Abstract 13907: Circulating Levels of Troponin Measured by a Highly Sensitive Assay for Cardiovascular Risk Assessment in Primary Prevention
Background: Measuring circulating troponin using novel high-sensitive assays revealed that even minute elevations are associated with increased mortality in patients with coronary artery disease or even in the general population. However, the incremental value of measuring circulating Troponin I by a high sensitive assay (hs cTnI) for risk assessment in primary prevention is unknown.
Methods and results: We measured circulating hs TnI in a total of 5388 subjects free of known cardiovascular disease recruited into the DETECT study and determined the prognostic implications for incident major adverse cardiovascular events (MACE) during 5 years of follow-up.
Circulating TnI was detectable in 19 % of the subjects. Increased levels of hs cTnI were associated with established risk factors for atherosclerosis, like male gender, age, arterial hypertension, diabetes mellitus, hyperlipidemia and body mass index, and demonstrated a significant graded relationship with all-cause mortality (HR=5.38) and incident MACE (HR=7.84) during 5-year follow-up. A single measurement of hs cTnI significantly (p=0.002) improved risk prediction over and above established risk factors (increase in C statistics from 0.800 to 0.839) and allowed effective reclassification of primary care subjects (NRI=7.6; IDI=1.62). In comparison with the etablished biomarkers Nt-pro-BNP and hs CRP, measurement of hs TnI was superior for prediction of incident MACE, but complemented simultaneously the predictive value of Nt-pro-BNP and hsCRP within a multimarker panel (C=0.859, p<0.001) in comparison to the classical cardiovascular risk factors.
Conclusions: Minute elevations in cTnI are associated with increased mortality and incident MACE in a large primary prevention cohort and, thus, identify contributors to cardiovascular risk not fully captured by traditional risk factor assessment.
- © 2011 by American Heart Association, Inc.