Shah Anoop S V, Keene Spencer J, Pennells Lisa, Kaptoge Stephen, Kimenai Dorien M, Walker Matthew, Halley Julianne D, Rocha Sara, Hoogeveen Ron C, Gudnason Vilmundur, Bakker Stephan J L, Wannamethee Sasiwarang G, Pareek Manan, Eggers Kai M, Jukema J Wouter, Hankey Graeme J, deLemos James A, Ford Ian, Omland Torbjørn, Lyngbakken Magnus Nakrem, Psaty Bruce M, deFilippi Christopher R, Wood Angela M, Danesh John, Welsh Paul, Sattar Naveed, Mills Nicholas L, Di Angelantonio Emanuele
Department of Non-Communicable Disease Epidemiology, London School of Hygiene and Tropical Medicine, London, United Kingdom; Department of Cardiology, Imperial College NHS Trust, London, United Kingdom.
British Heart Foundation Cardiovascular Epidemiology Unit, Department of Public Health and Primary Care, University of Cambridge, Cambridge, United Kingdom; Victor Phillip Dahdaleh Heart and Lung Research Institute, University of Cambridge, Cambridge, United Kingdom; National Institute for Health and Care Research Blood and Transplant Research Unit in Donor Health and Behaviour, University of Cambridge, Cambridge, United Kingdom.
J Am Coll Cardiol. 2025 Apr 15;85(14):1471-1484. doi: 10.1016/j.jacc.2025.02.016.
The extent to which high-sensitivity cardiac troponin can predict cardiovascular disease (CVD) is uncertain.
We aimed to quantify the potential advantage of adding information on cardiac troponins to conventional risk factors in the prevention of CVD.
We meta-analyzed individual-participant data from 15 cohorts, comprising 62,150 participants without prior CVD. We calculated HRs, measures of risk discrimination, and reclassification after adding cardiac troponin T (cTnT) or I (cTnI) to conventional risk factors. The primary outcome was first-onset CVD (ie, coronary heart disease or stroke). We then modeled the implications of initiating statin therapy using incidence rates from 2.1 million individuals from the United Kingdom.
Among participants with cTnT or cTnI measurements, 8,133 and 3,749 incident CVD events occurred during a median follow-up of 11.8 and 9.8 years, respectively. HRs for CVD per 1-SD higher concentration were 1.31 (95% CI: 1.25-1.37) for cTnT and 1.26 (95% CI: 1.19-1.33) for cTnI. Addition of cTnT or cTnI to conventional risk factors was associated with C-index increases of 0.015 (95% CI: 0.012-0.018) and 0.012 (95% CI: 0.009-0.015) and continuous net reclassification improvements of 6% and 5% in cases and 22% and 17% in noncases. One additional CVD event would be prevented for every 408 and 473 individuals screened based on statin therapy in those whose CVD risk is reclassified from intermediate to high risk after cTnT or cTnI measurement, respectively.
Measurement of cardiac troponin results in a modest improvement in the prediction of first-onset CVD that may translate into population health benefits if used at scale.
高敏心肌肌钙蛋白预测心血管疾病（CVD）的程度尚不确定。
我们旨在量化在预防CVD时，将心肌肌钙蛋白信息添加到传统危险因素中可能带来的优势。
我们对来自15个队列的个体参与者数据进行了荟萃分析，这些队列包括62150名无既往CVD的参与者。在将心肌肌钙蛋白T（cTnT）或I（cTnI）添加到传统危险因素后，我们计算了风险比（HRs）、风险辨别指标和重新分类情况。主要结局是首次发生的CVD（即冠心病或中风）。然后我们使用来自英国210万人的发病率数据对启动他汀类药物治疗的影响进行建模。
在进行了cTnT或cTnI测量的参与者中，分别在中位随访11.8年和9.8年期间发生了8133例和3749例CVD事件。cTnT每升高1个标准差时CVD的HR为1.31（95%CI：1.25 - 1.37），cTnI为1.26（95%CI：1.19 - 1.33）。将cTnT或cTnI添加到传统危险因素中，C指数分别增加0.015（95%CI：0.012 - 0.018）和0.012（95%CI：0.009 - 0.015），病例的连续净重新分类改善率分别为6%和5%，非病例为22%和17%。对于那些在测量cTnT或cTnI后CVD风险从中等重新分类为高风险的人群，基于他汀类药物治疗进行筛查时，每408人和473人分别可预防1例额外的CVD事件。
心肌肌钙蛋白的测量在首次发生CVD的预测方面有适度改善，如果大规模使用可能会给人群健康带来益处。
