Gender, High-Sensitivity Troponin I, and the Risk of Cardiovascular Events (from the Nord-Trøndelag Health Study)

Lyngbakken, Magnus Nakrem; Røsjø, Helge; Holmen, Oddgeir L.; Nygård, Ståle; Dalen, Håvard; Hveem, Kristian; Omland, Torbjørn

doi:10.1016/j.amjcard.2016.06.043

Cited by 33 publications

(38 citation statements)

References 30 publications

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“…In this study, we found women's baseline global cardiovascular risk profiles were strongly related to circulating hsTnI, and per SD increase in natural log transformed hsTnI, there was a 34% to 64% increase in the hazard for cardiac events after adjustment for Framingham risk factors. These findings are very similar to the HUNT (Nord‐Trøndelag Health Study) study of middle‐aged women where hsTnI was more strongly associated with myocardial infarction and HF in women than men with an adjusted HR of 1.50 for myocardial infarction and an HR of 1.69 for HF . Similarly, in the study by Zeller et al, in middle‐aged men and women per SD increase in hsTnI were associated with an adjusted HR for coronary death of 1.51 in women and 1.35 in men.…”

Section: Discussionsupporting

confidence: 84%

“…There have been a number of studies that have found that despite men having higher hsTnI than women, hsTnI is more strongly related to cardiovascular outcomes in women . In this study, we found women's baseline global cardiovascular risk profiles were strongly related to circulating hsTnI, and per SD increase in natural log transformed hsTnI, there was a 34% to 64% increase in the hazard for cardiac events after adjustment for Framingham risk factors.…”

Section: Discussionmentioning

confidence: 48%

“…There have been a number of studies that have found that despite men having higher hsTnI than women, hsTnI is more strongly related to cardiovascular outcomes in women. 11,15,28 In this study, we found women's baseline global cardiovascular risk profiles were strongly related to circulating hsTnI, and per SD increase in natural log transformed hsTnI, there was a 34% to 64% increase in the hazard for cardiac events after adjustment for Framingham risk factors. These findings are very similar to the HUNT (Nord-Trøndelag Health Study) study of middle-aged women where hsTnI was more strongly associated with myocardial infarction and HF in women than men with an adjusted HR of 1.50 for myocardial infarction and an HR of 1.69 for HF.…”

Section: Discussionmentioning

confidence: 55%

“…14 In middle-aged women, high-sensitivity cardiac troponin I (hsTnI) has been shown to be more strongly associated with myocardial infarction and heart failure (HF) outcomes than in men. 15 To expand understanding of the clinical utility of this marker to an older female population at higher risk of CHD, we examined the association between baseline circulating cardiac hsTnI and the risk of long-term cardiac hospitalizations and deaths. Furthermore, we assessed the clinical utility of measuring hsTnI in addition to the currently accepted Framingham risk factors.…”

mentioning

confidence: 99%

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Association Between High‐Sensitivity Cardiac Troponin I and Cardiac Events in Elderly Women

Lewis

Lim

Wong

et al. 2017

JAHA

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BackgroundElderly women are at high risk of coronary heart disease (CHD) and heart failure. High‐sensitivity assays allow detection of cardiac troponin I (hsTnI) well below diagnostic cutoffs for acute coronary syndrome. We investigated the association between these levels with future cardiac events in community‐based ambulant white women aged over 70 years initially recruited for a 5‐year randomized, controlled trial of calcium supplements.Methods and ResultsThis was a prospective study of 1081 elderly women without clinical CHD at baseline (1998) or hsTnI above the diagnostic cutoffs for acute coronary syndrome with 14.5‐year follow‐up hospitalization and mortality (events). Two hundred forty‐three (22%) women had CHD events, 163 (15%) myocardial infarction or CHD death (hard CHD), and 109 (10%) heart failure. In 99.6% of available serum samples, hsTnI was above the level of detection (median, 4.5 ng/L; interquartile range, 3.6–5.8). After adjusting for Framingham risk factors, each SD natural log‐transformed hsTnI increase was associated with an increased hazard for CHD (hazard ratio, 1.34; 95% CI, 1.18–1.53; P<0.001) hard CHD (hazard ratio, 1.51; 95% CI, 1.29–1.76; P<0.001), and heart failure (hazard ratio, 1.65; 95% CI, 1.36–1.99; P<0.001). Step‐wise increases in relative hazards were observed with increasing quartiles of hsTnI (P for trend, <0.001), whereas the addition of hsTnI to conventional risk factors modestly improved discrimination indices: Harrell's c‐statistic, net reclassification, and integrated discrimination (P<0.05).ConclusionsCardiac troponin I is independently associated with future cardiac events in elderly women without apparent clinical manifestations. The addition of cardiac troponin I to conventional risk factors may modestly improve risk prediction in this setting.

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Section: Discussionsupporting

confidence: 84%

Section: Discussionmentioning

confidence: 48%

Section: Discussionmentioning

confidence: 55%

mentioning

confidence: 99%

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Association Between High‐Sensitivity Cardiac Troponin I and Cardiac Events in Elderly Women

Lewis

Lim

Wong

et al. 2017

JAHA

View full text Add to dashboard Cite

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“…Recent studies in subjects recruited from the general population have suggested that elevations in circulating cardiac troponin are associated with a higher risk of a first-ever CVD event 4, 5, 6, 7, 8, 9, 10, 11, 12, 13, 14, 15, 16, 17, 18, 19, 20, 21, 22, 23, 24, 25, 26, 27, 28, 29, 30. The largest such study, from the BiomarCaRE (Biomarkers for Cardiovascular Risk Assessment in Europe) consortium, reported a hazard ratio (HR) for CVD of 1.92 (95% confidence interval [CI]: 1.76 to 2.10) comparing the highest versus the lowest quintile of hs-cTnI concentration (11).…”

mentioning

confidence: 99%

High-Sensitivity Cardiac Troponin Concentration and Risk of First-Ever Cardiovascular Outcomes in 154,052 Participants

Willeit¹,

Welsh

Evans

et al. 2017

Journal of the American College of Cardiology

251

162

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BackgroundHigh-sensitivity assays can quantify cardiac troponins I and T (hs-cTnI, hs-cTnT) in individuals with no clinically manifest myocardial injury.ObjectivesThe goal of this study was to assess associations of cardiac troponin concentration with cardiovascular disease (CVD) outcomes in primary prevention studies.MethodsA search was conducted of PubMed, Web of Science, and EMBASE for prospective studies published up to September 2016, reporting on associations of cardiac troponin concentration with first-ever CVD outcomes (i.e., coronary heart disease [CHD], stroke, or the combination of both). Study-specific estimates, adjusted for conventional risk factors, were extracted by 2 independent reviewers, supplemented with de novo data from PROSPER (Pravastatin in Elderly Individuals at Risk of Vascular Disease Study), then pooled by using random effects meta-analysis.ResultsA total of 28 relevant studies were identified involving 154,052 participants. Cardiac troponin was detectable in 80.0% (hs-cTnI: 82.6%; hs-cTnT: 69.7%). In PROSPER, positive associations of log-linear shape were observed between hs-cTnT and CVD outcomes. In the meta-analysis, the relative risks comparing the top versus the bottom troponin third were 1.43 (95% confidence interval [CI]: 1.31 to 1.56) for CVD (11,763 events), 1.67 (95% CI: 1.50 to 1.86) for fatal CVD (7,775 events), 1.59 (95% CI: 1.38 to 1.83) for CHD (7,061 events), and 1.35 (95% CI: 1.23 to 1.48) for stroke (2,526 events). For fatal CVD, associations were stronger in North American studies (p = 0.010) and those measuring hs-cTnT rather than hs-cTnI (p = 0.027).ConclusionsIn the general population, high cardiac troponin concentration within the normal range is associated with increased CVD risk. This association is independent of conventional risk factors, strongest for fatal CVD, and applies to both CHD and stroke.

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Value of troponin T versus I in the diagnosis of immune checkpoint inhibitor‐related myocarditis and myositis: rechallenge?

et al. 2023

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A 54-year old patient with metastatic melanoma presented with asymptomatic myositis and myocarditis after combined immune checkpoint inhibitors (ICI) therapy (anti-programmed cell death receptor-1, anti-lymphocyte activating gene-3, and anti-indoleamine 2,3-dioxygenase-1). The diagnosis was based on the typical time window after ICI, recurrence upon rechallenge, elevations of CK, high-sensitive troponin T (hs-TnT) and I (hs-TnI), mild NT-proBNP increase, and positive magnetic resonance imaging criteria. Notably, hsTnI was found to more rapidly increase and fall and to be more heart-specific than TnT in the context of ICI-related myocarditis. This led to ICI therapy withdrawal and switch to a less effective systemic therapy. This case report highlights the differential value of hs-TnT and hs-TnI for diagnosis and monitoring of ICI-related myositis and myocarditis.

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Gender, High-Sensitivity Troponin I, and the Risk of Cardiovascular Events (from the Nord-Trøndelag Health Study)

Cited by 33 publications

References 30 publications

Association Between High‐Sensitivity Cardiac Troponin I and Cardiac Events in Elderly Women

Association Between High‐Sensitivity Cardiac Troponin I and Cardiac Events in Elderly Women

High-Sensitivity Cardiac Troponin Concentration and Risk of First-Ever Cardiovascular Outcomes in 154,052 Participants

Value of troponin T versus I in the diagnosis of immune checkpoint inhibitor‐related myocarditis and myositis: rechallenge?

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