Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, USA.
Department of Medicine, Baylor College of Medicine, and Methodist DeBakey Heart and Vascular Center, Houston, Texas, USA.
J Am Geriatr Soc. 2021 Apr;69(4):986-994. doi: 10.1111/jgs.16912. Epub 2020 Nov 4.
BACKGROUND/OBJECTIVES: 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).
Prospective cohort study.
Population-based Atherosclerosis Risk in Communities (ARIC) Study.
We included 5,876 ARIC participants at Visit 5 (2011-2013).
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).
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.
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.
背景/目的：传统心血管危险因素在老年人中预测能力较差。高敏心肌肌钙蛋白 I（hs-cTnI）是一种与中年成年人心血管风险相关的亚临床心肌细胞损伤标志物。我们假设 hs-cTnI 除了传统心血管危险因素外，还能预示老年人的死亡率和心血管风险，并且与 hs-肌钙蛋白 T（hs-cTnT）相比，可能具有更高的判别能力。
前瞻性队列研究。
基于人群的动脉粥样硬化风险社区（ARIC）研究。
我们纳入了 ARIC 研究第 5 次（2011-2013 年）的 5876 名参与者。
我们使用 Cox 回归分析 hs-cTnI 类别（女性：<4、4-<10、≥10ng/ml；男性：<6、6-<12、≥12ng/ml，存在心血管疾病（CVD））与死亡率和新发 CVD（动脉粥样硬化性 CVD [ASCVD]：冠心病或中风，或心力衰竭）之间的关系。
参与者年龄为 66 至 90 岁，23%为黑人，42%为男性，24%存在既往 CVD。共有 1053 人（321 例 CVD）死亡（中位随访 6.3 年）。hs-cTnI 升高且无 CVD（占参与者的 7%）的死亡率风险与有 CVD 病史的参与者相似（每 1000 人年 55.6 例与 55.7 例死亡，P =.99）。经过调整后，hs-cTnI 升高且无 CVD（危险比（HR）=2.38，95%置信区间（CI）=1.85-3.06）和既往 CVD（HR = 2.21，95% CI = 1.90-2.57）与死亡率相关，与 hs-cTnI 水平低且无 CVD 相比。hs-cTnI 升高与新发 CVD（HR = 3.41，95% CI = 2.58-4.51）、ASCVD（HR = 2.02，95% CI = 1.36-2.98）和心力衰竭（HR = 6.16，95% CI = 4.24-8.95）独立相关。hs-cTnI 的加入显著提高了所有结局的 C 统计量，并比 hs-cTnT 更能提高心血管死亡率和新发心力衰竭的判别能力。
hs-cTnI 可改善老年人的死亡率和 CVD 风险分层，超越传统风险因素，并提高某些结局的模型判别能力，优于 hs-cTnT。hs-cTnI 升高但无 CVD 可识别出死亡率风险与有临床 CVD 病史的患者相当的高危人群。
