Higher concentrations of cardiac troponin T and I were associated with increased risk of first-onset CVD (HR 1.31, 95% CI 1.25-1.37 and HR 1.26, 95% CI 1.19-1.33 per 1-SD increase).
Meta-Analysis (n=62,150)
Yes
Hazard Ratio: 1.31 (95% CI 1.25–1.37)
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.
“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.”
Shah et al. (2025) conducted a meta-analysis in 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 (coronary heart disease or stroke) (HR 1.31, 95% CI 1.25-1.37). Higher concentrations of cardiac troponin T and I were associated with increased risk of first-onset CVD (HR 1.31, 95% CI 1.25-1.37 and HR 1.26, 95% CI 1.19-1.33 per 1-SD increase).