TY - JOUR
T1 - High-Sensitivity Cardiac Troponin I for Risk Stratification in Older Adults
AU - Tang, Olive
AU - Matsushita, Kunihiro
AU - Coresh, Josef
AU - Hoogeveen, Ron C.
AU - Windham, B. Gwen
AU - Ballantyne, Christie M.
AU - Selvin, Elizabeth
N1 - Funding Information:
O.T. is supported by NIH/NIDDK F30DK120160. E.S. is supported by NIH/NHLBI grant K24 HL152440. This work was supported by NIH/NIDDK grant R01DK089174 to E.S. and NIH/NHLBI R01HL134320 to C.B. and E.S. Reagents for the hs‐cTnI assay were donated by Abbott Diagnostics and reagents for the hs‐cTnT assay were donated by Roche Diagnostics.
Funding Information:
The ARIC Study has been funded in whole or in part with Federal funds from the National Heart, Lung, and Blood Institute, National Institutes of Health, Department of Health and Human Services, under Contract nos. (HHSN268201700001I, HHSN268201700002I, HHSN268201700003I, HHSN268201700004I, HHSN268201700005I). O.T. is supported by NIH/NIDDK F30DK120160. E.S. is supported by NIH/NHLBI grant K24 HL152440. This work was supported by NIH/NIDDK grant R01DK089174 to E.S. and NIH/NHLBI R01HL134320 to C.B. and E.S. The content of this work is solely the responsibility of the authors and does not necessarily represent the official views of the National Institutes of Health.
Funding Information:
The ARIC Study has been funded in whole or in part with Federal funds from the National Heart, Lung, and Blood Institute, National Institutes of Health, Department of Health and Human Services, under Contract nos. (HHSN268201700001I, HHSN268201700002I, HHSN268201700003I, HHSN268201700004I, HHSN268201700005I).
Publisher Copyright:
© 2020 The American Geriatrics Society
PY - 2020
Y1 - 2020
N2 - BACKGROUND/OBJECTIVES: Traditional cardiovascular risk factors are less predictive in older age. High-sensitivity cardiac troponin I (hs-cTnI) is a marker of subclinical cardiomyocyte damage associated with cardiovascular risk in middle-aged adults. We hypothesized hs-cTnI would be indicative of mortality and cardiovascular risk beyond traditional cardiovascular risk factors in older adults and may be more discriminatory compared to hs-troponin T (hs-cTnT). DESIGN: Prospective cohort study. SETTING: Population-based Atherosclerosis Risk in Communities (ARIC) Study. PARTICIPANTS: We included 5,876 ARIC participants at Visit 5 (2011–2013). OUTCOMES AND MEASURES: We used Cox regression for the association of hs-cTnI categories (women: <4, 4–<10, ≥10 ng/ml; men: <6, 6–<12, ≥12 ng/ml, prevalent cardiovascular disease (CVD)) with mortality and incident CVD (atherosclerotic CVD [ASCVD]: coronary heart disease or stroke, or heart failure). RESULTS: Participants were ages 66 to 90, 23% black, 42% male, and 24% had prevalent CVD. There were 1,053 (321 CVD) deaths (median follow-up 6.3 years). Participants with elevated hs-cTnI and no CVD (7% of participants) had mortality risk similar to those with a history of CVD (55.6 vs 55.7 deaths/1,000 person-years, P =.99). After adjustment, elevated hs-cTnI and no CVD (hazard ratio (HR) = 2.38, 95% confidence interval (CI) = 1.85–3.06) and prevalent CVD (HR = 2.21, 95% CI = 1.90–2.57) remained associated with mortality, compared to low hs-cTnI and no CVD. Elevated hs-cTnI was independently associated with incident CVD (HR = 3.41, 95% CI = 2.58–4.51), ASCVD (HR = 2.02, 95% CI = 1.36–2.98), and heart failure (HR = 6.16, 95% CI = 4.24–8.95). The addition of hs-cTnI significantly improved C-statistics for all outcomes and added greater discrimination than hs-cTnT for cardiovascular mortality and incident heart failure. CONCLUSIONS: Hs-cTnI improves mortality and CVD risk stratification in older adults beyond traditional risk factors and improved model discrimination more than hs-cTnT for certain outcomes. Elevated hs-cTnI without CVD identifies a high-risk group with comparable mortality risk as those with a history of clinical CVD.
AB - BACKGROUND/OBJECTIVES: Traditional cardiovascular risk factors are less predictive in older age. High-sensitivity cardiac troponin I (hs-cTnI) is a marker of subclinical cardiomyocyte damage associated with cardiovascular risk in middle-aged adults. We hypothesized hs-cTnI would be indicative of mortality and cardiovascular risk beyond traditional cardiovascular risk factors in older adults and may be more discriminatory compared to hs-troponin T (hs-cTnT). DESIGN: Prospective cohort study. SETTING: Population-based Atherosclerosis Risk in Communities (ARIC) Study. PARTICIPANTS: We included 5,876 ARIC participants at Visit 5 (2011–2013). OUTCOMES AND MEASURES: We used Cox regression for the association of hs-cTnI categories (women: <4, 4–<10, ≥10 ng/ml; men: <6, 6–<12, ≥12 ng/ml, prevalent cardiovascular disease (CVD)) with mortality and incident CVD (atherosclerotic CVD [ASCVD]: coronary heart disease or stroke, or heart failure). RESULTS: Participants were ages 66 to 90, 23% black, 42% male, and 24% had prevalent CVD. There were 1,053 (321 CVD) deaths (median follow-up 6.3 years). Participants with elevated hs-cTnI and no CVD (7% of participants) had mortality risk similar to those with a history of CVD (55.6 vs 55.7 deaths/1,000 person-years, P =.99). After adjustment, elevated hs-cTnI and no CVD (hazard ratio (HR) = 2.38, 95% confidence interval (CI) = 1.85–3.06) and prevalent CVD (HR = 2.21, 95% CI = 1.90–2.57) remained associated with mortality, compared to low hs-cTnI and no CVD. Elevated hs-cTnI was independently associated with incident CVD (HR = 3.41, 95% CI = 2.58–4.51), ASCVD (HR = 2.02, 95% CI = 1.36–2.98), and heart failure (HR = 6.16, 95% CI = 4.24–8.95). The addition of hs-cTnI significantly improved C-statistics for all outcomes and added greater discrimination than hs-cTnT for cardiovascular mortality and incident heart failure. CONCLUSIONS: Hs-cTnI improves mortality and CVD risk stratification in older adults beyond traditional risk factors and improved model discrimination more than hs-cTnT for certain outcomes. Elevated hs-cTnI without CVD identifies a high-risk group with comparable mortality risk as those with a history of clinical CVD.
KW - cardiovascular risk stratification
KW - epidemiology
KW - heart failure
KW - high-sensitivity troponin
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U2 - 10.1111/jgs.16912
DO - 10.1111/jgs.16912
M3 - Article
C2 - 33150614
AN - SCOPUS:85096671739
JO - Journal of the American Geriatrics Society
JF - Journal of the American Geriatrics Society
SN - 0002-8614
ER -