Association between high-sensitivity cardiac troponin T levels and the predicted cardiovascular risk in middle-aged men without overt cardiovascular disease

doi:10.1016/j.ahj.2010.02.036

American Heart Journal

Volume 159, Issue 6, June 2010, Pages 972-978

https://doi.org/10.1016/j.ahj.2010.02.036 Get rights and content

Background

A slight elevation of cardiac troponin T (TnT) levels in the circulating blood can be detected by the recently developed, high-sensitivity TnT (hsTnT) assay. However, it remains unclear whether a slight elevation of hsTnT is associated with an increased cardiovascular risk in subjects without overt cardiovascular disease (CVD).

Methods

The serum hsTnT levels were measured in a work site-based population of 1,072 middle-aged males (mean age 44 years) without any history or presence of CVD. The lower detection limit of the hsTnT assay used in the present study was 0.002 ng/mL. The association of the hsTnT levels with cardiovascular risk factors and the predicted CVD risk, as determined by the Framingham CVD risk prediction score, were examined.

Results

Detectable hsTnT levels were seen in 867 subjects (80.9%). The highest value of the hsTnT was 0.020 ng/mL. Among various cardiovascular risk factors, age, blood pressure, estimated glomerular filtration rate, current smoking, and left ventricular hypertrophy were independent determinants of hsTnT levels. The odds ratio for a high predicted CVD risk (10-year risk ≥20%) in the highest tertile of hsTnT (≥0.005 ng/mL) in comparison to the lowest tertile (≤0.002 ng/mL) was 3.98 (95% CI 1.72-9.24, P = .001) after adjusting for multiple potential confounders.

Conclusions

The present study showed the hsTnT levels to be significantly associated with several cardiovascular risk factors and the predicted CVD risk in middle-aged men without overt CVD, thus suggesting the usefulness of measuring hsTnT to identify high-risk subjects in the primary prevention of CVD.

Section snippets

Study population

This study was conducted during an annual medical examination at a company in Kanagawa, Japan, in 2005. The business of this company was the development of precision equipment. A total of 1,082 male workers, between 35 and 63 years of age, underwent a complete medical examination. All workers were engaged in daytime desk work. Among them, any subjects with a history or presence of CVD (n = 9) or those who had received hemodialysis (n = 1) were excluded from the study. Finally, 1,072 subjects

Results

The distribution of the hsTnT levels is described in Figure 1. Detectable hsTnT levels (≥0.002 ng/mL) were seen in 867 subjects (80.9%). The median hsTnT was 0.004 (0.002, 0.005) ng/mL. The hsTnT levels ≥0.010 ng/mL were found in 24 subjects (2.2%) with the highest value of 0.020 ng/mL. In contrast, no subjects demonstrated detectable TnT levels when measured by the conventional assay.

The mean age in the entire study population was 44 ± 6 years old. The characteristics of the study subjects,

Discussion

The present study showed that a substantial proportion of the subjects had slightly elevated hsTnT levels, and this elevation was associated with several cardiovascular risk factors and the predicted CVD risk in middle-aged men without any history or presence of CVD.

In the present study, approximately 80% of subjects showed detectable hsTnT levels, and 2.2% of the subjects showed the levels ≥0.010 ng/mL with the highest value of 0.020 ng/mL. Nevertheless, any subjects did not show conventional

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Association of high-sensitivity cardiac troponin T with all-cause and cardiovascular mortality in older adults with low lean mass: A 14.6-year longitudinal study
2024, Archives of Gerontology and Geriatrics
Current evidence on the association between high-sensitivity cardiac troponin T (hs-cTnT) levels and mortality in elderly sarcopenic patients is limited. This study aimed to investigate the association of serum hs-cTnT concentrations with all-cause and cardiovascular mortality in older adults with low lean mass (LLM) and without baseline cardiovascular disease.
This prospective cohort study included 369 older adults (representing 3.2 million people) from the National Health and Nutrition Examination Survey 1999–2004. Individuals were linked to national death records until 31 December 2019. The weighted Kaplan-Meier analysis, Cox proportional hazards models, restricted cubic spline models, stratified analysis, interaction analysis, and sensitivity analysis were performed to examine the association between hs-cTnT levels and mortality in older adults with LLM.
During 4697 person-years of follow-up (median duration, 14.6 years), 228 (65.6%) deaths were documented, including 56 (15.8%) deaths from cardiovascular disease. Individuals with a hs-cTnT level of ≥14 ng/L had 2.1- and 4.4-fold higher risks of all-cause and cardiovascular mortality, respectively. Compared with the lowest quartile, the fourth quartile of hs-cTnT levels was significantly associated with 3.1- and 6.4-fold higher risks of all-cause and cardiovascular mortality, respectively. Each one standard deviation increase in natural log-transformed hs-cTnT levels significantly and linearly increased the risks of all-cause and cardiovascular mortality by 39% and 61%, respectively. Stratified and sensitivity analyses confirmed the robustness of the association.
In this nationally representative cohort of US older adults with LLM, higher serum hs-cTnT concentrations were significantly associated with increased risks of all-cause and cardiovascular mortality.
Cardiac Troponin T as Early Marker of Subclinical Cardiovascular Deterioration in Black Hypertensive Women
2017, Heart Lung and Circulation
Hypertensive heart disease is a rising concern, especially among black South African women. As high sensitivity cardiac troponin T (cTnT) is a marker of cardiomyocyte damage, we determined the potential link of (i) systemic endothelial dysfunction (reflected by urinary albumin-to-creatinine ratio), (ii) large artery stiffness, (iii) cardiac volume load (estimated by the N-terminal prohormone B-type natriuretic peptide (Nt-proBNP)), and (iv) ECG left ventricular hypertrophy in post-menopausal black women.
In 121 (50 normotensive and 71 hypertensive) black women (mean age: 60.6 years), basic cardiovascular assessments including blood pressure and ECG were performed, along with plasma and urinary biomarkers including cTnT.
The cTnT levels (p=0.049) along with Nt-proBNP (p=0.003), pulse pressure (p<0.0001) and the Cornell product (p=0.030) were higher in hypertensive than normotensive women. Only in hypertensive women, was cTnT independently associated with urinary albumin-to-creatinine ratio (β=0.25; p=0.019), pulse pressure (β=0.31; p=0.019), Nt-proBNP (β=0.47; p<0.0001) and Cornell product (β=0.31; p=0.018). An independent association between albumin-to-creatinine ratio and cTnT was also evident in normotensive women (β=0.34; p=0.037).
We found cTnT to be a useful marker in an elderly black population relating to several measures of cardiovascular deterioration – from subclinical endothelial dysfunction to left ventricular hypertrophy.
Investigations, findings, and follow-up in patients with chest pain and elevated high-sensitivity cardiac troponin T levels but no myocardial infarction
2017, International Journal of Cardiology
Citation Excerpt :
It may be assumed that the associations found may be partly explained by undiagnosed cardiovascular disease in elderly patients with reduced GFR. This hypothesis is more plausible considering that even small increases in hs-cTn in the general population, undetectable by prior-generation assays [12], are associated with adverse cardiovascular outcomes, including structural heart disease and cardiovascular mortality [32–34]. The main strength of this study was the relatively large study cohort, which allowed us to stratify patients according to the somewhat narrow groups of hs-cTnT levels.
Elevated troponin levels, in patients without myocardial infarction (MI), are associated with increased mortality. In an observational cohort study we aimed to assess how patients with elevated high-sensitivity cardiac troponin T (hs-cTnT) levels, and no MI are investigated and followed up, compared to patients with MI.
During January 1, 2011 to December 31, 2012, all patients > 25 years of age, with chest pain and elevated hs-cTnT levels or MI, at the Karolinska University Hospital were included. We calculated risk ratios (RR) with 95% confidence intervals (CI) for echocardiographies, stress tests, and follow-up, and compared medication in patients with and without MI.
1848 patients with elevated hs-cTnT levels but no MI, of whom 871 (47%) had no prior heart disease, and 667 patients with MI were included. Echocardiography was performed in 609 patients (33%) without MI and 580 (87%) with MI (adjusted RR 0.42; 95% CI, 0.37–0.48). Follow-up was planned for 856 (46%) patients without MI and 611 (92%) with MI (adjusted RR 0.54; 95% CI, 0.48–0.60). Among patients without MI and no heart disease who underwent echocardiography 46 (14%) had a left ventricular ejection fraction of ≤ 40%, and on stress tests 27 (37%) had findings associated with ischemia. Platelet inhibitors and statins were started in 266 (25%) and 199 (17%) patients without MI, respectively, compared with 424 (93%), and 416 (86%) patients with MI.
Patients with elevated hs-cTnT levels and no MI are rarely investigated for detection of cardiac disease or followed up, or started on cardiovascular medication that potentially could prevent future cardiovascular events and death.
High-sensitivity cardiac troponin T in geriatric inpatients
2016, Archives of Gerontology and Geriatrics
High-sensitivity cardiac troponin T (hs-cTnT) is detectable in elderly patients without clinical diagnosed cardiovascular disease. Elevated hs-cTnT levels predict increased cardiovascular risks and poor prognosis. The aim of this study was to determine the distribution and associated factors of hs-cTnT in geriatric inpatients without acute coronary syndrome (ACS).
Hs-cTnT was measured with a highly sensitive assay in 679 geriatric inpatients without ACS. Patients were further divided into 3 groups according to the tertile of hs-cTnT levels and single and multiple variable analyses were performed to assess the association of hs-cTnT to cardiovascular risk factors, biochemical measurements and echocardiographic abnormalities.
Hs-cTnT was detectable (≥3 ng/L) in 98.4% of the subjects and 52.0% of the subjects had hs-cTnT levels ≥14 ng/L, which is at the 99th percentile Upper Reference Limit (URL). The levels of hs-cTnT were independently associated with N-terminal pro-brain natriuretic peptide (NT-proBNP), male gender, older age, estimated glomerular filtration rate (eGFR), left ventricular mass index (LVMI), diabetes mellitus (DM) and left ventricular ejection fraction (LVEF). There were no significant differences in hs-cTnT levels between geriatrics patients with stable coronary artery disease (SCAD) and those without SCAD.
Hs-cTnT elevation caused by non-ischemic acute conditions was very common in geriatric hospitalized patients. Due to increases in baseline hs-cTnT in the elderly, detection of a rise and/or fall in hs-cTnT levels is essential for determining a diagnosis of ACS or AMI in geriatric patients. Further studies are needed to establish age-specific 99th percentile values of hs-cTnT for elderly individuals.
Cardiac Troponin and its Relationship to Cardiovascular Outcomes in Community Populations - A Systematic Review and Meta-analysis
2016, Heart Lung and Circulation
The clinical relevance of minor elevations of cardiac troponin (cTn) in the general population remains uncertain. The objective of this systematic review was to examine the literature and evaluate the prevalence of raised cTn in asymptomatic, community populations and explore the strength of the relationship between cTn and cardiovascular mortality amongst those studied.
Studies were identified by searching Medline, Embase, CINAHL, EBM Reviews, Cochrane Library and using the “related citation” search tool in PubMed from inception through August 2014. Prospective cohort studies of asymptomatic individuals recruited from the community (age ≥ 18 years) that assessed the relationship between cTn levels and mortality or cardiovascular events were included.
Twenty-one prospective studies involving 64,855 participants were identified. An elevated cTn measurement (>99th percentile) occurred in 5% of individuals and was associated with a tripling of risk of mortality (adjusted RR 3.07, 95% confidence interval [CI] 2.32-4.06) and cardiovascular mortality (adjusted RR 3.30, 95% CI 1.77-6.12). In studies including high sensitivity assays, cTn was detectable in 58% of individuals. A detectable cardiac troponin T (cTnT) was also associated with an increased risk of cardiovascular mortality (adjusted RR 1.32, 95% CI 1.10 – 1.59). The risk increased with increasing cTnT level.
Elevated troponin in asymptomatic individuals in the community is associated with a tripling of risk of all-cause and cardiovascular mortality. Cardiac troponin T (cTnT) is generally not measured in this group of patients, but may potentially have utility in predicting risk in this population. Further research is required to assess if this risk is modifiable with usual primary prevention treatments.
Associations between obstructive sleep apnea and cardiac troponin T levels: a meta-analysis
2023, Current Psychology

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Clinical InvestigationAcute Ischemic Heart DiseaseAssociation between high-sensitivity cardiac troponin T levels and the predicted cardiovascular risk in middle-aged men without overt cardiovascular disease

Background

Methods

Results

Conclusions

Section snippets

Study population

Results

Discussion

J Am Coll Cardiol

J Am Coll Cardiol

Am J Kidney Dis

Kidney Int

J Am Coll Cardiol

Am J Cardiol

Am J Med

J Am Coll Cardiol

Universal definition of myocardial infarction

Circulation

Prevalence and determinants of troponin T elevation in the general population

Circulation

Prognostic value of very low plasma concentrations of troponin T in patients with stable chronic heart failure

Circulation

A sensitive cardiac troponin T assay in stable coronary artery disease

N Engl J Med

Cardiovascular survey methods, Annes 1: classification of the electrocardiogram for population studies

Clinical Investigation
Acute Ischemic Heart Disease
Association between high-sensitivity cardiac troponin T levels and the predicted cardiovascular risk in middle-aged men without overt cardiovascular disease