Epidemiology and Prevention Cardiac Troponin T Measured by a Highly Sensitive Assay Predicts Coronary Heart Disease, Heart Failure, and Mortality in the Atherosclerosis Risk in Communities Study

Background—We evaluated whether cardiac troponin T (cTnT) measured with a new highly sensitive assay was associated with incident coronary heart disease (CHD), mortality, and hospitalization for heart failure (HF) in a general population of participants in the Atherosclerosis Risk in Communities (ARIC) Study. Methods and Results—Associations between increasing cTnT levels and CHD, mortality, and HF hospitalization were evaluated with Cox proportional hazards models adjusted for traditional CHD risk factors, kidney function, high-sensitivity C-reactive protein, and N-terminal pro–B-type natriuretic peptide in 9698 participants aged 54 to 74 years who at baseline were free from CHD and stroke (and HF in the HF analysis). Measurable cTnT levels (Ն0.003 ␮g/L) were detected in 66.5% of individuals. In fully adjusted models, compared with participants with undetectable levels, those with cTnT levels in the highest category (Ն0.014 ␮g/L; 7.4% of the ARIC population) had significantly increased risk for CHD (hazard ratioϭ2. Even minimally elevated cTnT (Ն0.003 ␮g/L) was associated with increased risk for mortality and HF (PϽ0.05). Adding cTnT to traditional risk factors improved risk prediction parameters; the improvements were similar to those with N-terminal pro–B-type natriuretic peptide and better than those with the addition of high-sensitivity C-reactive protein. Conclusions— cTnT detectable with a highly sensitive assay was associated with incident CHD, mortality, and HF in individuals from a general population without known CHD/stroke. Key Words: biomarkers Ⅲ coronary disease Ⅲ heart failure Ⅲ risk factors Ⅲ troponin T C ardiac troponin T (cTnT) and troponin I are the biomarkers recommended for diagnosis of a myocar-dial infarction (MI) and in the setting of an acute coronary syndrome. 1 Cardiac troponin, which is released in response to cardiomyocyte necrosis, has been independently associated with adverse outcomes after acute coronary syndrome , 2 in patients with chronic heart failure (HF), 3 and in the general population, although cTnT levels are detectable in only a small fraction of the general population with the use of current assays. 4 – 8 A precommercial highly sensitive cTnT assay can detect 10-fold lower concentrations than currently available fourth-generation assays. With the use of this assay, cTnT levels below the detection range of standard assays were independently associated with adverse cardiovascular events in patients with HF 9 or stable coronary heart disease (CHD). 10 The clinical significance of detectable cTnT with the use of the new assay in the general population is not known. We determined prevalence of measurable cTnT with the …