Characteristics Associated With Detectable High-Sensitivity Cardiac Troponin in Patients With Rheumatoid Arthritis at
Ilana Usiskin1, Mary Jeffway1, Ying Qi1
1Brigham and Women's Hospital and Harvard Medical School, Boston, Massachusetts.
Insights
Detectable high-sensitivity cardiac troponin T (hs-cTnT) is common in rheumatoid arthritis (RA) patients with low to intermediate cardiovascular risk. Older age and male sex are linked to higher hs-cTnT levels, suggesting targeted screening for these individuals.
Area of Science:
- Cardiology
- Rheumatology
- Biomarkers
Background:
- Rheumatoid arthritis (RA) is associated with increased cardiovascular disease (CVD) risk.
- Subclinical myocardial injury, indicated by detectable high-sensitivity cardiac troponin T (hs-cTnT), is linked to adverse cardiac events in RA.
- Identifying factors associated with detectable hs-cTnT in RA patients with low to intermediate atherosclerotic cardiovascular disease (ASCVD) risk is crucial for risk stratification.
Purpose of the Study:
- To identify factors associated with detectable hs-cTnT in patients with RA at low to intermediate ASCVD risk.
- To determine if clinical factors and available biomarkers predict detectable hs-cTnT independently of ASCVD risk scores.
Main Methods:
- A cross-sectional cohort study of 294 RA patients without pre-existing CVD or high ASCVD risk (>20%).
- Univariable analysis compared demographics, RA clinical factors, inflammation markers, and lipids between patients with and without detectable hs-cTnT.
- Multivariable logistic regression models were used to identify independent predictors of detectable hs-cTnT.
Main Results:
- 29% (86/294) of RA patients had detectable hs-cTnT.
- Detectable hs-cTnT was associated with older age, male sex, hypertension, elevated inflammatory markers (hs-CRP, IL-6), lipoprotein-associated phospholipase A2, glucocorticoid use, and absence of methotrexate use.
- Higher 10-year ASCVD risk was associated with detectable hs-cTnT (OR 1.22); however, inflammatory markers were not significant in multivariable analysis.
- In the lowest ASCVD risk category (<5%), over 25% of men and 33% of patients >60 years had detectable hs-cTnT.
Conclusions:
- Detectable hs-cTnT is prevalent in RA patients with low to intermediate ASCVD risk.
- Male sex and age >60 are key factors associated with detectable hs-cTnT in this population.
- These findings suggest a need for enhanced cardiovascular screening in older male RA patients, irrespective of their calculated ASCVD risk.
Objective:
The objective of this study was to identify factors associated with detectable high-sensitivity cardiac troponin T (hs-cTnT), a marker of subclinical myocardial injury associated with cardiac events in rheumatoid arthritis (RA), among patients with RA at low to intermediate atherosclerotic cardiovascular disease (ASCVD) risk.
Methods:
We performed a cross-sectional cohort study among patients with RA, excluding those with pre-existing cardiovascular disease or high estimated 10-year ASCVD risk (>20%). In univariable analysis, we compared demographics, RA clinical factors, markers of inflammation, and routine lipids among patients with and without detectable hs-cTnT. Multivariable logistic regression models were constructed to determine whether clinical factors and clinically available biomarkers were associated with detectable hs-cTnT, independent of ASCVD risk.
Results:
We studied 294 patients with RA, of whom 86 (29%) had a detectable hs-cTnT level. Older age; male sex; hypertension; higher levels of high-sensitivity C-reactive protein, interleukin-6, and lipoprotein-associated phospholipase A2; glucocorticoid use; and the absence of methotrexate use were associated with detectable hs-cTnT. Higher 10-year ASCVD risk was associated with detectable hs-cTnT (odds ratio 1.22, 95% confidence interval 1.15-1.29); markers of inflammation were not associated with detectable hs-cTnT in multivariable analysis. Among patients with RA in the lowest ASCVD risk category (10-year risk <5%), more than 25% of men and more than 33% of patients aged >60 had detectable hs-cTnT.
Conclusion:
Detectable hs-cTnT was prevalent among a cohort of patients with RA with low to intermediate ASCVD risk. Patients who were male or aged >60 had the highest rates of detectable hs-cTnT, suggesting a role for additional screening in these individuals regardless of their ASCVD risk.
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