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

Journal of the American Heart Association: Cardiovascular and Cerebrovascular Disease

Germaine Wong¹  Peter L. Thompson²  Ee M. Lim³  Samuel Abbs⁴  Kun Zhu⁵  Joshua R. Lewis⁵  Wai H. Lim⁵  Richard L. Prince⁵ 

[1] Centre for Kidney Research, Children's Hospital at Westmead School of Public Health, Sydney Medical School, The University of Sydney, Australia;Department of Cardiology, Sir Charles Gairdner Hospital, Perth, Australia;Department of Endocrinology and Diabetes, Sir Charles Gairdner Hospital, Perth, Australia;PathWest, Sir Charles Gairdner Hospital, Perth, Australia;Sir Charles Gairdner Hospital Unit, University of Western Australia School of Medicine and Pharmacology, Perth, Australia;

关键词: elderly;    heart disease;    heart failure;    troponin;    women;   

DOI  :  10.1161/JAHA.116.004174

来源: DOAJ

【 摘 要 】

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.

【 授权许可】

Unknown