Abstract 14904: High-Sensitivity Cardiac Troponin, Natriuretic Peptide, and Subsequent Risk of Lower-Extremity Peripheral Artery Disease: The Atherosclerosis Risk in Communities (ARIC) Study
Background: Cardiac troponin T (cTnT) has been recently shown as a potential predictor of leg amputation in patients with symptomatic peripheral artery disease (PAD). However, whether cTnT predicts ischemic leg outcomes in the general population is unknown.
Methods: Among 12,780 ARIC participants without a history of PAD, we investigated whether high-sensitivity cTnT (hs-cTnT) was associated with future risk of clinical PAD, defined as hospitalizations with PAD diagnosis or leg revascularization. PAD cases with rest pain, gangrene, ulcer, or amputation were considered critical limb ischemia (CLI). We also analyzed another cardiac marker, N-terminal pro-brain natriuretic peptide (NT-proBNP). Both cardiac markers were categorized at 50th, 71th, 86th, and 95th percentiles, corresponding to hs-cTnT concentrations of 3, 5, 9, and 14 ng/L and NT-proBNP concentrations of 51.4, 86.4, 140.3, and 257.6 pg/mL.
Results: During a median follow-up of 21 years, 462 participants developed PAD (171 incident CLI cases). In demographically adjusted models, the hazard ratio (HR) of PAD for the highest vs. lowest category of hs-cTnT and NT-proBNP was ~8 (Model 1 for PAD in Table). The corresponding HR of CLI was ~24 for hs-cTnT and ~10 for NT-proBNP (Model 1 for CLI in Table). Additional adjustment for each cardiac marker and traditional cardiovascular risk factors attenuated the associations. In all models, a stronger association of hs-cTnT with CLI was observed compared to NT-proBNP. Both cardiac markers significantly improved PAD risk discrimination beyond traditional cardiovascular risk factors, but only hs-cTnT (but not NT-proBNP) significantly improved CLI risk discrimination (Δc-statistic 0.012 [0.001 to 0.023] vs. 0.006 [-0.009 to 0.022]).
Conclusions: Both hs-cTnT and NT-proBNP were independently associated with future risk of clinical PAD events in a community-based cohort. The CLI risk association was particularly evident for hs-cTnT.
Author Disclosures: K. Matsushita: None. L. Kwak: None. C. Yang: None. Y. Pang: None. S.H. Ballew: None. Y. Sang: None. R.C. Hoogeveen: None. B. Jaar: None. E. Selvin: None. C.M. Ballantyne: Consultant/Advisory Board; Modest; Abbott Diagnostics, Amarin, Amgen, Eli Lilly, Esperion, Ionis, Matinas BioPharma Inc, Novartis, Regeneron, Roche Diagnostic. Research Grant; Significant; NIH, AHA, ADA. Other Research Support; Significant; Abbott Diagnostic, Amarin, Amgen, Eli Lilly, Esperion, Ionis, Novartis, Pfizer, Regeneron, Roche Diagnostic, Sanofi-Synthelabo. Consultant/Advisory Board; Significant; Astra Zeneca, Merck, Pfizer, Sanofi-Synthelabo. R. Sharrett: None. A. Folsom: None. G. Heiss: None. J. Coresh: None. A. Hirsch: None.
- © 2016 by American Heart Association, Inc.