Adding hs-cTnT to Framingham risk factors significantly improved cardiovascular mortality risk classification in persons with obesity (NRI 0.22; 95% CI 0.17-0.28; P<0.001), but not in other groups.
Cohort (n=11,609)
Yes
Does the prognostic value of cardiac troponins for cardiovascular mortality vary across EASO-defined obesity phenotypes?
The prognostic value and clinical utility of cardiac troponins for cardiovascular mortality are significantly modified by obesity status, improving risk classification primarily in individuals with obesity.
Hazard Ratio: 2.47 (95% CI 2.19–2.79)
Objective: Cardiac troponins are established biomarkers for cardiovascular (CV) risk stratification. Whether their prognostic utility varies across obesity phenotypes defined by the European Association for the Study of Obesity (EASO) framework remains to be determined.Design and method: We analyzed 11,609 adults from the National Health and Nutrition Examination Survey (NHANES) 1999–2004 with median mortality follow-up of 16.8 years. Participants were categorized using the EASO framework into persons with normal weight (n=3,513), persons with overweight (n=2,211), and persons with obesity (n=5,885). Four cardiac troponins were assessed: high-sensitivity cardiac troponin T (hs-cTnT) and three cardiac troponin I assays (Abbott, Siemens, Ortho). Cox proportional hazards regression with Fine–Gray competing risk adjustment was used to estimate hazard ratios (HRs) for CV death. Multiplicative interaction tests were performed to assess effect modification by obesity status. Model discrimination and clinical utility were evaluated using C-statistics and net reclassification improvement (NRI). Results: In the overall population, all four troponins were significantly associated with CV mortality. Significant interactions with obesity status were observed for hs-cTnT (P-interaction=0.017) and cTnI-Ortho (P-interaction=0.014), indicating heterogeneity in prognostic associations across EASO-defined groups. For hs-cTnT, HRs (95% CI) per unit increase were 1.98 (1.70–2.31) in persons with normal weight, 2.94 (2.15–4.04) in persons with overweight, and 2.47 (2.19–2.79) in persons with obesity. NRI analyses revealed differential clinical utility: adding hs-cTnT to Framingham risk factors improved risk classification in persons with obesity (NRI 0.22, 95% CI 0.17–0.28; P<0.001) but not in persons with overweight (NRI -0.01; P=0.881) or persons with normal weight (NRI -0.13, 95% CI -0.21 to -0.05; P<0.001). Similar patterns were observed for cTnI assays, with consistent positive reclassification in obesity (NRIs 0.22–0.38) and null or negative reclassification in other groups. Conclusions: The prognostic value and clinical utility of cardiac troponins for CV mortality vary across EASO-defined obesity phenotypes. These findings suggest that obesity status should be considered when interpreting cardiac troponin levels for risk stratification and may inform personalized CV risk assessment approaches.
Fan et al. (2026) conducted a cohort in Obesity (n=11,609). Cardiac troponins vs. Lower levels (per unit increase) was evaluated on Cardiovascular mortality (HR 2.47, 95% CI 2.19-2.79). Adding hs-cTnT to Framingham risk factors significantly improved cardiovascular mortality risk classification in persons with obesity (NRI 0.22; 95% CI 0.17-0.28; P<0.001), but not in other groups.