Key result
Adding cardiac troponin T to conventional risk factors is linked to ~31% higher CVD risk per SD.
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Why the study?
The extent to which high-sensitivity cardiac troponin can predict CVD was uncertain.
Does the addition of high-sensitivity cardiac troponin to conventional risk factors improve the prediction of first-onset CVD in individuals without prior CVD?
Meta-Analysis (n=62,150)
Yes
Does the addition of high-sensitivity cardiac troponin to conventional risk factors improve the prediction of first-onset CVD in individuals without prior CVD?
Captured external expert commentary on this paper, strongest first. Original sources are linked where available.
“Troponin, even in the normal range, is a powerful indicator of silent heart muscle damage. As such, the test provides an extra layer of information that we can use to boost our accuracy when predicting people's risk. Incorporation of troponin into current cardiovascular risk estimation guidelines can be useful for identifying high risk individuals who will benefit from preventative treatment, reducing the risk of future circulatory problems.”
“Our study found that measuring troponin can help reduce uncertainty in this decision-making process, especially for individuals at intermediate cardiovascular disease risk, where the next steps are often unclear. Additionally, troponin measurement may further improve accuracy in older adults and those with diabetes. More research is needed to assess whether targeting troponin testing to these and other specific subgroups can improve screening efficiency, particularly when considering the costs and practical feasibility of implementation.”
“I think a lot of clinicians prefer troponin I and thought that it was a better prognostic marker than troponin T, and we essentially found that they're either similar or even that troponin T is better.”
Adding high-sensitivity cardiac troponin to conventional risk factors modestly improves first-onset CVD risk prediction and could prevent additional events if used to guide statin therapy.
BACKGROUND The extent to which high-sensitivity cardiac troponin can predict cardiovascular disease (CVD) is uncertain. OBJECTIVES We aimed to quantify the potential advantage of adding information on cardiac troponins to conventional risk factors in the prevention of CVD. METHODS We meta-analyzed individual-participant data from 15 cohorts, comprising 62,150 participants without prior CVD. We calculated HRs, measures of risk discrimination, and reclassification after adding cardiac troponin T (cTnT) or I (cTnI) to conventional risk factors. The primary outcome was first-onset CVD (ie, coronary heart disease or stroke). We then modeled the implications of initiating statin therapy using incidence rates from 2.1 million individuals from the United Kingdom. RESULTS Among participants with cTnT or cTnI measurements, 8,133 and 3,749 incident CVD events occurred during a median follow-up of 11.8 and 9.8 years, respectively. HRs for CVD per 1-SD higher concentration were 1.31 (95% CI: 1.25-1.37) for cTnT and 1.26 (95% CI: 1.19-1.33) for cTnI. Addition of cTnT or cTnI to conventional risk factors was associated with C-index increases of 0.015 (95% CI: 0.012-0.018) and 0.012 (95% CI: 0.009-0.015) and continuous net reclassification improvements of 6% and 5% in cases and 22% and 17% in noncases. One additional CVD event would be prevented for every 408 and 473 individuals screened based on statin therapy in those whose CVD risk is reclassified from intermediate to high risk after cTnT or cTnI measurement, respectively. CONCLUSIONS Measurement of cardiac troponin results in a modest improvement in the prediction of first-onset CVD that may translate into population health benefits if used at scale.
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Shah et al. (2025) conducted a meta-analysis in Without prior cardiovascular disease (n=62,150). High-sensitivity cardiac troponin T (cTnT) or I (cTnI) vs. Conventional risk factors alone was evaluated on First-onset CVD (composite of fatal or nonfatal coronary heart disease or stroke) (HR 1.31, 95% CI 1.25-1.37). Addition of cardiac troponin T to conventional risk factors modestly improved prediction of first-onset CVD, with a hazard ratio of 1.31 per 1-SD higher concentration.
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