title: Impact of sex on the prognostic value of high-sensitivity cardiac troponin I in the general population: the HUNT study.
abstract: BACKGROUND
  A new, high-sensitivity assay for cardiac troponin I (hs-cTnI) permits evaluation of the prognostic value of cardiac troponins within the reference interval. Men have higher hs-cTnI concentrations than women, but the underlying pathophysiological mechanisms and prognostic implications are unclear. The aim of this study was to assess the potential impact of sex on the association between hs-cTnI and cardiovascular death.
  
  
  METHODS
  By use of the Architect STAT High-Sensitive Troponin assay, we measured hs-cTnI in 4431 men and 5281 women aged ≥20 years participating in the prospective observational Nord-Trøndelag Health Study (HUNT).
  
  
  RESULTS
  hs-cTnI was detectable in 98.5% of men and 94.7% of women. During a mean follow-up period of 13.9 years, 708 cardiovascular deaths were registered. hs-cTnI was associated with the incidence of cardiovascular death [adjusted hazard ratio (HR) per 1 SD in log hs-cTnI 1.23 (95% CI 1.15-1.31)], with higher relative risk in women than men [HR 1.44 (1.31-1.58) vs 1.10 (1.00-1.20); Pinteraction < 0.001]. This finding was mediated by both lower risk associated with low hs-cTnI concentrations in women than in men and higher risk associated with high concentrations of hs-cTnI in women than in men. Male sex was associated with a higher risk of cardiovascular death [HR 1.28 (1.11-1.49)], but after adjustment for hs-cTnI, this association disappeared [HR 0.87 (0.75-1.02)].
  
  
  CONCLUSIONS
  The prognostic value of hs-cTnI concentrations in the general population is stronger in women than in men. Subtle impairment of cardiovascular status may contribute to higher hs-cTnI concentrations in men, reflecting sex-dependent differences in cardiovascular risk.
authors.affiliation: Division of Medicine and Center for Heart Failure Research and K.G. Jebsen Cardiac Research Centre and torbjorn.omland@medisin.uio.no.
authors.forename: Torbjørn
authors.initials: T
authors.lastname: Omland
authors.affiliation: Division of Cardiology, University of Texas Southwestern Medical Center, Dallas, TX;
authors.forename: James A
authors.initials: JA
authors.lastname: de Lemos
authors.affiliation: HUNT Research Centre, Department of Public Health and General Practice, Norwegian University of Science and Technology, Levanger, Norway;
authors.forename: Oddgeir L
authors.initials: OL
authors.lastname: Holmen
authors.affiliation: Department of Medicine, Levanger Hospital, Nord-Trøndelag Health Trust, Levanger, Norway; MI Laboratory and Department of Circulation and Medical Imaging, Norwegian University of Science and Technology, Trondheim, Norway;
authors.forename: Håvard
authors.initials: H
authors.lastname: Dalen
authors.affiliation: Institute of Clinical Medicine, University of Oslo, Oslo, Norway; HØKH Research Centre, Akershus University Hospital, Lørenskog, Norway;
authors.forename: Jūratė Šaltytė
authors.initials: JŠ
authors.lastname: Benth
authors.affiliation: Center for Heart Failure Research and K.G. Jebsen Cardiac Research Centre and Institute for Experimental Medical Research and Bioinformatics Core Facility, Institute for Medical Informatics, Oslo University Hospital and University of Oslo, Oslo, Norway.
authors.forename: Ståle
authors.initials: S
authors.lastname: Nygård
authors.affiliation: HUNT Research Centre, Department of Public Health and General Practice, Norwegian University of Science and Technology, Levanger, Norway;
authors.forename: Kristian
authors.initials: K
authors.lastname: Hveem
authors.affiliation: Division of Medicine and Center for Heart Failure Research and K.G. Jebsen Cardiac Research Centre and.
authors.forename: Helge
authors.initials: H
authors.lastname: Røsjø
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D015415:Biomarkers / Q000097:blood; D002318:Cardiovascular Diseases / Q000401:mortality*; D015331:Cohort Studies; D005260:Female; D006801:Humans; D015994:Incidence; D008297:Male; D008875:Middle Aged; D009664:Norway / Q000453:epidemiology; D011237:Predictive Value of Tests; D016016:Proportional Hazards Models; D011446:Prospective Studies; D012372:ROC Curve; D012737:Sex Factors; D019210:Troponin I / Q000097:blood*; D055815:Young Adult
chemical_list: D015415:Biomarkers; D019210:Troponin I