Association between high-sensitivity cardiac troponin I and cardiac events in elderly women

Joshua R Lewis, Wai H Lim, Germaine Wong, Samuel Abbs, Kun Zhu, Ee M Lim, Peter L Thompson, Richard L Prince

    Research output: Contribution to journalArticle

    5 Citations (Scopus)

    Abstract

    BACKGROUND: Elderly 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 RESULTS: This 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).

    CONCLUSIONS: Cardiac 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.

    Original languageEnglish
    Article numbere004174
    Number of pages13
    JournalJournal of the American Heart Association
    Volume6
    Issue number8
    DOIs
    Publication statusPublished - 30 Jul 2017

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    Troponin I
    Coronary Disease
    Heart Failure
    Acute Coronary Syndrome
    Hospitalization
    Randomized Controlled Trials
    Myocardial Infarction
    Prospective Studies
    Calcium
    Mortality
    Serum

    Cite this

    @article{f6b718b9d6b347b2ad5eccf76c1172a1,
    title = "Association between high-sensitivity cardiac troponin I and cardiac events in elderly women",
    abstract = "BACKGROUND: Elderly 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 RESULTS: This 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).CONCLUSIONS: Cardiac 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.",
    keywords = "Journal Article",
    author = "Lewis, {Joshua R} and Lim, {Wai H} and Germaine Wong and Samuel Abbs and Kun Zhu and Lim, {Ee M} and Thompson, {Peter L} and Prince, {Richard L}",
    note = "{\circledC} 2017 The Authors. Published on behalf of the American Heart Association, Inc., by Wiley.",
    year = "2017",
    month = "7",
    day = "30",
    doi = "10.1161/JAHA.116.004174",
    language = "English",
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    Association between high-sensitivity cardiac troponin I and cardiac events in elderly women. / Lewis, Joshua R; Lim, Wai H; Wong, Germaine; Abbs, Samuel; Zhu, Kun; Lim, Ee M; Thompson, Peter L; Prince, Richard L.

    In: Journal of the American Heart Association, Vol. 6, No. 8, e004174, 30.07.2017.

    Research output: Contribution to journalArticle

    TY - JOUR

    T1 - Association between high-sensitivity cardiac troponin I and cardiac events in elderly women

    AU - Lewis, Joshua R

    AU - Lim, Wai H

    AU - Wong, Germaine

    AU - Abbs, Samuel

    AU - Zhu, Kun

    AU - Lim, Ee M

    AU - Thompson, Peter L

    AU - Prince, Richard L

    N1 - © 2017 The Authors. Published on behalf of the American Heart Association, Inc., by Wiley.

    PY - 2017/7/30

    Y1 - 2017/7/30

    N2 - BACKGROUND: Elderly 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 RESULTS: This 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).CONCLUSIONS: Cardiac 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.

    AB - BACKGROUND: Elderly 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 RESULTS: This 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).CONCLUSIONS: Cardiac 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.

    KW - Journal Article

    U2 - 10.1161/JAHA.116.004174

    DO - 10.1161/JAHA.116.004174

    M3 - Article

    VL - 6

    JO - Journal of the American Heart Association

    JF - Journal of the American Heart Association

    SN - 2047-9980

    IS - 8

    M1 - e004174

    ER -