26.9 ng/L) vs >70 years 17.3 ng/L (90 % CI 9.7-33.2 ng/L).
Conclusions:
Age was associated with increased cTn concentrations for all assays. The correlation was strongest for hs-cTnT, where the 99th percentile for participants >70 years was more than double compared to those <50 years, with over 20 % exceeding the manufacturer's 99th percentile.
Registration:
URL: https://www.
Clinicaltrials:
gov; Unique identifier: NCT05336435.
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