title: Factors independently associated with cardiac troponin I levels in young and healthy adults from the general population.
abstract: BACKGROUND
  Determinants of cardiomyocyte injury as quantified by high-sensitivity cardiac troponin I (cTnI) in young and healthy individuals, and sex-specific 99th percentiles are largely unknown.
  
  
  METHODS
  Our study included 2077 adults from the general population aged 25-41 years without cardiovascular disease. cTnI was measured using a high-sensitivity assay. We performed stepwise backward linear regression analyses to identify variables independently associated with hs-cTnI levels, and calculated narrow-sense heritability from 1638-genotyped participants.
  
  
  RESULTS
  Median age was 37 years. cTnI was quantifiable in all but 11 participants (99.5 %). Median (interquartile range) cTnI was significantly higher in men than in women [0.99 (0.71; 1.65) versus 0.47 (0.33; 0.71) ng/L, p < 0.0001]. The 99th percentile of cTnI was 15.79 ng/L in men and 5.11 ng/L in women. Out of 46 variables, 22 independent determinants for cTnI were identified. The strongest associations were observed with sex, age, systolic blood pressure, heart rate, left ventricular mass, N-terminal pro B-type natriuretic peptide, and creatine kinase (all p < 0.0001). The final model explained 36 % of the overall cTnI variability. Heritability of cTnI was estimated to be 29 % (p = 0.005), but became non-significant when the residuals of the multivariable model were used for analysis (5 %, p = 0.36).
  
  
  CONCLUSIONS
  Sex, age, and systolic blood pressure belong to the strongest determinants of hs-cTnI in healthy adults. The 99th percentile was three times higher in men compared to women. Hence, sex-specific cut-off values may be preferable when applying hs-cTnI for screening purposes. Our results may also improve the interpretation of cTn levels in daily clinical practice.
authors.affiliation: Cardiology Division, Department of Medicine, University Hospital Basel, Petersgraben 4, 4031, Basel, Switzerland.|Cardiovascular Research Institute Basel, University Hospital Basel, Spitalstrasse 2, 4031, Basel, Switzerland.|Division of Cardiology, Hamilton General Hospital, Hamilton Health Sciences, 237 Barton Street East, Hamilton, ON, L8L 2X2, Canada.|Population Health Research Institute, David Braley Cardiac, Vascular and Stroke Research Institute, 237 Barton Street East, Hamilton, ON, L8L 2X2, Canada.
authors.forename: Matthias
authors.initials: M
authors.lastname: Bossard
authors.affiliation: Population Health Research Institute, David Braley Cardiac, Vascular and Stroke Research Institute, 237 Barton Street East, Hamilton, ON, L8L 2X2, Canada.|Department of Pathology and Molecular Medicine, Michael G. DeGroote School of Medicine, McMaster University, 1280 Main Street West, Hamilton, ON, L8S 4K1, Canada.
authors.forename: Sébastien
authors.initials: S
authors.lastname: Thériault
authors.affiliation: Cardiovascular Research Institute Basel, University Hospital Basel, Spitalstrasse 2, 4031, Basel, Switzerland.|Division of Internal Medicine, Department of Medicine, University Hospital Basel, Petersgraben 4, 4031, Basel, Switzerland.
authors.forename: Stefanie
authors.initials: S
authors.lastname: Aeschbacher
authors.affiliation: Cardiology Division, Department of Medicine, University Hospital Basel, Petersgraben 4, 4031, Basel, Switzerland.|Cardiovascular Research Institute Basel, University Hospital Basel, Spitalstrasse 2, 4031, Basel, Switzerland.
authors.forename: Tobias
authors.initials: T
authors.lastname: Schoen
authors.affiliation: Cardiovascular Research Institute Basel, University Hospital Basel, Spitalstrasse 2, 4031, Basel, Switzerland.
authors.forename: Seraina
authors.initials: S
authors.lastname: Kunz
authors.affiliation: Cardiovascular Research Institute Basel, University Hospital Basel, Spitalstrasse 2, 4031, Basel, Switzerland.|Division of Internal Medicine, Department of Medicine, University Hospital Basel, Petersgraben 4, 4031, Basel, Switzerland.
authors.forename: Mirco
authors.initials: M
authors.lastname: von Rotz
authors.affiliation: Singulex Inc, Clinical Research, 1701 Harbor Bay Pkwy 200, Alameda, CA, 94502, USA.
authors.forename: Joel
authors.initials: J
authors.lastname: Estis
authors.affiliation: Singulex Inc, Clinical Research, 1701 Harbor Bay Pkwy 200, Alameda, CA, 94502, USA.
authors.forename: John
authors.initials: J
authors.lastname: Todd
authors.affiliation: Labormedizinisches Zentrum Dr. Risch, Landstrasse 157, 9494, Schaan, Principality of Liechtenstein.|Division of Laboratory Medicine, Kantonsspital Graubünden, 7000, Chur, Switzerland.
authors.forename: Martin
authors.initials: M
authors.lastname: Risch
authors.affiliation: Cardiology Division, Department of Medicine, University Hospital Basel, Petersgraben 4, 4031, Basel, Switzerland.|Cardiovascular Research Institute Basel, University Hospital Basel, Spitalstrasse 2, 4031, Basel, Switzerland.|Division of Internal Medicine, Department of Medicine, University Hospital Basel, Petersgraben 4, 4031, Basel, Switzerland.
authors.forename: Christian
authors.initials: C
authors.lastname: Mueller
authors.affiliation: Labormedizinisches Zentrum Dr. Risch, Landstrasse 157, 9494, Schaan, Principality of Liechtenstein.|Division of Clinical Biochemistry, Medical University, 6020, Innsbruck, Austria.|Private University, Dorfstrasse 24, 9495, Triesen, Principality of Liechtenstein.
authors.forename: Lorenz
authors.initials: L
authors.lastname: Risch
authors.affiliation: Population Health Research Institute, David Braley Cardiac, Vascular and Stroke Research Institute, 237 Barton Street East, Hamilton, ON, L8L 2X2, Canada.|Department of Pathology and Molecular Medicine, Michael G. DeGroote School of Medicine, McMaster University, 1280 Main Street West, Hamilton, ON, L8S 4K1, Canada.
authors.forename: Guillaume
authors.initials: G
authors.lastname: Paré
authors.affiliation: Cardiology Division, Department of Medicine, University Hospital Basel, Petersgraben 4, 4031, Basel, Switzerland. david.conen@usb.ch.|Cardiovascular Research Institute Basel, University Hospital Basel, Spitalstrasse 2, 4031, Basel, Switzerland. david.conen@usb.ch.|Division of Internal Medicine, Department of Medicine, University Hospital Basel, Petersgraben 4, 4031, Basel, Switzerland. david.conen@usb.ch.
authors.forename: David
authors.initials: D
authors.lastname: Conen
mesh_terms: D000328:Adult; D000367:Age Factors; D015415:Biomarkers / Q000097:blood; D001794:Blood Pressure; D002318:Cardiovascular Diseases / Q000097:blood* / Q000175:diagnosis / Q000235:genetics / Q000503:physiopathology; D016009:Chi-Square Distribution; D003430:Cross-Sectional Studies; D005260:Female; D005838:Genotype; D064368:Healthy Volunteers; D040941:Heredity; D006801:Humans; D016014:Linear Models; D008297:Male; D015999:Multivariate Analysis; D017711:Nonlinear Dynamics; D010641:Phenotype; D011237:Predictive Value of Tests; D012307:Risk Factors; D012737:Sex Factors; D019210:Troponin I / Q000097:blood*
chemical_list: D015415:Biomarkers; D019210:Troponin I
keywords: Age; B-type natriuretic peptide; Blood pressure; Epidemiology; Heritability; Hypertrophy; Sex; Troponin