Temporal changes in cardiac troponin i are associated with risk of cardiovascular events in the general population: The Nord-Trøndelag health study

Abstract

BACKGROUND:Cardiac troponins are associated with car-diovascular risk in the general population, but whethertemporal changes in cardiac troponin I provide indepen-dent prognostic information remains uncertain. Using alarge community-based cohort with follow-up close tothe present day, we aimed to investigate the associationsbetween temporal changes in cardiac troponin and car-diovascular events.METHODS:We measured cardiac troponin I with a high-sensitivity assay (hs-cTnI) in 4805 participants attendingboth the second (HUNT 2, 1995–97) and third wave(HUNT 3, 2006–2008) of the prospective observationalNord-Trøndelag Health (HUNT) Study. Wecon-structed statistical models with both relative and absolutechanges of hs-cTnI from HUNT 2 to HUNT 3. Acomposite end point of cardiovascular death or firstadmission for myocardial infarction or heart failurewas generated.RESULTS:Participants with relative decrease in hs-cTnIwere more frequently younger and female and had lowerblood pressure and body mass index. Participants withrelative increase in hs-cTnI more frequently were olderand male, with higher systolic blood pressure. The ad-justed hazard ratio (HR) for relative increase in hs-cTnIwas 1.68 (95% CI, 1.16–2.42) and the adjusted HR forrelative decrease was 1.19 (95% CI, 0.84–1.68). Abso-lute increases in hs-cTnI exhibited similar prognosticproperties as relative increases in hs-cTnI. The most re-cent measurement of hs-cTnI outperformed the changevariables in discrimination and reclassification models.CONCLUSIONS:Both relative and absolute increases in hs-cTnI are independently associated with cardiovascularrisk. For refinement of risk prediction models, the mostrecent measurement of hs-cTnI should be preferred inclinical practice.