High-sensitivity troponin I is associated with cardiovascular outcomes but not with breast arterial calcification among postmenopausal women

Carlos Iribarren; Malini Chandra; Catherine Lee; Gabriela Sanchez; Danny L Sam; Farima Faith Azamian; Hyo-Min Cho; Huanjun Ding; Nathan D Wong; Sabee Molloi

doi:10.1016/j.ijcrp.2022.200157

High-sensitivity troponin I is associated with cardiovascular outcomes but not with breast arterial calcification among postmenopausal women

Int J Cardiol Cardiovasc Risk Prev. 2022 Nov 1:15:200157. doi: 10.1016/j.ijcrp.2022.200157. eCollection 2022 Dec.

Authors

Affiliations

¹ Kaiser Permanente Division of Research, 2000 Broadway, Oakland, CA, USA.
² Kaiser Permanente Santa Clara Medical Center, Santa Clara, CA, USA.
³ Department of Radiological Sciences, University of California Irvine School of Medicine, Irvine, CA, USA.
⁴ Medical Measurement Team, Korea Research Institute of Standards and Science, Daejeon, South Korea.
⁵ Division of Cardiology, Department of Medicine and Department of Epidemiology, University of California Irvine, Irvine, CA, USA.

Abstract

Background: Prior studies support the utility of high sensitivity troponin I (hsTnI) for cardiovascular disease (CVD) risk stratification among asymptomatic populations; however, only two prior studies examined women separately. The association between hsTnI and breast arterial calcification is unknown.

Methods: Cohort study of 2896 women aged 60-79 years recruited after attending mammography screening between 10/2012 and 2/2015. BAC status (presence versus absence) and quantity (calcium mass mg) was determined using digital mammograms. Pre-specified endpoints were incident coronary heart disease (CHD), ischemic stroke, heart failure and its subtypes and all CVD.

Results: After 7.4 (SD = 1.7) years of follow-up, 51 CHD, 30 ischemic stroke and 46 heart failure events were ascertained. At a limit of detection of 1.6 ng/L, 98.3 of the cohort had measurable hsTnI concentration. HsTnI in the 4-10 ng/L range were independently associated of CHD (adjusted hazard ratio[aHR] = 2.78; 95% CI, 1.48-5.22; p = 0.002) and all CVD (aHR = 2.06; 95% CI, 1.37-3.09; p = 0.0005) and hsTnI over 10 ng/L was independently associated with CHD (aHR = 4.75; 95% CI, 1.83-12.3; p = 0.001), ischemic stroke (aHR = 3.81; 95% CI, 1.22-11.9; p = 0.02), heart failure (aHR = 3.29; 95% CI, 1.33-8.13; p = 0.01) and all CVD (aHR = 4.78; 95% CI, 2.66-8.59; p < 0.0001). No significant association was found between hsTnI and BAC. Adding hsTnI to a model containing the Pooled Cohorts Equation resulted in significant and clinical important improved calibration, discrimination (Δ C_index = 6.5; p = 0.02) and reclassification (bias-corrected clinical NRI = 0.18; 95% CI, -0.13-0.49 after adding hsTnI categories).

Conclusions: Our results support the consideration of hsTnI as a risk enhancing factor for CVD in asymptomatic women that could drive preventive or therapeutic decisions.

Keywords: Breast arterial calcification; Cardiovascular disease; Cohort study; High-sensitivity troponin I; Women's health.