Search

Key Points: Question: What is the value of cardiovascular biomarkers when added to established risk factors to predict incident cardiovascular events in the population? Findings: In this large, individual-level data analysis from 28 general population–based cohorts from 12 countries, high-sensitivity cardiac troponins I and T, B-type natriuretic peptide, and high-sensitivity C-reactive protein were associated with fatal and nonfatal events. Meaning: The addition of biomarkers to established risk factors leads to only a small improvement in risk prediction metrics for atherosclerotic cardiovascular disease, but was more favorable for heart failure and mortality. Importance: Identification of individuals at high risk for atherosclerotic cardiovascular disease within the population is important to inform primary prevention strategies. Objective: To evaluate the prognostic value of routinely available cardiovascular biomarkers when added to established risk factors. Design, Setting, and Participants: Individual-level analysis including data on cardiovascular biomarkers from 28 general population–based cohorts from 12 countries and 4 continents with assessments by participant age. The median follow-up was 11.8 years. Exposure: Measurement of high-sensitivity cardiac troponin I, high-sensitivity cardiac troponin T, N-terminal pro-B-type natriuretic peptide, B-type natriuretic peptide, or high-sensitivity C-reactive protein. Main Outcomes and Measures: The primary outcome was incident atherosclerotic cardiovascular disease, which included all fatal and nonfatal events. The secondary outcomes were all-cause mortality, heart failure, ischemic stroke, and myocardial infarction. Subdistribution hazard ratios (HRs) for the association of biomarkers and outcomes were calculated after adjustment for established risk factors. The additional predictive value of the biomarkers was assessed using the C statistic and reclassification analyses. Results: The analyses included 164 054 individuals (median age, 53.1 years [IQR, 42.7-62.9 years] and 52.4% were women). There were 17 211 incident atherosclerotic cardiovascular disease events. All biomarkers were significantly associated with incident atherosclerotic cardiovascular disease (subdistribution HR per 1-SD change, 1.13 [95% CI, 1.11-1.16] for high-sensitivity cardiac troponin I; 1.18 [95% CI, 1.12-1.23] for high-sensitivity cardiac troponin T; 1.21 [95% CI, 1.18-1.24] for N-terminal pro-B-type natriuretic peptide; 1.14 [95% CI, 1.08-1.22] for B-type natriuretic peptide; and 1.14 [95% CI, 1.12-1.16] for high-sensitivity C-reactive protein) and all secondary outcomes. The addition of each single biomarker to a model that included established risk factors improved the C statistic. For 10-year incident atherosclerotic cardiovascular disease in younger people (aged <65 years), the combination of high-sensitivity cardiac troponin I, N-terminal pro-B-type natriuretic peptide, and high-sensitivity C-reactive protein resulted in a C statistic improvement from 0.812 (95% CI, 0.8021-0.8208) to 0.8194 (95% CI, 0.8089-0.8277). The combination of these biomarkers also improved reclassification compared with the conventional model. Improvements in risk prediction were most pronounced for the secondary outcomes of heart failure and all-cause mortality. The incremental value of biomarkers was greater in people aged 65 years or older vs younger people. Conclusions and Relevance: Cardiovascular biomarkers were strongly associated with fatal and nonfatal cardiovascular events and mortality. The addition of biomarkers to established risk factors led to only a small improvement in risk prediction metrics for atherosclerotic cardiovascular disease, but was more favorable for heart failure and mortality. This study evaluates the prognostic value of routinely available cardiovascular biomarkers when added to established risk factors in the identification of individuals at high risk for atherosclerotic cardiovascular disease. [ABSTRACT FROM AUTHOR]

The study aims to evaluate whether a relationship exists between the measurement of cardiac troponin T (cTnT) using a sensitive assay with incident heart failure and cardiovascular mortality in older adults. The results conclude that such forms of measurement of cTnT were significantly associated with incident heart failure (HT) and cardiovascular death.

Hemodialysis patients who have elevated blood levels of cardiac troponin T and C-reactive protein have a higher risk of premature death than other hemodialysis patients, according to a study of 224 patients. In addition, an elevated cardiac troponin T level was a risk factor for coronary artery disease and heart failure. Cardiac troponin T is a protein released by the heart when it is damaged. C-reactive protein is a marker of inflammation.

Delayed coronary angiography in patients with suspected coronary artery disease may increase the risk of heart attack and other complications. Researchers monitored 381 patients referred for radiologic examination of their coronary arteries, but required to wait until services became available. Seven percent of the patients required hospitalization, 1% had a heart attack, and 2% died awaiting angiography. Delays longer than two weeks, particularly in patients with very poor stress test results or requiring 2-3 anti-ischemia medications, should be avoided.

A letter to the editor is presented in response to the article "Association of Serial Measures of Cardiac Troponin T Using a Sensitive Assay With Incident Heart Failure and Cardiovascular Mortality in Older Adults," by C. R. deFilippi and colleagues in a 2010 issue, as well as a response from the authors of the article.