March 11, 2020Open Access
Performance of High-Sensitivity Cardiac Troponin Assays to Reflect Comorbidity Burden and Improve Mortality Risk Stratification in Older Adults With Diabetes
Key Result
Elevations in high-sensitivity cardiac troponin I or T were associated with higher mortality risk beyond comorbidity burden in older adults with diabetes (hs-cTnI HR 3.0; 95% CI 1.7-5.4).
Study Design
Type
Cohort (n=1,835)
PICO
P
Population
1,835 older adults (ages 67-89 years) with diabetes from the ARIC study, followed for a median of 6.2 years to assess mortality risk.
E
Exposure / Comparator
Elevations in high-sensitivity cardiac troponin I (≥9.4 ng/L) or T (≥25 ng/L) vs Low troponin levels
O
Primary Outcome
Mortality — HR 3.0 (1.7-5.4)
Main Result
Hazard Ratio: 3 (95% CI 1.7–5.4)
Abstract
OBJECTIVE: Incorporation of comorbidity burden to inform diabetes management in older adults remains challenging. High-sensitivity cardiac troponins are objective, quantifiable biomarkers that may improve risk monitoring in older adults. We assessed the associations of elevations in high-sensitivity cardiac troponin I (hs-cTnI) and T (hs-cTnT) with comorbidities and improvements in mortality risk stratification. RESEARCH DESIGN AND METHODS: We used logistic regression to examine associations of comorbidities with elevations in either troponin (≥85th percentile) among 1,835 participants in the Atherosclerosis Risk in Communities (ARIC) Study with diabetes (ages 67-89 years, 43% male, 31% black) at visit 5 (2011-2013). We used Cox models to compare associations of high cardiac troponins with mortality across comorbidity levels. RESULTS: Elevations in either troponin (≥9.4 ng/L for hs-cTnI, ≥25 ng/L for hs-cTnT) were associated with prevalent coronary heart disease, heart failure, chronic kidney disease, pulmonary disease, hypoglycemia, hypertension, dementia, and frailty. Over a median follow-up of 6.2 years (418 deaths), both high hs-cTnI and high hs-cTnT further stratified mortality risk beyond comorbidity levels; those with a high hs-cTnI or hs-cTnT and high comorbidity were at highest mortality risk. Even among those with low comorbidity, a high hs-cTnI (hazard ratio 3.0 95% CI 1.7, 5.4) or hs-cTnT (hazard ratio 3.3 95% CI 1.8, 6.2) was associated with elevated mortality. CONCLUSIONS: Many comorbidities were reflected by both hs-cTnI and hs-cTnT; elevations in either of the troponins were associated with higher mortality risk beyond comorbidity burden. High-sensitivity cardiac troponins may identify older adults at high mortality risk and be useful in guiding clinical care of older adults with diabetes.