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Increase in cardiac biomarker associated with increased risk of heart disease, heart failure and death

In a study published online by JAMA Cardiology Elizabeth Selvin, Ph.D., M.P.H., of the Johns Hopkins Bloomberg School of Public Health, Baltimore, and colleagues examined the association of 6-year change in high-sensitivity cardiac troponin T with incident coronary heart disease, heart failure and all-cause mortality.

High-sensitivity cardiac troponin T (hs-cTnT), a protein that can be measured via a blood test, is a biomarker of cardiovascular risk and could be approved in the United States for clinical use soon. Cardiac troponin is critical to the clinical diagnosis of heart attack, particularly among symptomatic persons with chest pain. However, little is known about the implications of changes in hs-cTnT levels over time. This analysis included 8,838 participants from the Atherosclerosis Risk in Communities Study who were initially free of coronary heart disease (CHD) and heart failure (HF) and who had hs-cTnT measured twice, 6 years apart.

Of the participants (average age, 56 years; 59 percent female; 21 percent black), there were 1,157 CHD events, 965 HF events, and 1,813 deaths overall. Incident detectable hs-cTnT (baseline, <0.005 ng/ml; follow-up, ? 0.005 ng/ml) was independently associated with subsequent CHD, HF and death relative to an hs-cTnT level less than 0.005 ng/ml at both visits. Individuals with the most marked hs-cTnT increases (e.g. baseline, < 0.005 ng/ml; follow-up, ? 0.014 ng/ml) had significantly increased risks for CHD, HF and death. In persons with decreasing hs-cTnT levels (e.g., 6-year reductions >50 percent from baseline), there was also evidence suggestive of lower risk for outcomes compared with persons with stable or increasing concentrations.

“Our results indicate that 2 measurements of hs-cTnT appear to be better than 1 for characterizing risk and that large increases in hs-cTnT are particularly deleterious. Temporal change in hs-cTnT may help guide the preventive management of asymptomatic persons at risk for CHD and adults with stage A or B HF,” the authors write.

Article: Six-Year Change in High-Sensitivity Cardiac Troponin T and Risk of Subsequent Coronary Heart Disease, Heart Failure, and Death, John W. McEvoy, MB, BCh, MHS; Yuan Chen, MS; Chiadi E. Ndumele, MD, MHS; Scott D. Solomon, MD; Vijay Nambi, MD, PhD; Christie M. Ballantyne, MD; Roger S. Blumenthal, MD; Josef Coresh, MD, PhD; Elizabeth Selvin, PhD, MPH, JAMA Cardiology, doi:10.1001/jamacardio.2016.0765, published online 8 June 2016.

Commentary: Biomarkers to Predict Risk in Apparently Well Populations, James L. Januzzi Jr, MD, JAMA Cardiology, doi:10.1001/jamacardio.2016.1019, published online 8 June 2016.