biostudies-literatureTang ONational Institute of Diabetes and Digestive and Kidney DiseasesNIDDK NIH HHSNHLBI NIH HHSNational Heart, Lung, and Blood InstituteNIGMS NIH HHS986-994https://www.ebi.ac.uk/biostudies/studies/S-EPMC8049956biostudies-literatureUnknown69(4)<h4>Background/objectives</h4>Traditional cardiovascular risk factors are less predictive in older age. High-sensitivity cardiac troponin I (hs-cTnI) is a marker of subclinical cardiomyocyte damage associated with cardiovascular risk in middle-aged adults. We hypothesized hs-cTnI would be indicative of mortality and cardiovascular risk beyond traditional cardiovascular risk factors in older adults and may be more discriminatory compared to hs-troponin T (hs-cTnT).<h4>Design</h4>Prospective cohort study.<h4>Setting</h4>Population-based Atherosclerosis Risk in Communities (ARIC) Study.<h4>Participants</h4>We included 5,876 ARIC participants at Visit 5 (2011-2013).<h4>Outcomes and measures</h4>We used Cox regression for the association of hs-cTnI categories (women: <4, 4-<10, ≥10 ng/ml; men: <6, 6-<12, ≥12 ng/ml, prevalent cardiovascular disease (CVD)) with mortality and incident CVD (atherosclerotic CVD [ASCVD]: coronary heart disease or stroke, or heart failure).<h4>Results</h4>Participants were ages 66 to 90, 23% black, 42% male, and 24% had prevalent CVD. There were 1,053 (321 CVD) deaths (median follow-up 6.3 years). Participants with elevated hs-cTnI and no CVD (7% of participants) had mortality risk similar to those with a history of CVD (55.6 vs 55.7 deaths/1,000 person-years, P = .99). After adjustment, elevated hs-cTnI and no CVD (hazard ratio (HR) = 2.38, 95% confidence interval (CI) = 1.85-3.06) and prevalent CVD (HR = 2.21, 95% CI = 1.90-2.57) remained associated with mortality, compared to low hs-cTnI and no CVD. Elevated hs-cTnI was independently associated with incident CVD (HR = 3.41, 95% CI = 2.58-4.51), ASCVD (HR = 2.02, 95% CI = 1.36-2.98), and heart failure (HR = 6.16, 95% CI = 4.24-8.95). The addition of hs-cTnI significantly improved C-statistics for all outcomes and added greater discrimination than hs-cTnT for cardiovascular mortality and incident heart failure.<h4>Conclusions</h4>Hs-cTnI improves mortality and CVD risk stratification in older adults beyond traditional risk factors and improved model discrimination more than hs-cTnT for certain outcomes. Elevated hs-cTnI without CVD identifies a high-risk group with comparable mortality risk as those with a history of clinical CVD.Journal of the American Geriatrics SocietyHigh-Sensitivity Cardiac Troponin I for Risk Stratification in Older Adults.PMC8049956T32 GM007309R01HL134320K24 HL152440R01 HL134320HHSN268201700003IHHSN268201700004IHHSN268201700005IR01DK089174F30 DK120160HHSN268201700001IHHSN268201700002IHHSN268201700005CF30DK120160R01 DK089174HHSN268201700001CHHSN268201700002CHHSN268201700003CHHSN268201700004CK24HL152440Coresh JWindham BGHoogeveen RCTang OSelvin EBallantyne CMMatsushita KfalseHigh-Sensitivity Cardiac Troponin I for Risk Stratification in Older Adults.<h4>Background/objectives</h4>Traditional cardiovascular risk factors are less predictive in older age. High-sensitivity cardiac troponin I (hs-cTnI) is a marker of subclinical cardiomyocyte damage associated with cardiovascular risk in middle-aged adults. We hypothesized hs-cTnI would be indicative of mortality and cardiovascular risk beyond traditional cardiovascular risk factors in older adults and may be more discriminatory compared to hs-troponin T (hs-cTnT).<h4>Design</h4>Prospective cohort study.<h4>Setting</h4>Population-based Atherosclerosis Risk in Communities (ARIC) Study.<h4>Participants</h4>We included 5,876 ARIC participants at Visit 5 (2011-2013).<h4>Outcomes and measures</h4>We used Cox regression for the association of hs-cTnI categories (women: <4, 4-<10, ≥10 ng/ml; men: <6, 6-<12, ≥12 ng/ml, prevalent cardiovascular disease (CVD)) with mortality and incident CVD (atherosclerotic CVD [ASCVD]: coronary heart disease or stroke, or heart failure).<h4>Results</h4>Participants were ages 66 to 90, 23% black, 42% male, and 24% had prevalent CVD. There were 1,053 (321 CVD) deaths (median follow-up 6.3 years). Participants with elevated hs-cTnI and no CVD (7% of participants) had mortality risk similar to those with a history of CVD (55.6 vs 55.7 deaths/1,000 person-years, P = .99). After adjustment, elevated hs-cTnI and no CVD (hazard ratio (HR) = 2.38, 95% confidence interval (CI) = 1.85-3.06) and prevalent CVD (HR = 2.21, 95% CI = 1.90-2.57) remained associated with mortality, compared to low hs-cTnI and no CVD. Elevated hs-cTnI was independently associated with incident CVD (HR = 3.41, 95% CI = 2.58-4.51), ASCVD (HR = 2.02, 95% CI = 1.36-2.98), and heart failure (HR = 6.16, 95% CI = 4.24-8.95). The addition of hs-cTnI significantly improved C-statistics for all outcomes and added greater discrimination than hs-cTnT for cardiovascular mortality and incident heart failure.<h4>Conclusions</h4>Hs-cTnI improves mortality and CVD risk stratification in older adults beyond traditional risk factors and improved model discrimination more than hs-cTnT for certain outcomes. Elevated hs-cTnI without CVD identifies a high-risk group with comparable mortality risk as those with a history of clinical CVD.2021-01-01T00:00:00Z2021 Apr2024-02-15T01:35:25.69Z2022-02-10T16:56:38.047ZS-EPMC80499563315061410.1111/jgs.16912