Cardiac Troponins and Cardiovascular Disease Risk Prediction: An Individual-Participant-Data Meta-Analysis (JACC April 2025-1)-Article: Cardiac Troponins and Cardiovascular Disease Risk Prediction: An Individual-Participant-Data Meta-Analysis

Article: Cardiac Troponins and Cardiovascular Disease Risk Prediction: An Individual-Participant-Data Meta-Analysis

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This research investigates the role of high-sensitivity cardiac troponins (cTnT and cTnI) in predicting cardiovascular disease (CVD) beyond conventional risk factors. The study analyzed data from 62,150 participants across 15 cohorts without prior CVD, focusing on first-onset CVD (coronary heart disease or stroke). The results showed that higher concentrations of cTnT and cTnI were associated with increased risk of CVD, with hazard ratios (HRs) of 1.31 and 1.26, respectively, per 1-SD increase. Adding troponin to conventional risk factors improved risk prediction, with a C-index increase of 0.015 for cTnT and 0.012 for cTnI, and notable net reclassification improvements.<br /><br />In practical terms, for every 408 to 473 screened individuals reclassified from intermediate to high risk through cTnT or cTnI measurement, one CVD event could potentially be prevented using statin therapy. The study advocates for the potential population health benefits of integrating cardiac troponin measurements in CVD risk assessment at a large scale, as it could improve the identification of individuals at high risk for CVD, particularly among those initially classified at intermediate risk using current guidelines.<br /><br />The study points out that using cardiac troponins for risk assessment could help capture approximately 5% more CVD events than conventional risk factors alone, suggesting substantial public health implications if adopted broadly. The research also compared troponin's prediction improvements to other biomarkers like NT-proBNP and CRP, finding that troponins offer a promising predictive edge, though NT-proBNP shows similar utility.<br /><br />The findings suggest that incorporating cardiac troponins into standard risk assessment models could enhance early recognition and prevention strategies for CVD, particularly when statin therapy is considered a potential intervention. These results, however, are mainly applicable to populations akin to the study sample and require careful implementation considerations for different demographic groups.

Keywords

high-sensitivity cardiac troponins

cardiovascular disease

CVD risk prediction

cTnT and cTnI

hazard ratios

risk assessment

statin therapy

population health benefits

biomarkers comparison

public health implications