Characteristics Associated With Detectable High‐Sensitivity Cardiac Troponin in Patients With Rheumatoid Arthritis at Low‐Intermediate Cardiac Risk

The objective of this study was to identify factors associated with detectable high-sensitivity cardiac troponin T (hs-cTnT), a marker of subclinical myocardial injury associated with cardiac events in rheumatoid arthritis (RA), among patients with RA at low to intermediate atherosclerotic cardiovascular disease (ASCVD) risk. We performed a cross-sectional cohort study among patients with RA, excluding those with pre-existing cardiovascular disease or high estimated 10-year ASCVD risk (>20%). In univariable analysis, we compared demographics, RA clinical factors, markers of inflammation, and routine lipids among patients with and without detectable hs-cTnT. Multivariable logistic regression models were constructed to determine whether clinical factors and clinically available biomarkers were associated with detectable hs-cTnT, independent of ASCVD risk. We studied 294 patients with RA, of whom 86 (29%) had a detectable hs-cTnT level. Older age; male sex; hypertension; higher levels of high-sensitivity C-reactive protein, interleukin-6, and lipoprotein-associated phospholipase A2; glucocorticoid use; and the absence of methotrexate use were associated with detectable hs-cTnT. Higher 10-year ASCVD risk was associated with detectable hs-cTnT (odds ratio 1.22, 95% confidence interval 1.15-1.29); markers of inflammation were not associated with detectable hs-cTnT in multivariable analysis. Among patients with RA in the lowest ASCVD risk category (10-year risk <5%), more than 25% of men and more than 33% of patients aged >60 had detectable hs-cTnT. Detectable hs-cTnT was prevalent among a cohort of patients with RA with low to intermediate ASCVD risk. Patients who were male or aged >60 had the highest rates of detectable hs-cTnT, suggesting a role for additional screening in these individuals regardless of their ASCVD risk.