In the acute setting, high-sensitivity troponin I and T (hs-TnI and hs-TnT) assays enable the early risk stratification of patients with suspected acute coronary syndrome. Given that these assays can detect much lower concentrations of troponins in plasma than conventional assays, they might have a role in the risk stratification of individuals without known cardiovascular disease (CVD). A new study published in Circulation now reports that hs-TnI is strongly associated with global CVD and all-cause mortality in people without prior coronary heart disease or heart failure.

In total, 8,121 individuals aged 54–74 years without clinical CVD from the ARIC cohort were included in the analysis, and followed up for approximately 15 years. Elevated levels of hs-TnI (≥3.8 ng/l) in plasma were associated with higher incidence of coronary heart disease, ischaemic stroke, atherosclerotic CVD, hospitalization for heart failure and all-cause mortality than low levels of hs-TnI (≥1.3 ng/l), independent of traditional risk factors. HsTnI was more strongly associated with global CVD in white individuals than in black individuals.

Although both hs-TnI and hs-TnT are used to diagnose acute myocardial infarction, only a weak correlation was observed between the two tests in this study. Individuals who showed elevations in both hs-TnI and hs-TnT had increased risk of CVD events and all-cause death compared with those with elevated hs-TnI or hs-TnT alone, suggesting that the two biomarkers are complementary for predicting risk.

“This study, in addition to others, provides a strong scientific basis to use hs-TnI to identify individuals who are at high risk of myocardial infarction, stroke and heart failure to target with more intensive lifestyle modification and risk factor control,” comments Christie Ballantyne, the senior author of the study. Additional studies are needed in other populations to determine any differences related to sex, race or age in the predictive capacity of hs-TnI and hs-TnT assays.