title: High-sensitivity troponin T and cardiovascular events in systolic blood pressure categories: atherosclerosis risk in communities study.
abstract: Based on observational studies, there is a linear increase in cardiovascular risk with higher systolic blood pressure (SBP), yet clinical trials have not shown benefit across all SBP categories. We assessed whether troponin T measured using high-sensitivity assay was associated with cardiovascular disease within SBP categories in 11 191 Atherosclerosis Risk in Communities study participants. Rested sitting SBP by 10-mm Hg increments and troponin categories were identified. Incident heart failure hospitalization, coronary heart disease, and stroke were ascertained for a median of 12 years after excluding individuals with corresponding disease. Approximately 53% of each type of cardiovascular event occurred in individuals with SBP<140 mm Hg and troponin T ≥3 ng/L. Higher troponin T was associated with increasing cardiovascular events across most SBP categories. The association was strongest for heart failure and least strong for stroke. There was no similar association of SBP with cardiovascular events across troponin T categories. Individuals with troponin T ≥3 ng/L and SBP <140 mm Hg had higher cardiovascular risk compared with those with troponin T <3 ng/L and SBP 140 to 159 mm Hg. Higher troponin T levels within narrow SBP categories portend increased cardiovascular risk, particularly for heart failure. Individuals with lower SBP but measurable troponin T had greater cardiovascular risk compared with those with suboptimal SBP but undetectable troponin T. Future trials of systolic hypertension may benefit by using high-sensitivity troponin T to target high-risk patients.
authors.affiliation: From the Department of Medicine, Michael E. DeBakey Veterans Affairs Hospital, Houston, TX (S.S.V., B.B., V.N.); Baylor College of Medicine, Houston, TX (Y.P., W.S., G.E.T., S.S.V., R.C.H., B.B., C.M.B., V.N.); Department of Medicine, Methodist DeBakey Heart Center, Houston, TX (Y.P., S.S.V., R.C.H., C.M.B., V.N.); Department of Medicine, University of Texas Southwestern Medical Center, Dallas (J.A.d.L.); Cardiovascular Research Institute, Baylor College of Medicine, Houston, TX (S.S.V., B.B., C.M.B., V.N.); Department of Medicine, Johns Hopkins University, Baltimore, MD (C.E.N., J.C.); Department of Medicine, University of Mississippi Medical Center, Jackson (T.H.M.); National Heart, Lung, and Blood Institute, National Institutes of Health, Bethesda, MD (J.D.W.); Department of Epidemiology, Gillings School of Global Public Health, University of North Carolina at Chapel Hill (G.H.); Department of Epidemiology, School of Public Health, University of Texas Health Science Center at Houston (E.A.B.); and Department of Medicine, Harvard Medical School, Boston, MA (S.D.S.).
authors.forename: Yashashwi
authors.initials: Y
authors.lastname: Pokharel
authors.affiliation: From the Department of Medicine, Michael E. DeBakey Veterans Affairs Hospital, Houston, TX (S.S.V., B.B., V.N.); Baylor College of Medicine, Houston, TX (Y.P., W.S., G.E.T., S.S.V., R.C.H., B.B., C.M.B., V.N.); Department of Medicine, Methodist DeBakey Heart Center, Houston, TX (Y.P., S.S.V., R.C.H., C.M.B., V.N.); Department of Medicine, University of Texas Southwestern Medical Center, Dallas (J.A.d.L.); Cardiovascular Research Institute, Baylor College of Medicine, Houston, TX (S.S.V., B.B., C.M.B., V.N.); Department of Medicine, Johns Hopkins University, Baltimore, MD (C.E.N., J.C.); Department of Medicine, University of Mississippi Medical Center, Jackson (T.H.M.); National Heart, Lung, and Blood Institute, National Institutes of Health, Bethesda, MD (J.D.W.); Department of Epidemiology, Gillings School of Global Public Health, University of North Carolina at Chapel Hill (G.H.); Department of Epidemiology, School of Public Health, University of Texas Health Science Center at Houston (E.A.B.); and Department of Medicine, Harvard Medical School, Boston, MA (S.D.S.).
authors.forename: Wensheng
authors.initials: W
authors.lastname: Sun
authors.affiliation: From the Department of Medicine, Michael E. DeBakey Veterans Affairs Hospital, Houston, TX (S.S.V., B.B., V.N.); Baylor College of Medicine, Houston, TX (Y.P., W.S., G.E.T., S.S.V., R.C.H., B.B., C.M.B., V.N.); Department of Medicine, Methodist DeBakey Heart Center, Houston, TX (Y.P., S.S.V., R.C.H., C.M.B., V.N.); Department of Medicine, University of Texas Southwestern Medical Center, Dallas (J.A.d.L.); Cardiovascular Research Institute, Baylor College of Medicine, Houston, TX (S.S.V., B.B., C.M.B., V.N.); Department of Medicine, Johns Hopkins University, Baltimore, MD (C.E.N., J.C.); Department of Medicine, University of Mississippi Medical Center, Jackson (T.H.M.); National Heart, Lung, and Blood Institute, National Institutes of Health, Bethesda, MD (J.D.W.); Department of Epidemiology, Gillings School of Global Public Health, University of North Carolina at Chapel Hill (G.H.); Department of Epidemiology, School of Public Health, University of Texas Health Science Center at Houston (E.A.B.); and Department of Medicine, Harvard Medical School, Boston, MA (S.D.S.).
authors.forename: James A
authors.initials: JA
authors.lastname: de Lemos
authors.affiliation: From the Department of Medicine, Michael E. DeBakey Veterans Affairs Hospital, Houston, TX (S.S.V., B.B., V.N.); Baylor College of Medicine, Houston, TX (Y.P., W.S., G.E.T., S.S.V., R.C.H., B.B., C.M.B., V.N.); Department of Medicine, Methodist DeBakey Heart Center, Houston, TX (Y.P., S.S.V., R.C.H., C.M.B., V.N.); Department of Medicine, University of Texas Southwestern Medical Center, Dallas (J.A.d.L.); Cardiovascular Research Institute, Baylor College of Medicine, Houston, TX (S.S.V., B.B., C.M.B., V.N.); Department of Medicine, Johns Hopkins University, Baltimore, MD (C.E.N., J.C.); Department of Medicine, University of Mississippi Medical Center, Jackson (T.H.M.); National Heart, Lung, and Blood Institute, National Institutes of Health, Bethesda, MD (J.D.W.); Department of Epidemiology, Gillings School of Global Public Health, University of North Carolina at Chapel Hill (G.H.); Department of Epidemiology, School of Public Health, University of Texas Health Science Center at Houston (E.A.B.); and Department of Medicine, Harvard Medical School, Boston, MA (S.D.S.).
authors.forename: George E
authors.initials: GE
authors.lastname: Taffet
authors.affiliation: From the Department of Medicine, Michael E. DeBakey Veterans Affairs Hospital, Houston, TX (S.S.V., B.B., V.N.); Baylor College of Medicine, Houston, TX (Y.P., W.S., G.E.T., S.S.V., R.C.H., B.B., C.M.B., V.N.); Department of Medicine, Methodist DeBakey Heart Center, Houston, TX (Y.P., S.S.V., R.C.H., C.M.B., V.N.); Department of Medicine, University of Texas Southwestern Medical Center, Dallas (J.A.d.L.); Cardiovascular Research Institute, Baylor College of Medicine, Houston, TX (S.S.V., B.B., C.M.B., V.N.); Department of Medicine, Johns Hopkins University, Baltimore, MD (C.E.N., J.C.); Department of Medicine, University of Mississippi Medical Center, Jackson (T.H.M.); National Heart, Lung, and Blood Institute, National Institutes of Health, Bethesda, MD (J.D.W.); Department of Epidemiology, Gillings School of Global Public Health, University of North Carolina at Chapel Hill (G.H.); Department of Epidemiology, School of Public Health, University of Texas Health Science Center at Houston (E.A.B.); and Department of Medicine, Harvard Medical School, Boston, MA (S.D.S.).
authors.forename: Salim S
authors.initials: SS
authors.lastname: Virani
authors.affiliation: From the Department of Medicine, Michael E. DeBakey Veterans Affairs Hospital, Houston, TX (S.S.V., B.B., V.N.); Baylor College of Medicine, Houston, TX (Y.P., W.S., G.E.T., S.S.V., R.C.H., B.B., C.M.B., V.N.); Department of Medicine, Methodist DeBakey Heart Center, Houston, TX (Y.P., S.S.V., R.C.H., C.M.B., V.N.); Department of Medicine, University of Texas Southwestern Medical Center, Dallas (J.A.d.L.); Cardiovascular Research Institute, Baylor College of Medicine, Houston, TX (S.S.V., B.B., C.M.B., V.N.); Department of Medicine, Johns Hopkins University, Baltimore, MD (C.E.N., J.C.); Department of Medicine, University of Mississippi Medical Center, Jackson (T.H.M.); National Heart, Lung, and Blood Institute, National Institutes of Health, Bethesda, MD (J.D.W.); Department of Epidemiology, Gillings School of Global Public Health, University of North Carolina at Chapel Hill (G.H.); Department of Epidemiology, School of Public Health, University of Texas Health Science Center at Houston (E.A.B.); and Department of Medicine, Harvard Medical School, Boston, MA (S.D.S.).
authors.forename: Chiadi E
authors.initials: CE
authors.lastname: Ndumele
authors.affiliation: From the Department of Medicine, Michael E. DeBakey Veterans Affairs Hospital, Houston, TX (S.S.V., B.B., V.N.); Baylor College of Medicine, Houston, TX (Y.P., W.S., G.E.T., S.S.V., R.C.H., B.B., C.M.B., V.N.); Department of Medicine, Methodist DeBakey Heart Center, Houston, TX (Y.P., S.S.V., R.C.H., C.M.B., V.N.); Department of Medicine, University of Texas Southwestern Medical Center, Dallas (J.A.d.L.); Cardiovascular Research Institute, Baylor College of Medicine, Houston, TX (S.S.V., B.B., C.M.B., V.N.); Department of Medicine, Johns Hopkins University, Baltimore, MD (C.E.N., J.C.); Department of Medicine, University of Mississippi Medical Center, Jackson (T.H.M.); National Heart, Lung, and Blood Institute, National Institutes of Health, Bethesda, MD (J.D.W.); Department of Epidemiology, Gillings School of Global Public Health, University of North Carolina at Chapel Hill (G.H.); Department of Epidemiology, School of Public Health, University of Texas Health Science Center at Houston (E.A.B.); and Department of Medicine, Harvard Medical School, Boston, MA (S.D.S.).
authors.forename: Thomas H
authors.initials: TH
authors.lastname: Mosley
authors.affiliation: From the Department of Medicine, Michael E. DeBakey Veterans Affairs Hospital, Houston, TX (S.S.V., B.B., V.N.); Baylor College of Medicine, Houston, TX (Y.P., W.S., G.E.T., S.S.V., R.C.H., B.B., C.M.B., V.N.); Department of Medicine, Methodist DeBakey Heart Center, Houston, TX (Y.P., S.S.V., R.C.H., C.M.B., V.N.); Department of Medicine, University of Texas Southwestern Medical Center, Dallas (J.A.d.L.); Cardiovascular Research Institute, Baylor College of Medicine, Houston, TX (S.S.V., B.B., C.M.B., V.N.); Department of Medicine, Johns Hopkins University, Baltimore, MD (C.E.N., J.C.); Department of Medicine, University of Mississippi Medical Center, Jackson (T.H.M.); National Heart, Lung, and Blood Institute, National Institutes of Health, Bethesda, MD (J.D.W.); Department of Epidemiology, Gillings School of Global Public Health, University of North Carolina at Chapel Hill (G.H.); Department of Epidemiology, School of Public Health, University of Texas Health Science Center at Houston (E.A.B.); and Department of Medicine, Harvard Medical School, Boston, MA (S.D.S.).
authors.forename: Ron C
authors.initials: RC
authors.lastname: Hoogeveen
authors.affiliation: From the Department of Medicine, Michael E. DeBakey Veterans Affairs Hospital, Houston, TX (S.S.V., B.B., V.N.); Baylor College of Medicine, Houston, TX (Y.P., W.S., G.E.T., S.S.V., R.C.H., B.B., C.M.B., V.N.); Department of Medicine, Methodist DeBakey Heart Center, Houston, TX (Y.P., S.S.V., R.C.H., C.M.B., V.N.); Department of Medicine, University of Texas Southwestern Medical Center, Dallas (J.A.d.L.); Cardiovascular Research Institute, Baylor College of Medicine, Houston, TX (S.S.V., B.B., C.M.B., V.N.); Department of Medicine, Johns Hopkins University, Baltimore, MD (C.E.N., J.C.); Department of Medicine, University of Mississippi Medical Center, Jackson (T.H.M.); National Heart, Lung, and Blood Institute, National Institutes of Health, Bethesda, MD (J.D.W.); Department of Epidemiology, Gillings School of Global Public Health, University of North Carolina at Chapel Hill (G.H.); Department of Epidemiology, School of Public Health, University of Texas Health Science Center at Houston (E.A.B.); and Department of Medicine, Harvard Medical School, Boston, MA (S.D.S.).
authors.forename: Josef
authors.initials: J
authors.lastname: Coresh
authors.affiliation: From the Department of Medicine, Michael E. DeBakey Veterans Affairs Hospital, Houston, TX (S.S.V., B.B., V.N.); Baylor College of Medicine, Houston, TX (Y.P., W.S., G.E.T., S.S.V., R.C.H., B.B., C.M.B., V.N.); Department of Medicine, Methodist DeBakey Heart Center, Houston, TX (Y.P., S.S.V., R.C.H., C.M.B., V.N.); Department of Medicine, University of Texas Southwestern Medical Center, Dallas (J.A.d.L.); Cardiovascular Research Institute, Baylor College of Medicine, Houston, TX (S.S.V., B.B., C.M.B., V.N.); Department of Medicine, Johns Hopkins University, Baltimore, MD (C.E.N., J.C.); Department of Medicine, University of Mississippi Medical Center, Jackson (T.H.M.); National Heart, Lung, and Blood Institute, National Institutes of Health, Bethesda, MD (J.D.W.); Department of Epidemiology, Gillings School of Global Public Health, University of North Carolina at Chapel Hill (G.H.); Department of Epidemiology, School of Public Health, University of Texas Health Science Center at Houston (E.A.B.); and Department of Medicine, Harvard Medical School, Boston, MA (S.D.S.).
authors.forename: Jacqueline D
authors.initials: JD
authors.lastname: Wright
authors.affiliation: From the Department of Medicine, Michael E. DeBakey Veterans Affairs Hospital, Houston, TX (S.S.V., B.B., V.N.); Baylor College of Medicine, Houston, TX (Y.P., W.S., G.E.T., S.S.V., R.C.H., B.B., C.M.B., V.N.); Department of Medicine, Methodist DeBakey Heart Center, Houston, TX (Y.P., S.S.V., R.C.H., C.M.B., V.N.); Department of Medicine, University of Texas Southwestern Medical Center, Dallas (J.A.d.L.); Cardiovascular Research Institute, Baylor College of Medicine, Houston, TX (S.S.V., B.B., C.M.B., V.N.); Department of Medicine, Johns Hopkins University, Baltimore, MD (C.E.N., J.C.); Department of Medicine, University of Mississippi Medical Center, Jackson (T.H.M.); National Heart, Lung, and Blood Institute, National Institutes of Health, Bethesda, MD (J.D.W.); Department of Epidemiology, Gillings School of Global Public Health, University of North Carolina at Chapel Hill (G.H.); Department of Epidemiology, School of Public Health, University of Texas Health Science Center at Houston (E.A.B.); and Department of Medicine, Harvard Medical School, Boston, MA (S.D.S.).
authors.forename: Gerardo
authors.initials: G
authors.lastname: Heiss
authors.affiliation: From the Department of Medicine, Michael E. DeBakey Veterans Affairs Hospital, Houston, TX (S.S.V., B.B., V.N.); Baylor College of Medicine, Houston, TX (Y.P., W.S., G.E.T., S.S.V., R.C.H., B.B., C.M.B., V.N.); Department of Medicine, Methodist DeBakey Heart Center, Houston, TX (Y.P., S.S.V., R.C.H., C.M.B., V.N.); Department of Medicine, University of Texas Southwestern Medical Center, Dallas (J.A.d.L.); Cardiovascular Research Institute, Baylor College of Medicine, Houston, TX (S.S.V., B.B., C.M.B., V.N.); Department of Medicine, Johns Hopkins University, Baltimore, MD (C.E.N., J.C.); Department of Medicine, University of Mississippi Medical Center, Jackson (T.H.M.); National Heart, Lung, and Blood Institute, National Institutes of Health, Bethesda, MD (J.D.W.); Department of Epidemiology, Gillings School of Global Public Health, University of North Carolina at Chapel Hill (G.H.); Department of Epidemiology, School of Public Health, University of Texas Health Science Center at Houston (E.A.B.); and Department of Medicine, Harvard Medical School, Boston, MA (S.D.S.).
authors.forename: Eric A
authors.initials: EA
authors.lastname: Boerwinkle
authors.affiliation: From the Department of Medicine, Michael E. DeBakey Veterans Affairs Hospital, Houston, TX (S.S.V., B.B., V.N.); Baylor College of Medicine, Houston, TX (Y.P., W.S., G.E.T., S.S.V., R.C.H., B.B., C.M.B., V.N.); Department of Medicine, Methodist DeBakey Heart Center, Houston, TX (Y.P., S.S.V., R.C.H., C.M.B., V.N.); Department of Medicine, University of Texas Southwestern Medical Center, Dallas (J.A.d.L.); Cardiovascular Research Institute, Baylor College of Medicine, Houston, TX (S.S.V., B.B., C.M.B., V.N.); Department of Medicine, Johns Hopkins University, Baltimore, MD (C.E.N., J.C.); Department of Medicine, University of Mississippi Medical Center, Jackson (T.H.M.); National Heart, Lung, and Blood Institute, National Institutes of Health, Bethesda, MD (J.D.W.); Department of Epidemiology, Gillings School of Global Public Health, University of North Carolina at Chapel Hill (G.H.); Department of Epidemiology, School of Public Health, University of Texas Health Science Center at Houston (E.A.B.); and Department of Medicine, Harvard Medical School, Boston, MA (S.D.S.).
authors.forename: Biykem
authors.initials: B
authors.lastname: Bozkurt
authors.affiliation: From the Department of Medicine, Michael E. DeBakey Veterans Affairs Hospital, Houston, TX (S.S.V., B.B., V.N.); Baylor College of Medicine, Houston, TX (Y.P., W.S., G.E.T., S.S.V., R.C.H., B.B., C.M.B., V.N.); Department of Medicine, Methodist DeBakey Heart Center, Houston, TX (Y.P., S.S.V., R.C.H., C.M.B., V.N.); Department of Medicine, University of Texas Southwestern Medical Center, Dallas (J.A.d.L.); Cardiovascular Research Institute, Baylor College of Medicine, Houston, TX (S.S.V., B.B., C.M.B., V.N.); Department of Medicine, Johns Hopkins University, Baltimore, MD (C.E.N., J.C.); Department of Medicine, University of Mississippi Medical Center, Jackson (T.H.M.); National Heart, Lung, and Blood Institute, National Institutes of Health, Bethesda, MD (J.D.W.); Department of Epidemiology, Gillings School of Global Public Health, University of North Carolina at Chapel Hill (G.H.); Department of Epidemiology, School of Public Health, University of Texas Health Science Center at Houston (E.A.B.); and Department of Medicine, Harvard Medical School, Boston, MA (S.D.S.).
authors.forename: Scott D
authors.initials: SD
authors.lastname: Solomon
authors.affiliation: From the Department of Medicine, Michael E. DeBakey Veterans Affairs Hospital, Houston, TX (S.S.V., B.B., V.N.); Baylor College of Medicine, Houston, TX (Y.P., W.S., G.E.T., S.S.V., R.C.H., B.B., C.M.B., V.N.); Department of Medicine, Methodist DeBakey Heart Center, Houston, TX (Y.P., S.S.V., R.C.H., C.M.B., V.N.); Department of Medicine, University of Texas Southwestern Medical Center, Dallas (J.A.d.L.); Cardiovascular Research Institute, Baylor College of Medicine, Houston, TX (S.S.V., B.B., C.M.B., V.N.); Department of Medicine, Johns Hopkins University, Baltimore, MD (C.E.N., J.C.); Department of Medicine, University of Mississippi Medical Center, Jackson (T.H.M.); National Heart, Lung, and Blood Institute, National Institutes of Health, Bethesda, MD (J.D.W.); Department of Epidemiology, Gillings School of Global Public Health, University of North Carolina at Chapel Hill (G.H.); Department of Epidemiology, School of Public Health, University of Texas Health Science Center at Houston (E.A.B.); and Department of Medicine, Harvard Medical School, Boston, MA (S.D.S.).
authors.forename: Christie M
authors.initials: CM
authors.lastname: Ballantyne
authors.affiliation: From the Department of Medicine, Michael E. DeBakey Veterans Affairs Hospital, Houston, TX (S.S.V., B.B., V.N.); Baylor College of Medicine, Houston, TX (Y.P., W.S., G.E.T., S.S.V., R.C.H., B.B., C.M.B., V.N.); Department of Medicine, Methodist DeBakey Heart Center, Houston, TX (Y.P., S.S.V., R.C.H., C.M.B., V.N.); Department of Medicine, University of Texas Southwestern Medical Center, Dallas (J.A.d.L.); Cardiovascular Research Institute, Baylor College of Medicine, Houston, TX (S.S.V., B.B., C.M.B., V.N.); Department of Medicine, Johns Hopkins University, Baltimore, MD (C.E.N., J.C.); Department of Medicine, University of Mississippi Medical Center, Jackson (T.H.M.); National Heart, Lung, and Blood Institute, National Institutes of Health, Bethesda, MD (J.D.W.); Department of Epidemiology, Gillings School of Global Public Health, University of North Carolina at Chapel Hill (G.H.); Department of Epidemiology, School of Public Health, University of Texas Health Science Center at Houston (E.A.B.); and Department of Medicine, Harvard Medical School, Boston, MA (S.D.S.). vnambi@bcm.edu.
authors.forename: Vijay
authors.initials: V
authors.lastname: Nambi
mesh_terms: D050197:Atherosclerosis / Q000097:blood / Q000453:epidemiology; D015415:Biomarkers / Q000097:blood; D001794:Blood Pressure / Q000502:physiology*; D002318:Cardiovascular Diseases / Q000097:blood* / Q000453:epidemiology; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D015994:Incidence; D008297:Male; D008875:Middle Aged; D015995:Prevalence; D018570:Risk Assessment / Q000379:methods*; D012307:Risk Factors; D020107:Troponin T / Q000097:blood*; D014481:United States / Q000453:epidemiology
chemical_list: D015415:Biomarkers; D020107:Troponin T
keywords: cardiovascular diseases; heart failure; hypertension