Temporal hs-cTNT changes may predict future heart disease

By Laura Cowen

Temporal increases in high-sensitivity cardiac troponin T (hs-cTnT) are associated with a significantly increased risk of coronary heart disease (CHD), heart failure (HF) and death among people initially free from cardiovascular disease, US study data show.

Conversely, temporal reductions in this marker of myocardial damage coincided with a reduction in adverse outcomes, albeit nonsignificantly so, report Elizabeth Selvin (Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland) and colleagues.

They say: "Serial determination of hs-cTnT trajectory adds clinically relevant information to baseline testing and may be useful in prognostic assessments and the targeting of prevention strategies to high-risk individuals, especially among persons with stage A or B HF."

Of the 8838 members of the Atherosclerosis Risk in Communities Study included in this analysis, 24.3% developed detectable hs-cTnT (≥0.005 ng/mL) between their first and second measurements, taken 6 years apart.

During a median follow-up period of 14 years, these individuals had a 1.4-fold increased risk of CHD, a 2.0-fold increased risk of HF and a 1.5-fold increased risk of death compared with participants whose hs-cTnT level was undetectable (<0.005 ng/mL) at both visits.

Similar results were observed when HF was divided into cases with a reduced or preserved ejection fraction.

Furthermore, participants with the greatest increases in hs-cTnT had the highest risk for all three events, "suggesting that accelerated progression of myocardial damage represents an extreme risk phenotype", Selvin et al remark.

Specifically, an increase from undetectable hs-cTnT at baseline to a level at or above 0.014 ng/mL increased the risk of CHD and death by up to fourfold and that of HF by up to eightfold.

The researchers also found that participants with a greater than 50% decrease in hs-cTnT had a nonsignificant 43% to 53% lower risk for each event compared with those with a change of 50% or less.

And when added to a model that included traditional risk factors, N-terminal pro-brain natriuretic peptide and baseline hs-cTnT level, information on change in hs-cTNT level significantly improved discrimination for HF and death.

Writing in JAMA Cardiology, Selvin and co-authors say that their findings "add to a compelling argument that serial hs-cTnT monitoring, alone or with other biomarkers, may identify high-risk individuals and guide the prevention of CHD or HF."

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