title: Cardiac troponin T measured by a highly sensitive assay predicts coronary heart disease, heart failure, and mortality in the Atherosclerosis Risk in Communities Study.
abstract: BACKGROUND
  We evaluated whether cardiac troponin T (cTnT) measured with a new highly sensitive assay was associated with incident coronary heart disease (CHD), mortality, and hospitalization for heart failure (HF) in a general population of participants in the Atherosclerosis Risk in Communities (ARIC) Study.
  
  
  RESULTS
  Associations between increasing cTnT levels and CHD, mortality, and HF hospitalization were evaluated with Cox proportional hazards models adjusted for traditional CHD risk factors, kidney function, high-sensitivity C-reactive protein, and N-terminal pro-B-type natriuretic peptide in 9698 participants aged 54 to 74 years who at baseline were free from CHD and stroke (and HF in the HF analysis). Measurable cTnT levels (≥0.003 μg/L) were detected in 66.5% of individuals. In fully adjusted models, compared with participants with undetectable levels, those with cTnT levels in the highest category (≥0.014 μg/L; 7.4% of the ARIC population) had significantly increased risk for CHD (hazard ratio=2.29; 95% confidence interval, 1.81 to 2.89), fatal CHD (hazard ratio=7.59; 95% confidence interval, 3.78 to 15.25), total mortality (hazard ratio=3.96; 95% confidence interval, 3.21 to 4.88), and HF (hazard ratio=5.95; 95% confidence interval, 4.47 to 7.92). Even minimally elevated cTnT (≥0.003 μg/L) was associated with increased risk for mortality and HF (P<0.05). Adding cTnT to traditional risk factors improved risk prediction parameters; the improvements were similar to those with N-terminal pro-B-type natriuretic peptide and better than those with the addition of high-sensitivity C-reactive protein.
  
  
  CONCLUSIONS
  cTnT detectable with a highly sensitive assay was associated with incident CHD, mortality, and HF in individuals from a general population without known CHD/stroke.
authors.affiliation: 6565 Fannin, MS A-601, Houston, TX 77030, USA.
authors.forename: Justin T
authors.initials: JT
authors.lastname: Saunders
authors.forename: Vijay
authors.initials: V
authors.lastname: Nambi
authors.forename: James A
authors.initials: JA
authors.lastname: de Lemos
authors.forename: Lloyd E
authors.initials: LE
authors.lastname: Chambless
authors.forename: Salim S
authors.initials: SS
authors.lastname: Virani
authors.forename: Eric
authors.initials: E
authors.lastname: Boerwinkle
authors.forename: Ron C
authors.initials: RC
authors.lastname: Hoogeveen
authors.forename: Xiaoxi
authors.initials: X
authors.lastname: Liu
authors.forename: Brad C
authors.initials: BC
authors.lastname: Astor
authors.forename: Thomas H
authors.initials: TH
authors.lastname: Mosley
authors.forename: Aaron R
authors.initials: AR
authors.lastname: Folsom
authors.forename: Gerardo
authors.initials: G
authors.lastname: Heiss
authors.forename: Josef
authors.initials: J
authors.lastname: Coresh
authors.forename: Christie M
authors.initials: CM
authors.lastname: Ballantyne
mesh_terms: D000368:Aged; D050197:Atherosclerosis / Q000097:blood* / Q000175:diagnosis* / Q000401:mortality; D015415:Biomarkers / Q000097:blood; D002097:C-Reactive Protein / Q000592:standards; D003327:Coronary Disease / Q000097:blood / Q000175:diagnosis / Q000401:mortality; D005260:Female; D005500:Follow-Up Studies; D006333:Heart Failure / Q000097:blood* / Q000175:diagnosis* / Q000401:mortality; D006760:Hospitalization / Q000639:trends; D006801:Humans; D015994:Incidence; D008297:Male; D008875:Middle Aged; D011237:Predictive Value of Tests; D015203:Reproducibility of Results; D012111:Residence Characteristics; D012307:Risk Factors; D012680:Sensitivity and Specificity; D020107:Troponin T / Q000097:blood*
chemical_list: D015415:Biomarkers; D020107:Troponin T; D002097:C-Reactive Protein