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High-sensitivity cardiac troponin I and incident coronary heart disease among asymptomatic older adults
  1. Carlos Iribarren1,2,
  2. Malini Chandra1,
  3. Jamal S Rana3,
  4. Mark A Hlatky4,
  5. Stephen P Fortmann4,5,
  6. Thomas Quertermous4,
  7. Alan S Go1,2,4
  1. 1Kaiser Permanente Northern California Division of Research, Oakland, California, USA
  2. 2San Francisco Departments of Epidemiology, University of California, Biostatistics and Medicine, San Francisco, California, USA
  3. 3Division of Cardiology, Kaiser Permanente Oakland Medical Center, Oakland, California, USA
  4. 4Stanford University School of Medicine, Palo Alto, California, USA
  5. 5Center for Health Research, Kaiser Permanente Northwest, Portland, Oregon, USA
  1. Correspondence to Carlos Iribarren, Division of Research, Kaiser Permanente Northern California, 2000 Broadway, Oakland, CA 94612, USA; Carlos.Iribarren{at}kp.org

Abstract

Objective High-sensitivity cardiac troponin I (hs-cTnI) is a novel biomarker of myocardial injury and ischaemia. Our objective was to ascertain correlates of hs-cTnI and its incremental prognostic utility for incident coronary heart disease (CHD) among older asymptomatic subjects.

Methods We performed a cohort study among 1135 asymptomatic control participants in the ADVANCE (Atherosclerotic Disease, VAscular FunctioN and GenetiC Epidemiology) study at Kaiser Permanente Northern California and Stanford University, with follow-up through 31 December 2014. Hs-cTnI was measured in stored baseline (2002–2004) serum samples.

Results After a median follow-up of 11.3 years, 164 CHD events were documented. The most significant correlates of hs-cTnI were black race, body mass index, hypertension, LDL cholesterol and estimated glomerular filtration rate (eGFR) (R2=0.16) After adjustment for race/ethnicity, education level, diabetes status, ATP-III Framingham risk score (FRS), C reactive protein and eGFR, each 1 SD increment of log-transformed Hs-cTnI was associated with 1.11 (95% CI 1.01 to 1.23, p=0.04) increased hazard of CHD. The c-statistic increased to 0.70 from 0.68 (p=0.16) and the category-based net reclassification index was 18% (95% CI 8% to 30%) after adding hs-cTnI to the model containing the ATP-III FRS.

Conclusions Hs-cTnI conveys incremental prognostic information for incident CHD among asymptomatic older adults.

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