Hs-cTnI outperforms hs-cTnT in CVD risk assessment in seniors
High-sensitivity cardiac troponin I (hs-cTnI) is a better marker of cardiovascular disease (CVD) risk in elderly adults than hs-cTnT and improves risk stratification in this population, a recent study has found.
Researchers conducted a prospective cohort study on 5,876 elderly adults (mean age, 75.5±5.2 years; 42 percent male) in whom hs-cTnI levels were measured from stored plasma samples. Study outcomes included mortality, surveilled through linkage to a national death registry and semi-annual telephone calls, as well as incident cardiovascular outcomes, such as CVDs, atherosclerotic CVDs, and heart failure.
Over a median follow-up of 6.3 years, a total of 1,053 deaths occurred. Both all-cause and cardiovascular mortalities were higher among elderly adults with elevated hs-cTnI.
In adjusted analyses, an elevated hs-cTnI (≥10 ng/mL for women, ≥12 ng/mL for men) more than doubled the risk of all-cause mortality (hazard ratio [HR], 2.38, 95 percent confidence interval [CI], 1.85–3.06) and almost quadrupled the likelihood of cardiovascular mortality (HR, 3.83, 95 percent CI, 2.33–6.27).
Similarly, elevated hs-cTnI also emerged as a significant risk factor for incident global CVD (HR, 3.41, 95 percent CI, 2.58–4.51), atherosclerotic CVD (HR, 2.02, 95 percent CI, 1.36–2.98), and heart failure (HR, 6.16, 4.24–8.95).
While hs-cTnT also had a comparable effect on the above outcomes, hs-cTnI appeared to be more valuable as a risk stratification factor. Improvements in the model discrimination for global CVD was greater with hs-cTnI (change in C-statistic, 0.0297, 95 percent CI, 0.0144–0.0438; p≤0.001).
The same was true for cardiovascular mortality (change in C-statistic, 0.0108, 95 percent CI, 0.0018–0.0198; p=0.02) and heart failure (change in C-statistic, 0.0465, 95 percent CI, 0.0241–0.0690; p≤0.001), but not for all-cause deaths (p=0.19).