High-Sensitivity Cardiac Troponin I and T for Cardiovascular Risk Stratification in Adults With Diabetes
Olive Tang, Kunihiro Matsushita, Josef Coresh, Chiadi E. Ndumele, John W. McEvoy, A. Richey Sharrett, Ron C. Hoogeveen, Christie M. Ballantyne, Elizabeth Selvin
Abstract
New therapeutics for cardiovascular disease (CVD) prevention in diabetes are costly, highlighting the need for better risk stratification so that interventions may be targeted to those at the highest risk. High-sensitivity cardiac troponin I (hs-cTnI) and T (hs-cTnT) are measures of subclinical cardiac damage associated with cardiovascular risk in the general population (1,2). The troponins appear differentially associated with diabetes (3). We assessed whether hs-cTnI or hs-cTnT could improve cardiovascular and mortality risk stratification in adults with diabetes and whether elevated concentrations of either troponin (≥90th percentile) were associated with mortality risk similar to those having a history of clinical CVD. We included 1,704 adults (ages 54–75 years) with diabetes (47.5% of whom were male, 33.8% Black, and 24.4% with CVD) in the Atherosclerosis Risk in Communities (ARIC) study who attended visit 4 (1996–1998). Diabetes status was defined based on self-reported physician diagnosis, medication use, or blood glucose (fasting ≥126 mg/dL; nonfasting ≥200 mg/dL). hs-cTnI was measured in stored plasma using the ARCHITECT STAT High Sensitive Troponin-I assay (Abbott Diagnostics, Chicago, IL). hs-cTnT was measured in stored plasma using the Elecsys Troponin T assay (Roche Diagnostics, Indianapolis, IN). To compare hs-cTnI and hs-cTnT, we used percentile categories among those without CVD: <50th (reference), ≥50th to <75th, 75th to 90th, and ≥90th. We examined incident CVD ( N = 1,280): atherosclerotic CVD (ASCVD) (including myocardial infarction, revascularization procedure, or stroke) and heart failure (based on hospitalization, supplemented with adjudicated events after 2005) (4,5). The last date of follow-up was 31 December 2018 (median follow-up 19 years). We used Cox regression …