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High-sensitivity troponin I for cardiovascular risk stratification in the general asymptomatic population: Perspectives from Asia-Pacific. Int J Cardiol 2019; 282:93-98. [DOI: 10.1016/j.ijcard.2019.01.107] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/02/2018] [Revised: 12/22/2018] [Accepted: 01/14/2019] [Indexed: 11/15/2022]
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52
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Mariathas M, Allan R, Ramamoorthy S, Olechowski B, Hinton J, Azor M, Nicholas Z, Calver A, Corbett S, Mahmoudi M, Rawlins J, Simpson I, Wilkinson J, Kwok CS, Cook P, Mamas MA, Curzen N. True 99th centile of high sensitivity cardiac troponin for hospital patients: prospective, observational cohort study. BMJ 2019; 364:l729. [PMID: 30867154 PMCID: PMC6415647 DOI: 10.1136/bmj.l729] [Citation(s) in RCA: 35] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
OBJECTIVE To determine the distribution, and specifically the true 99th centile, of high sensitivity cardiac troponin I (hs-cTnI) for a whole hospital population by applying the hs-cTnI assay currently used routinely at a large teaching hospital. DESIGN Prospective, observational cohort study. SETTING University Hospital Southampton NHS Foundation Trust, Southampton, United Kingdom, between 29 June 2017 and 24 August 2017. PARTICIPANTS 20 000 consecutive inpatients and outpatients undergoing blood tests for any clinical reason. Hs-cTnI concentrations were measured in all study participants and nested for analysis except when the supervising doctor had requested hs-cTnI for clinical reasons. MAIN OUTCOME MEASURES Distribution of hs-cTnI concentrations of all study participants and specifically the 99th centile. RESULTS The 99th centile of hs-cTnI for the whole population was 296 ng/L compared with the manufacturer's quoted level of 40 ng/L (currently used clinically as the upper limit of normal; ULN). Hs-cTnI concentrations were greater than 40 ng/L in one in 20 (5.4%, n=1080) of the total population. After excluding participants diagnosed as having acute myocardial infarction (n=122) and those in whom hs-cTnI was requested for clinical reasons (n=1707), the 99th centile was 189 ng/L for the remainder (n=18 171). The 99th centile was 563 ng/L for inpatients (n=4759) and 65 ng/L for outpatients (n=9280). Patients from the emergency department (n=3706) had a 99th centile of 215 ng/L, with 6.07% (n=225) greater than the recommended ULN. 39.02% (n=48) of all patients from the critical care units (n=123) and 14.16% (n=67) of all medical inpatients had an hs-cTnI concentration greater than the recommended ULN. CONCLUSIONS Of 20 000 consecutive patients undergoing a blood test for any clinical reason at our hospital, one in 20 had an hs-cTnI greater than the recommended ULN. These data highlight the need for clinical staff to interpret hs-cTnI concentrations carefully, particularly when applying the recommended ULN to diagnose acute myocardial infarction, in order to avoid misdiagnosis in the absence of an appropriate clinical presentation. TRIAL REGISTRATION Clinicaltrials.gov NCT03047785.
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Affiliation(s)
- Mark Mariathas
- Coronary Research Group, University Hospital Southampton NHS Foundation Trust, Southampton, UK
| | - Rick Allan
- Biochemistry Department, University Hospital Southampton NHS Foundation Trust, Southampton, UK
| | - Sanjay Ramamoorthy
- Emergency Medicine Department, University Hospital Southampton NHS Foundation Trust, Southampton, UK
| | - Bartosz Olechowski
- Coronary Research Group, University Hospital Southampton NHS Foundation Trust, Southampton, UK
| | - Jonathan Hinton
- Coronary Research Group, University Hospital Southampton NHS Foundation Trust, Southampton, UK
| | - Martin Azor
- Coding Department, University Hospital Southampton NHS Foundation Trust, Southampton, UK
| | - Zoe Nicholas
- Coronary Research Group, University Hospital Southampton NHS Foundation Trust, Southampton, UK
| | - Alison Calver
- Wessex Cardiothoracic Unit, University Hospital Southampton NHS Foundation Trust, Southampton, UK
| | - Simon Corbett
- Wessex Cardiothoracic Unit, University Hospital Southampton NHS Foundation Trust, Southampton, UK
| | - Michael Mahmoudi
- Coronary Research Group, University Hospital Southampton NHS Foundation Trust, Southampton, UK
- Wessex Cardiothoracic Unit, University Hospital Southampton NHS Foundation Trust, Southampton, UK
| | - John Rawlins
- Wessex Cardiothoracic Unit, University Hospital Southampton NHS Foundation Trust, Southampton, UK
| | - Iain Simpson
- Wessex Cardiothoracic Unit, University Hospital Southampton NHS Foundation Trust, Southampton, UK
| | - James Wilkinson
- Wessex Cardiothoracic Unit, University Hospital Southampton NHS Foundation Trust, Southampton, UK
| | - Chun Shing Kwok
- Keele Cardiovascular Research Group, Centre for Prognosis Research, Institute of Primary Care and Health Sciences, Keele University, Stoke on Trent, UK
| | - Paul Cook
- Biochemistry Department, University Hospital Southampton NHS Foundation Trust, Southampton, UK
| | - Mamas A Mamas
- Keele Cardiovascular Research Group, Centre for Prognosis Research, Institute of Primary Care and Health Sciences, Keele University, Stoke on Trent, UK
| | - Nick Curzen
- Coronary Research Group, University Hospital Southampton NHS Foundation Trust, Southampton, UK
- Wessex Cardiothoracic Unit, University Hospital Southampton NHS Foundation Trust, Southampton, UK
- Faculty of Medicine, University of Southampton, Southampton, UK
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Aleksova A, Paldino A, Beltrami AP, Padoan L, Iacoviello M, Sinagra G, Emdin M, Maisel AS. Cardiac Biomarkers in the Emergency Department: The Role of Soluble ST2 (sST2) in Acute Heart Failure and Acute Coronary Syndrome-There is Meat on the Bone. J Clin Med 2019; 8:jcm8020270. [PMID: 30813357 PMCID: PMC6406787 DOI: 10.3390/jcm8020270] [Citation(s) in RCA: 33] [Impact Index Per Article: 6.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/30/2019] [Revised: 02/18/2019] [Accepted: 02/19/2019] [Indexed: 01/02/2023] Open
Abstract
Soluble ST2 (sST2) has recently emerged as a promising biomarker in the field of acute cardiovascular diseases. Several clinical studies have demonstrated a significant link between sST2 values and patients' outcome. Further, it has been found that higher levels of sST2 are associated with an increased risk of adverse left ventricular remodeling. Therefore, sST2 could represent a useful tool that could help the risk stratification and diagnostic and therapeutic work-up of patients admitted to an emergency department. With this review, based on recent literature, we have built sST2-assisted flowcharts applicable to three very common clinical scenarios of the emergency department: Acute heart failure, type 1, and type 2 acute myocardial infarction. In particular, we combined sST2 levels together with clinical and instrumental evaluation in order to offer a practical tool for emergency medicine physicians.
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Affiliation(s)
- Aneta Aleksova
- Cardiovascular Department, Azienda Sanitaria Universitaria di Trieste and Department of Medical Surgical and Health Sciences, University of Trieste, 34100 Trieste, Italy.
| | - Alessia Paldino
- Cardiovascular Department, Azienda Sanitaria Universitaria di Trieste and Department of Medical Surgical and Health Sciences, University of Trieste, 34100 Trieste, Italy.
| | | | - Laura Padoan
- Sport and Exercise Medicine Division, Department of Medicine, University of Padova, 35122 Padova, Italy.
| | - Massimo Iacoviello
- University Cardiology Unit, Cardiothoracic Department, University Policlinic Hospital of Bari, 70124 Bari, Italy.
| | - Gianfranco Sinagra
- Cardiovascular Department, Azienda Sanitaria Universitaria di Trieste and Department of Medical Surgical and Health Sciences, University of Trieste, 34100 Trieste, Italy.
| | - Michele Emdin
- Department of Life science, Scuola Superiore Sant'Anna, 56127 Pisa, Italy.
- Fondazione Toscana Gabriele Monasterio, National Research Council, 56124 Pisa, Italy.
| | - Alan S Maisel
- Division of Cardiology, University of California San Diego, San Diego, CA 92093, USA.
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54
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Clerico A, Zaninotto M, Padoan A, Masotti S, Musetti V, Prontera C, Ndreu R, Zucchelli G, Passino C, Migliardi M, Plebani M. Evaluation of analytical performance of immunoassay methods for cTnI and cTnT: From theory to practice. Adv Clin Chem 2019; 93:239-262. [PMID: 31655731 DOI: 10.1016/bs.acc.2019.07.005] [Citation(s) in RCA: 32] [Impact Index Per Article: 6.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/21/2023]
Abstract
Current guidelines worldwide recommend cardiac troponins I (cTnI) and T (cTnT) as the biomarkers of choice for the differential diagnosis of acute coronary syndrome (ACS), and the measurement of the 99th upper reference population limit (URL) value for cardiac troponins, with an imprecision of ≤10 CV%. Measuring the 99th URL of cTnI and cTnT is a challenging analytical task due to low biomarker concentrations present in healthy subjects. Therefore, since the year 2006, several manufacturers have established new generation cTnI and cTnT immunoassays with an improved analytical sensitivity in accordance with the quality specifications described in international guidelines, the more recent of which state that only immunoassays that meet the required quality specifications should be considered "high-sensitivity" methods. For the early diagnosis of ACS, and for the stratification of cardiovascular risk in cardiac patients and the general population, high-sensitivity methods should be employed. It is therefore important for laboratory professionals and clinicians to gain a thorough understanding of the analytical performances of immunoassay methods for cTnI and cTnT, especially at low to normal concentration ranges. The aim of the present study was to analyze critical aspects related to definition, analytical performance, pathophysiological interpretations, and the clinical relevance of high-sensitivity cardiac troponin assays.
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Affiliation(s)
- Aldo Clerico
- Fondazione CNR, Regione Toscana G. Monasterio and Scuola Superiore Sant'Anna, Pisa, Italy.
| | - Martina Zaninotto
- Department of Laboratory Medicine, University Hospital, Padova, Italy
| | - Andrea Padoan
- Department of Laboratory Medicine, University Hospital, Padova, Italy
| | - Silvia Masotti
- Fondazione CNR, Regione Toscana G. Monasterio and Scuola Superiore Sant'Anna, Pisa, Italy
| | - Veronica Musetti
- Fondazione CNR, Regione Toscana G. Monasterio and Scuola Superiore Sant'Anna, Pisa, Italy
| | - Concetta Prontera
- Fondazione CNR, Regione Toscana G. Monasterio and Scuola Superiore Sant'Anna, Pisa, Italy
| | - Rudina Ndreu
- QualiMedLab and CNR Clinical Physiology Institute, Pisa, Italy
| | | | - Claudio Passino
- Fondazione CNR, Regione Toscana G. Monasterio and Scuola Superiore Sant'Anna, Pisa, Italy
| | - Marco Migliardi
- S.C. Laboratorio Analisi, A.O. Ordine Mauriziano di Torino, Torino, Italy
| | - Mario Plebani
- Department of Laboratory Medicine, University Hospital, Padova, Italy
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55
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Sandoval Y, Sharain K, Saenger AK, Smith SW, Apple FS, Jaffe AS. Clinical use of cardiac troponin for acute cardiac care and emerging opportunities in the outpatient setting. Minerva Med 2018; 110:139-156. [PMID: 30484592 DOI: 10.23736/s0026-4806.18.05874-3] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
Abstract
Cardiac troponin (cTn) testing has evolved significantly in recent times. Because of increased sensitivity, its use has shifted from a marker used to help diagnose acute myocardial infarction (MI) to a marker than can be used in the outpatient setting, as well as for both detection of myocardial injury and risk-stratification. Its main role remains in the diagnosis of acute MI and the risk-stratification of patients presenting with suspected acute coronary syndrome. The analytical improvements in assays leading to precise high-sensitivity cTn assays have contributed to the development of numerous strategies to identify patients at both low- and high-risk for acute MI within a few hours. These approaches should reduce overcrowding in the emergency room and expedite triaging. The ability of measuring cTn in most patients using high-sensitivity (hs) assays has allowed for the opportunity to examine its use in the detection of cardiotoxicity in patients undergoing chemotherapy, as well as exploring the application in both primary and secondary prevention of coronary artery disease. This particular field of research has become increasingly complex, partly due to the numerous cTn assays available (I and T; point-of-care, contemporary, hs) and an array of approaches in which one can use the test. The purpose of this document is to summarize the analytical and clinical information relevant to cTn assays, in particular, hs-cTn assays, and describe present and future opportunities for use of cTn in acute cardiac care and in the outpatient setting.
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Affiliation(s)
- Yader Sandoval
- Department of Cardiovascular Medicine, Mayo Clinic, Rochester, MN, USA -
| | - Korosh Sharain
- Department of Cardiovascular Medicine, Mayo Clinic, Rochester, MN, USA
| | - Amy K Saenger
- Department of Laboratory Medicine and Pathology, University of Minnesota, Minneapolis, MN, USA.,Department of Laboratory Medicine and Pathology, Hennepin County Medical Center, Minneapolis, MN, USA
| | - Stephen W Smith
- Department of Emergency Medicine, Hennepin County Medical Center and University of Minnesota, Minneapolis, MN, USA
| | - Fred S Apple
- Department of Laboratory Medicine and Pathology, University of Minnesota, Minneapolis, MN, USA.,Department of Laboratory Medicine and Pathology, Hennepin County Medical Center, Minneapolis, MN, USA
| | - Allan S Jaffe
- Department of Cardiovascular Medicine, Mayo Clinic, Rochester, MN, USA.,Department of Laboratory Medicine and Pathology, Mayo Clinic, Rochester, MN, USA
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56
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Adamson PD, Mills NL. High-Sensitivity Troponin and the Selection of Patients for Cardiac Imaging in the Outpatient Clinic. Clin Chem 2018; 64:1555-1557. [PMID: 30237147 DOI: 10.1373/clinchem.2018.294629] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/03/2018] [Accepted: 09/04/2018] [Indexed: 11/06/2022]
Affiliation(s)
- Philip D Adamson
- BHF Centre for Cardiovascular Research, University of Edinburgh, Edinburgh, United Kingdom.,Christchurch Heart Institute, University of Otago, Christchurch, New Zealand
| | - Nicholas L Mills
- BHF Centre for Cardiovascular Research, University of Edinburgh, Edinburgh, United Kingdom; .,Usher Institute of Population Health Sciences and Informatics, University of Edinburgh, Edinburgh, United Kingdom
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57
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GRODIN JUSTINL, BUTLER JAVED, METRA MARCO, FELKER GMICHAEL, VOORS ADRIAANA, MCMURRAY JOHNJ, ARMSTRONG PAULW, HERNANDEZ ADRIANF, O'CONNOR CHRISTOPHER, STARLING RANDALLC, TANG WWILSON. Circulating Cardiac Troponin I Levels Measured by a Novel Highly Sensitive Assay in Acute Decompensated Heart Failure: Insights From the ASCEND-HF Trial. J Card Fail 2018; 24:512-519. [DOI: 10.1016/j.cardfail.2018.06.008] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/14/2017] [Revised: 06/02/2018] [Accepted: 06/28/2018] [Indexed: 12/23/2022]
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58
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Kawasoe S, Kubozono T, Ojima S, Miyata M, Ohishi M. Combined Assessment of the Red Cell Distribution Width and B-type Natriuretic Peptide: A More Useful Prognostic Marker of Cardiovascular Mortality in Heart Failure Patients. Intern Med 2018; 57:1681-1688. [PMID: 29434163 PMCID: PMC6047991 DOI: 10.2169/internalmedicine.9846-17] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
Objective An increased red cell distribution width (RDW) has been reported to be associated with adverse outcomes in patients with heart failure (HF). This study aimed to evaluate the prognostic power of the combined measurement of RDW and B-type natriuretic peptide (BNP) concentrations in patients with HF. Methods and Results We retrospectively studied 116 patients (mean age, 63.7±14.3 years) who were admitted for the treatment of HF. Data including demographic information, vital signs, and laboratory and echocardiographic measurements at admission were collected from medical records. The observational period was defined as the number of days from hospitalization, and the study endpoint was defined as cardiovascular death. The mean RDW and BNP concentration at admission were 14.5±2.0% and 626±593 pg/mL, respectively. During a median observation period of 1,046 days, 22 patients died of cardiovascular disease. A univariate Cox proportional hazard analysis revealed that both RDW [hazard ratio (HR) 1.252, p = 0.0391] and BNP (HR 1.001, p = 0.0445) were significant prognostic indices for cardiovascular death. A receiver operating characteristic curve analysis revealed that the optimal cut-off RDW and BNP values for cardiovascular death were 14.9% and 686 pg/mL, respectively. The Kaplan-Meier survival curve revealed that the survival rate of patients with both RDW ≥ 14.9% and BNP ≥ 686 pg/mL showed the poorest prognosis in comparison to the patients in the other groups. Conclusion The combined assessment of the RDW and BNP concentrations may be useful for predicting mortality in patients with HF.
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Affiliation(s)
- Shin Kawasoe
- Department of Cardiovascular Medicine and Hypertension, Graduate School of Medical and Dental Sciences, Kagoshima University, Japan
| | - Takuro Kubozono
- Department of Cardiovascular Medicine and Hypertension, Graduate School of Medical and Dental Sciences, Kagoshima University, Japan
| | - Satoko Ojima
- Department of Cardiovascular Medicine and Hypertension, Graduate School of Medical and Dental Sciences, Kagoshima University, Japan
| | - Masaaki Miyata
- Department of Cardiovascular Medicine and Hypertension, Graduate School of Medical and Dental Sciences, Kagoshima University, Japan
| | - Mitsuru Ohishi
- Department of Cardiovascular Medicine and Hypertension, Graduate School of Medical and Dental Sciences, Kagoshima University, Japan
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59
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Saeed A, Nambi V, Sun W, Virani SS, Taffet GE, Deswal A, Selvin E, Matsushita K, Wagenknecht LE, Hoogeveen R, Coresh J, de Lemos JA, Ballantyne CM. Short-Term Global Cardiovascular Disease Risk Prediction in Older Adults. J Am Coll Cardiol 2018; 71:2527-2536. [PMID: 29535064 PMCID: PMC5984171 DOI: 10.1016/j.jacc.2018.02.050] [Citation(s) in RCA: 46] [Impact Index Per Article: 7.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/09/2018] [Revised: 02/26/2018] [Accepted: 02/27/2018] [Indexed: 11/21/2022]
Abstract
BACKGROUND Current prevention guidelines recommend using the Pooled Cohort Equation (PCE) for 10-year atherosclerotic cardiovascular disease (CVD) risk assessment. However, the PCE has serious limitations in older adults: it excludes heart failure (HF) hospitalization, estimates 10-year risk, which may not be the most relevant time frame, and is not indicated for individuals age >79 years. OBJECTIVES This study sought to determine whether adding biomarkers to PCE variables improves global CVD (coronary heart disease, stroke, and HF) risk prediction in older adults over a shorter time period. METHODS Atherosclerosis Risk in Communities study participants without prevalent CVD including HF (n = 4,760; age 75.4 ± 5.1 years) were followed for incident global CVD events. Adding N-terminal pro-B-type natriuretic peptide, high-sensitivity cardiac troponin T, and high-sensitivity C-reactive protein to the PCE and a "lab model" with the biomarkers, age, race, and gender were assessed for prediction improvement. Area under the receiver operating characteristic curve (AUC) and net reclassification index (NRI) were calculated. RESULTS Over median follow-up of ∼4 years, incident HF was the leading CVD event (n = 193 vs. 118 coronary heart disease and 81 stroke events). Compared to the PCE, each biomarker improved risk prediction. The largest improvement in risk prediction metrics was with the addition of all 3 biomarkers (ΔAUC 0.103; continuous NRI 0.484). The lab model also performed better than the PCE model (ΔAUC 0.091, continuous NRI 0.355). CONCLUSIONS Adding biomarkers to the PCE or a simpler "lab model" improves short-term global CVD risk prediction and may be useful to inform short-term preventive strategies in older adults.
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Affiliation(s)
- Anum Saeed
- Baylor College of Medicine, Houston, Texas
| | - Vijay Nambi
- Baylor College of Medicine, Houston, Texas; Michael E. DeBakey Veterans Affairs Medical Center, Houston, Texas
| | | | - Salim S Virani
- Baylor College of Medicine, Houston, Texas; Michael E. DeBakey Veterans Affairs Medical Center, Houston, Texas
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60
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Otsuka K, Nakanishi K, Shimada K, Nakamura H, Inanami H, Nishioka H, Fujimoto K, Kasayuki N, Yoshiyama M. Associations of sensitive cardiac troponin-I with left ventricular morphology, function and prognosis in end-stage renal disease patients with preserved ejection fraction. Heart Vessels 2018; 33:1334-1342. [PMID: 29789900 DOI: 10.1007/s00380-018-1192-7] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/17/2018] [Accepted: 05/18/2018] [Indexed: 01/20/2023]
Abstract
Sensitive cardiac troponin I (cTnI) predicts all-cause and cardiovascular mortality in various clinical settings. However, its clinical significance in hemodialysis (HD) patients with preserved left ventricular ejection fraction (LVEF) has not been fully elucidated. This study investigated the association of cTnI with LV morphology and function, and its long-term outcome in HD patients with preserved LVEF. This prospective study consists of 96 HD patients with preserved LVEF (69 ± 8 years and 63% male) who underwent two-dimensional echocardiographic examination and biomarker tests including cTnI, brain natriuretic peptide, and high-sensitive C-reactive protein. The primary endpoint was all-cause death and secondary endpoint was cardiovascular death. Factors independently associated with cTnI were systolic blood pressure (β = - 0.239, p = 0.011), heart rate (β = 0.216, p = 0.021), LV mass index (β = 0.231, p = 0.020), and E to e' ratio (β = 0.237, p = 0.016). During a mean follow-up of 3.6 years, primary and secondary endpoints were observed in 23 (24%) and 18 (19%) patients, respectively. In the multivariate Cox proportional hazard analysis, the upper cTnI tertile has significantly increased risk of all-cause mortality [hazard ratio (HR), 2.69; 95% confidence interval (CI), 1.139-6.386; p = 0.024] and that of cardiovascular death (HR, 4.56; 95% CI 2.021-16.968; p = 0.006) independent of echocardiographic measures and other serum biomarkers. In HD patients with preserved LVEF, serum cTnI levels were significantly associated with diastolic function and risk of mortality independent of echocardiographic variables and other biomarkers.
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Affiliation(s)
- Kenichiro Otsuka
- Department of Cardiovascular Medicine, Ishikiri-seiki Hospital, Higashi-osaka, 18-28 Yayoi, Higashi-osaka, 550-0022, Japan.
| | - Koki Nakanishi
- Department of Cardiovascular Medicine, Baba Memorial Hospital, Sakai, Japan
| | - Kenei Shimada
- Department of Cardiovascular Medicine, Osaka City University Graduate School of Medicine, Osaka, Japan
| | - Haruo Nakamura
- Department of Cardiovascular Medicine, Ishikiri-seiki Hospital, Higashi-osaka, 18-28 Yayoi, Higashi-osaka, 550-0022, Japan
| | - Hitoshi Inanami
- Department of Cardiovascular Medicine, Ishikiri-seiki Hospital, Higashi-osaka, 18-28 Yayoi, Higashi-osaka, 550-0022, Japan
| | - Hiroki Nishioka
- Department of Cardiovascular Medicine, Ishikiri-seiki Hospital, Higashi-osaka, 18-28 Yayoi, Higashi-osaka, 550-0022, Japan
| | - Kohei Fujimoto
- Department of Cardiovascular Medicine, Ishikiri-seiki Hospital, Higashi-osaka, 18-28 Yayoi, Higashi-osaka, 550-0022, Japan
| | - Noriaki Kasayuki
- Department of Cardiovascular Medicine, Ishikiri-seiki Hospital, Higashi-osaka, 18-28 Yayoi, Higashi-osaka, 550-0022, Japan
| | - Minoru Yoshiyama
- Department of Cardiovascular Medicine, Osaka City University Graduate School of Medicine, Osaka, Japan
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Bodde MC, Welsh P, Bergheanu SC, Lijfering WM, Mertens B, Liem AH, van der Laarse A, Sattar N, Jukema JW. A Rapid (Differential) Effect of Rosuvastatin and Atorvastatin on High-Sensitivity Cardiac Troponin-I in Subjects With Stable Cardiovascular Disease. Clin Pharmacol Ther 2018; 104:311-316. [DOI: 10.1002/cpt.1095] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/26/2018] [Revised: 04/10/2018] [Accepted: 04/11/2018] [Indexed: 01/09/2023]
Affiliation(s)
- Mathijs C. Bodde
- Department of Cardiology; Leiden University Medical Center (LUMC); Leiden The Netherlands
| | - Paul Welsh
- Institute of Cardiovascular and Medical Sciences; University of Glasgow; Glasgow UK
| | | | - Willem M. Lijfering
- Department of Clinical Epidemiology; Leiden University Medical Centre (LUMC); Leiden The Netherlands
| | - Bart Mertens
- Department of Medical Statistics and Bioinformatics; Leiden University Medical Center (LUMC); Leiden The Netherlands
| | - An-Ho Liem
- Department of Cardiology; Sint Franciscus Gasthuis & Vlietland; Rotterdam The Netherlands
| | - Arnoud van der Laarse
- Department of Cardiology; Leiden University Medical Center (LUMC); Leiden The Netherlands
- Department of Clinical Chemistry & Laboratory Medicine; Leiden University Medical Center; Leiden the Netherlands
| | - Naveed Sattar
- Institute of Cardiovascular and Medical Sciences; University of Glasgow; Glasgow UK
| | - J. Wouter Jukema
- Department of Cardiology; Leiden University Medical Center (LUMC); Leiden The Netherlands
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62
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Than MP, Aldous SJ, Troughton RW, Pemberton CJ, Richards AM, Frampton CMA, Florkowski CM, George PM, Bailey S, Young JM, Cullen L, Greenslade JH, Parsonage WA, Everett BM, Peacock WF, Jaffe AS, Pickering JW. Detectable High-Sensitivity Cardiac Troponin within the Population Reference Interval Conveys High 5-Year Cardiovascular Risk: An Observational Study. Clin Chem 2018; 64:1044-1053. [PMID: 29760219 DOI: 10.1373/clinchem.2017.285700] [Citation(s) in RCA: 26] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/16/2018] [Accepted: 04/10/2018] [Indexed: 12/31/2022]
Abstract
BACKGROUND Increased cardiac troponin I or T detected by high-sensitivity assays (hs-cTnI or hs-cTnT) confers an increased risk of adverse prognosis. We determined whether patients presenting with putatively normal, detectable cTn concentrations [> limit of detection and < upper reference limit (URL)] have increased risk of major adverse cardiovascular events (MACE) or all-cause mortality. METHODS A prospective 5-year follow-up of patients recruited in the emergency department with possible acute coronary syndrome (ACS) and cTn concentrations measured with hs-cTnI (Abbott) and hs-cTnT (Roche) assays. Cox regression models were generated with adjustment for covariates in those without MACE on presentation. Hazard ratios (HRs) for hs-cTn were calculated relative to the HRs at the median concentration. RESULTS Of 1113 patients, 836 were without presentation MACE. Of these, 138 incurred a MACE and 169 died during a median 5.8-year follow-up. HRs for MACE at the URLs were 2.3 (95% CI, 1.7-3.2) for hs-cTnI and 1.8 (95% CI, 1.3-2.4) for hs-cTnT. Corresponding HRs for mortality were 1.7 (95% CI, 1.2-2.2) for hs-cTnI and 2.3 (95 % CI, 1.7-3.1) for hs-cTnT. The HR for MACE increased with increasing hs-cTn concentration similarly for both assays, but the HR for mortality increased at approximately twice the rate for hs-cTnT than hs-cTnI. Patients with hs-cTnI ≥10 ng/L or hs-cTnT ≥16 ng/L had the same percentage of MACE at 5-year follow-up (33%) as patients with presentation MACE. CONCLUSIONS Many patients with ACS ruled out and putatively normal but detectable hs-cTnI concentrations are at similar long-term risk as those with MACE. hs-cTnT concentrations are more strongly associated with 5-year mortality than hs-cTnI.
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Affiliation(s)
| | | | - Richard W Troughton
- Christchurch Hospital, Christchurch, New Zealand.,Christchurch Heart Institute, University of Otago Christchurch, Christchurch, New Zealand
| | | | - A Mark Richards
- Christchurch Heart Institute, University of Otago Christchurch, Christchurch, New Zealand.,National University of Singapore, Singapore
| | | | | | | | | | | | - Louise Cullen
- Royal Brisbane and Women's Hospital, Herston, Australia.,University of Technology, Brisbane, Australia.,University of Queensland, Brisbane, Australia
| | - Jaimi H Greenslade
- Royal Brisbane and Women's Hospital, Herston, Australia.,University of Queensland, Brisbane, Australia
| | | | - Brendan M Everett
- Divisions of Cardiovascular and Preventive Medicine, Brigham and Women's Hospital and Harvard Medical School, Boston, MA
| | | | | | - John W Pickering
- Christchurch Hospital, Christchurch, New Zealand; .,Christchurch Heart Institute, University of Otago Christchurch, Christchurch, New Zealand
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63
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Wu YS, Zhu B, Luo AL, Yang L, Yang C. The Role of Cardiokines in Heart Diseases: Beneficial or Detrimental? BIOMED RESEARCH INTERNATIONAL 2018; 2018:8207058. [PMID: 29744364 PMCID: PMC5878913 DOI: 10.1155/2018/8207058] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 11/30/2017] [Revised: 01/19/2018] [Accepted: 02/07/2018] [Indexed: 12/11/2022]
Abstract
Cardiovascular disease remains the leading cause of morbidity and mortality, imposing a major disease burden worldwide. Therefore, there is an urgent need to identify new therapeutic targets. Recently, the concept that the heart acts as a secretory organ has attracted increasing attention. Proteins secreted by the heart are called cardiokines, and they play a critical physiological role in maintaining heart homeostasis or responding to myocardial damage and thereby influence the development of heart diseases. Given the critical role of cardiokines in heart disease, they might represent a promising therapeutic target. This review will focus on several cardiokines and discuss their roles in the pathogenesis of heart diseases and as potential therapeutics.
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Affiliation(s)
- Ye-Shun Wu
- Department of Cardiology, The Third Affiliated Hospital of Soochow University, Changzhou 213003, China
| | - Bin Zhu
- Department of Critical Care Medicine, The Third Affiliated Hospital of Soochow University, Changzhou 213003, China
| | - Ai-Lin Luo
- Department of Anesthesiology, Tongji Hospital, Tongji Medical College, Huazhong University of Science & Technology, Wuhan 430030, China
| | - Ling Yang
- Department of Cardiology, The Third Affiliated Hospital of Soochow University, Changzhou 213003, China
| | - Chun Yang
- Department of Anesthesiology, Tongji Hospital, Tongji Medical College, Huazhong University of Science & Technology, Wuhan 430030, China
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64
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Patterson CC, Blankenberg S, Ben-Shlomo Y, Heslop L, Bayer A, Lowe G, Zeller T, Gallacher J, Young I, Yarnell JWG. Troponin and BNP are markers for subsequent non-ischaemic congestive heart failure: the Caerphilly Prospective Study (CaPS). Open Heart 2018. [PMID: 29531757 PMCID: PMC5845403 DOI: 10.1136/openhrt-2017-000692] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/14/2022] Open
Abstract
Objective To examine the long-term predictive value of 28 biomarkers for subsequent non-ischaemic congestive heart failure (CHF) and separately for other cardiovascular outcomes (myocardial infarction (MI) and stroke). Methods The Caerphilly Prospective Study recruited 2171 men aged 55–69 years from the general population in 1989–1993; men were screened for evidence of cardiovascular disease (CVD) and followed for clinical cardiovascular events. Fasting blood samples were stored at −70°C until assayed for novel biomarkers in 2010–2013. A competing risks proportional hazards regression analysis was used to estimate subhazard ratios (SHRs) for each biomarker for each cardiovascular outcome. Results During follow-up (average 13 years), only new, initial events were evaluated in the whole cohort: 584 MIs, 313 strokes and 261 episodes of CHF (not associated with acute MI). In a subcohort of men who had no clinical history or evidence of CVD at baseline examination (n=1279) those in the top third of the distributions of troponin and B-type natriuretic peptide (BNP) showed a threefold increase in risk for subsequent CHF as a first event after adjustment for all conventional risk factors (SHRs 3.37, 95% CI 1.39 to 8.14 and 3.23, 95% CI 1.45 to 7.23), respectively, in contrast to moderate elevations in risk for acute MI (troponin SHR 1.63, 95% CI 1.10 to 2.41) and for stroke (BNP SHR 1.75 95% CI 1.06 to 2.88). Conclusion Troponin and BNP could be considered as potentially useful screening tools to detect subjects without prior CVD at increased risk of developing CHF in subsequent years in addition to having lesser roles for predicting subsequent MI (troponin) or stroke (BNP).
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Affiliation(s)
| | - Stefan Blankenberg
- Department of General and Interventional Cardiology, University Heart Centre Hamburg, Hamburg, Germany.,DZHK German Center for Cardiovascular Research, Partner Sites Hamburg, Lubeck, Kiel, Hamburg, Germany
| | - Yoav Ben-Shlomo
- School of Social and Community Medicine, University of Bristol, Bristol, UK
| | - Luke Heslop
- Division of Population Medicine, Cardiff University School of Medicine, Cardiff, UK
| | - Anthony Bayer
- Division of Population Medicine, Cardiff University School of Medicine, Cardiff, UK
| | - Gordon Lowe
- Institute of Cardiovascular and Medical Sciences, University of Glasgow, Glasgow, UK
| | - Tanja Zeller
- Department of General and Interventional Cardiology, University Heart Centre Hamburg, Hamburg, Germany.,DZHK German Center for Cardiovascular Research, Partner Sites Hamburg, Lubeck, Kiel, Hamburg, Germany
| | - John Gallacher
- Department of Psychiatry, University of Oxford, Warneford Hospital, Oxford, UK
| | - Ian Young
- Centre for Public Health, Queen's University Belfast, Belfast, UK
| | - John W G Yarnell
- Centre for Public Health, Queen's University Belfast, Belfast, UK
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65
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Wang TKM, Dugo C, Gillian Y, Yvonne W, Heather S, Kevin S, Peter C, Jonathan C, Andrew T, Nezar A, Scott T, Ross B, Patrick G. Diagnostic Utility of High Sensitivity Troponins for Echocardiographic Markers of Structural Heart Disease. Med Sci (Basel) 2018; 6:medsci6010017. [PMID: 29462878 PMCID: PMC5872174 DOI: 10.3390/medsci6010017] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/25/2018] [Revised: 02/12/2018] [Accepted: 02/13/2018] [Indexed: 12/15/2022] Open
Abstract
The conventional use of high-sensitivity troponins (hs-troponins) is for diagnosing myocardial infarction however they also have a role in chronic disease management. This pilot study assessed the relationship of hs-troponins with echocardiographic markers of left ventricular hypertrophy (LVH) and structural heart disease (SHD). Patients undergoing computer gomography (CT) coronary angiogram for low-intermediate risk chest pain and healthy volunteers were recruited. Hs-troponins Singulex I, Abbott I and Roche T and N-terminal pro-brain natriuretic peptide (NT-proBNP) were evaluated in relation to SHD parameters including left ventricular hypertrophy (LVHEcho) and left atrial enlargement (LAEEcho) on echocardiography. 78 subjects who underwent echocardiography were included in this study. C-statistics (95% confidence interval) of the four biomarkers for predicting LVHEcho were 0.84 (0.72–0.92), 0.84 (0.73–0.92), 0.75 (0.63–0.85) and 0.62 (0.49–0.74); for LAEEcho 0.74 (0.6–0.85), 0.78 (0.66–0.88), 0.55 (0.42–0.67) and 0.68 (0.62–0.85); and composite SHD 0.79 (0.66–0.88), 0.87 (0.75–0.94), 0.62 (0.49–0.73) and 0.74 (0.62–0.84) respectively. Optimal cut points for SHD were >1.2 ng/L, >1.6 ng/L, >8 ng/L and >18 pmol/L respectively. These results advocate the potential role of hs-troponins as screening tools for structural heart disease with theranostic implications.
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Affiliation(s)
- Tom Kai Ming Wang
- Lakeview Cardiology Centre, North Shore Hospital, Auckland 0620, New Zealand.
- Green Lane Cardiovascular Service, Auckland City Hospital, Auckland 1023, New Zealand.
| | - Clementina Dugo
- Division of Cardiology, Azienda Ospedaliera Universitaria Integrata, 37126 Verona, Italy.
| | - Yvonne Gillian
- Unitech University of Technology, Auckland 1025, New Zealand.
| | - Wynne Yvonne
- Lakeview Cardiology Centre, North Shore Hospital, Auckland 0620, New Zealand.
| | - Semple Heather
- Lakeview Cardiology Centre, North Shore Hospital, Auckland 0620, New Zealand.
| | - Smith Kevin
- Lakeview Cardiology Centre, North Shore Hospital, Auckland 0620, New Zealand.
| | - Cleave Peter
- Department of Pathology, Middlemore Hospital, Auckland 2025, New Zealand.
| | | | - To Andrew
- Lakeview Cardiology Centre, North Shore Hospital, Auckland 0620, New Zealand.
| | - Amir Nezar
- Lakeview Cardiology Centre, North Shore Hospital, Auckland 0620, New Zealand.
| | - Tony Scott
- Lakeview Cardiology Centre, North Shore Hospital, Auckland 0620, New Zealand.
| | - Boswell Ross
- Department of Pathology, Middlemore Hospital, Auckland 2025, New Zealand.
| | - Gladding Patrick
- Lakeview Cardiology Centre, North Shore Hospital, Auckland 0620, New Zealand.
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66
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Sugiura T, Dohi Y, Takase H, Ito A, Fujii S, Ohte N. Differential effects of brachial and central blood pressures on circulating levels of high-sensitivity cardiac troponin I in the general population. Atherosclerosis 2018; 269:185-191. [DOI: 10.1016/j.atherosclerosis.2018.01.015] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/20/2017] [Revised: 11/21/2017] [Accepted: 01/12/2018] [Indexed: 01/17/2023]
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67
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Adamson PD, Hunter A, Madsen DM, Shah ASV, McAllister DA, Pawade TA, Williams MC, Berry C, Boon NA, Flather M, Forbes J, McLean S, Roditi G, Timmis AD, van Beek EJR, Dweck MR, Mickley H, Mills NL, Newby DE. High-Sensitivity Cardiac Troponin I and the Diagnosis of Coronary Artery Disease in Patients With Suspected Angina Pectoris. Circ Cardiovasc Qual Outcomes 2018; 11:e004227. [PMID: 29444926 PMCID: PMC5837016 DOI: 10.1161/circoutcomes.117.004227] [Citation(s) in RCA: 35] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/24/2017] [Accepted: 12/22/2017] [Indexed: 01/16/2023]
Abstract
BACKGROUND We determined whether high-sensitivity cardiac troponin I can improve the estimation of the pretest probability for obstructive coronary artery disease (CAD) in patients with suspected stable angina. METHODS AND RESULTS In a prespecified substudy of the SCOT-HEART trial (Scottish Computed Tomography of the Heart), plasma cardiac troponin was measured using a high-sensitivity single-molecule counting assay in 943 adults with suspected stable angina who had undergone coronary computed tomographic angiography. Rates of obstructive CAD were compared with the pretest probability determined by the CAD Consortium risk model with and without cardiac troponin concentrations. External validation was undertaken in an independent study population from Denmark comprising 487 patients with suspected stable angina. Higher cardiac troponin concentrations were associated with obstructive CAD with a 5-fold increase across quintiles (9%-48%; P<0.001) independent of known cardiovascular risk factors (odds ratio, 1.35; 95% confidence interval, 1.25-1.46 per doubling of troponin). Cardiac troponin concentrations improved the discrimination and calibration of the CAD Consortium model for identifying obstructive CAD (C statistic, 0.788-0.800; P=0.004; χ2=16.8 [P=0.032] to 14.3 [P=0.074]). The updated model also improved classification of the American College of Cardiology/American Heart Association pretest probability risk categories (net reclassification improvement, 0.062; 95% confidence interval, 0.035-0.089). The revised model achieved similar improvements in discrimination and calibration when applied in the external validation cohort. CONCLUSIONS High-sensitivity cardiac troponin I concentration is an independent predictor of obstructive CAD in patients with suspected stable angina. Use of this test may improve the selection of patients for further investigation and treatment. CLINICAL TRIAL REGISTRATION URL: https://www.clinicaltrials.gov. Unique identifier: NCT01149590.
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Affiliation(s)
- Philip D Adamson
- From the British Heart Foundation Centre for Cardiovascular Science (P.D.A., A.H., A.S.V.S., T.A.P., N.A.B., E.J.R.v.B., M.R.D., N.L.M., D.E.N.) and Clinical Research Imaging Centre (M.C.W.), University of Edinburgh, United Kingdom; Department of Cardiology, Odense University Hospital, Denmark (D.M.M., H.M.); Institute of Health and Wellbeing (D.A.M.) and Institute of Clinical Sciences (C.B., G.R.), University of Glasgow, United Kingdom; Norwich Medical School, University of East Anglia, Norwich, United Kingdom (M.F.); Health Research Institute, University of Limerick, Ireland (J.F.); National Health Service, Fife, United Kingdom (S.M.); and William Harvey Research Institute, Queen Mary University of London, United Kingdom (A.D.T.).
| | - Amanda Hunter
- From the British Heart Foundation Centre for Cardiovascular Science (P.D.A., A.H., A.S.V.S., T.A.P., N.A.B., E.J.R.v.B., M.R.D., N.L.M., D.E.N.) and Clinical Research Imaging Centre (M.C.W.), University of Edinburgh, United Kingdom; Department of Cardiology, Odense University Hospital, Denmark (D.M.M., H.M.); Institute of Health and Wellbeing (D.A.M.) and Institute of Clinical Sciences (C.B., G.R.), University of Glasgow, United Kingdom; Norwich Medical School, University of East Anglia, Norwich, United Kingdom (M.F.); Health Research Institute, University of Limerick, Ireland (J.F.); National Health Service, Fife, United Kingdom (S.M.); and William Harvey Research Institute, Queen Mary University of London, United Kingdom (A.D.T.)
| | - Debbie M Madsen
- From the British Heart Foundation Centre for Cardiovascular Science (P.D.A., A.H., A.S.V.S., T.A.P., N.A.B., E.J.R.v.B., M.R.D., N.L.M., D.E.N.) and Clinical Research Imaging Centre (M.C.W.), University of Edinburgh, United Kingdom; Department of Cardiology, Odense University Hospital, Denmark (D.M.M., H.M.); Institute of Health and Wellbeing (D.A.M.) and Institute of Clinical Sciences (C.B., G.R.), University of Glasgow, United Kingdom; Norwich Medical School, University of East Anglia, Norwich, United Kingdom (M.F.); Health Research Institute, University of Limerick, Ireland (J.F.); National Health Service, Fife, United Kingdom (S.M.); and William Harvey Research Institute, Queen Mary University of London, United Kingdom (A.D.T.)
| | - Anoop S V Shah
- From the British Heart Foundation Centre for Cardiovascular Science (P.D.A., A.H., A.S.V.S., T.A.P., N.A.B., E.J.R.v.B., M.R.D., N.L.M., D.E.N.) and Clinical Research Imaging Centre (M.C.W.), University of Edinburgh, United Kingdom; Department of Cardiology, Odense University Hospital, Denmark (D.M.M., H.M.); Institute of Health and Wellbeing (D.A.M.) and Institute of Clinical Sciences (C.B., G.R.), University of Glasgow, United Kingdom; Norwich Medical School, University of East Anglia, Norwich, United Kingdom (M.F.); Health Research Institute, University of Limerick, Ireland (J.F.); National Health Service, Fife, United Kingdom (S.M.); and William Harvey Research Institute, Queen Mary University of London, United Kingdom (A.D.T.)
| | - David A McAllister
- From the British Heart Foundation Centre for Cardiovascular Science (P.D.A., A.H., A.S.V.S., T.A.P., N.A.B., E.J.R.v.B., M.R.D., N.L.M., D.E.N.) and Clinical Research Imaging Centre (M.C.W.), University of Edinburgh, United Kingdom; Department of Cardiology, Odense University Hospital, Denmark (D.M.M., H.M.); Institute of Health and Wellbeing (D.A.M.) and Institute of Clinical Sciences (C.B., G.R.), University of Glasgow, United Kingdom; Norwich Medical School, University of East Anglia, Norwich, United Kingdom (M.F.); Health Research Institute, University of Limerick, Ireland (J.F.); National Health Service, Fife, United Kingdom (S.M.); and William Harvey Research Institute, Queen Mary University of London, United Kingdom (A.D.T.)
| | - Tania A Pawade
- From the British Heart Foundation Centre for Cardiovascular Science (P.D.A., A.H., A.S.V.S., T.A.P., N.A.B., E.J.R.v.B., M.R.D., N.L.M., D.E.N.) and Clinical Research Imaging Centre (M.C.W.), University of Edinburgh, United Kingdom; Department of Cardiology, Odense University Hospital, Denmark (D.M.M., H.M.); Institute of Health and Wellbeing (D.A.M.) and Institute of Clinical Sciences (C.B., G.R.), University of Glasgow, United Kingdom; Norwich Medical School, University of East Anglia, Norwich, United Kingdom (M.F.); Health Research Institute, University of Limerick, Ireland (J.F.); National Health Service, Fife, United Kingdom (S.M.); and William Harvey Research Institute, Queen Mary University of London, United Kingdom (A.D.T.)
| | - Michelle C Williams
- From the British Heart Foundation Centre for Cardiovascular Science (P.D.A., A.H., A.S.V.S., T.A.P., N.A.B., E.J.R.v.B., M.R.D., N.L.M., D.E.N.) and Clinical Research Imaging Centre (M.C.W.), University of Edinburgh, United Kingdom; Department of Cardiology, Odense University Hospital, Denmark (D.M.M., H.M.); Institute of Health and Wellbeing (D.A.M.) and Institute of Clinical Sciences (C.B., G.R.), University of Glasgow, United Kingdom; Norwich Medical School, University of East Anglia, Norwich, United Kingdom (M.F.); Health Research Institute, University of Limerick, Ireland (J.F.); National Health Service, Fife, United Kingdom (S.M.); and William Harvey Research Institute, Queen Mary University of London, United Kingdom (A.D.T.)
| | - Colin Berry
- From the British Heart Foundation Centre for Cardiovascular Science (P.D.A., A.H., A.S.V.S., T.A.P., N.A.B., E.J.R.v.B., M.R.D., N.L.M., D.E.N.) and Clinical Research Imaging Centre (M.C.W.), University of Edinburgh, United Kingdom; Department of Cardiology, Odense University Hospital, Denmark (D.M.M., H.M.); Institute of Health and Wellbeing (D.A.M.) and Institute of Clinical Sciences (C.B., G.R.), University of Glasgow, United Kingdom; Norwich Medical School, University of East Anglia, Norwich, United Kingdom (M.F.); Health Research Institute, University of Limerick, Ireland (J.F.); National Health Service, Fife, United Kingdom (S.M.); and William Harvey Research Institute, Queen Mary University of London, United Kingdom (A.D.T.)
| | - Nicholas A Boon
- From the British Heart Foundation Centre for Cardiovascular Science (P.D.A., A.H., A.S.V.S., T.A.P., N.A.B., E.J.R.v.B., M.R.D., N.L.M., D.E.N.) and Clinical Research Imaging Centre (M.C.W.), University of Edinburgh, United Kingdom; Department of Cardiology, Odense University Hospital, Denmark (D.M.M., H.M.); Institute of Health and Wellbeing (D.A.M.) and Institute of Clinical Sciences (C.B., G.R.), University of Glasgow, United Kingdom; Norwich Medical School, University of East Anglia, Norwich, United Kingdom (M.F.); Health Research Institute, University of Limerick, Ireland (J.F.); National Health Service, Fife, United Kingdom (S.M.); and William Harvey Research Institute, Queen Mary University of London, United Kingdom (A.D.T.)
| | - Marcus Flather
- From the British Heart Foundation Centre for Cardiovascular Science (P.D.A., A.H., A.S.V.S., T.A.P., N.A.B., E.J.R.v.B., M.R.D., N.L.M., D.E.N.) and Clinical Research Imaging Centre (M.C.W.), University of Edinburgh, United Kingdom; Department of Cardiology, Odense University Hospital, Denmark (D.M.M., H.M.); Institute of Health and Wellbeing (D.A.M.) and Institute of Clinical Sciences (C.B., G.R.), University of Glasgow, United Kingdom; Norwich Medical School, University of East Anglia, Norwich, United Kingdom (M.F.); Health Research Institute, University of Limerick, Ireland (J.F.); National Health Service, Fife, United Kingdom (S.M.); and William Harvey Research Institute, Queen Mary University of London, United Kingdom (A.D.T.)
| | - John Forbes
- From the British Heart Foundation Centre for Cardiovascular Science (P.D.A., A.H., A.S.V.S., T.A.P., N.A.B., E.J.R.v.B., M.R.D., N.L.M., D.E.N.) and Clinical Research Imaging Centre (M.C.W.), University of Edinburgh, United Kingdom; Department of Cardiology, Odense University Hospital, Denmark (D.M.M., H.M.); Institute of Health and Wellbeing (D.A.M.) and Institute of Clinical Sciences (C.B., G.R.), University of Glasgow, United Kingdom; Norwich Medical School, University of East Anglia, Norwich, United Kingdom (M.F.); Health Research Institute, University of Limerick, Ireland (J.F.); National Health Service, Fife, United Kingdom (S.M.); and William Harvey Research Institute, Queen Mary University of London, United Kingdom (A.D.T.)
| | - Scott McLean
- From the British Heart Foundation Centre for Cardiovascular Science (P.D.A., A.H., A.S.V.S., T.A.P., N.A.B., E.J.R.v.B., M.R.D., N.L.M., D.E.N.) and Clinical Research Imaging Centre (M.C.W.), University of Edinburgh, United Kingdom; Department of Cardiology, Odense University Hospital, Denmark (D.M.M., H.M.); Institute of Health and Wellbeing (D.A.M.) and Institute of Clinical Sciences (C.B., G.R.), University of Glasgow, United Kingdom; Norwich Medical School, University of East Anglia, Norwich, United Kingdom (M.F.); Health Research Institute, University of Limerick, Ireland (J.F.); National Health Service, Fife, United Kingdom (S.M.); and William Harvey Research Institute, Queen Mary University of London, United Kingdom (A.D.T.)
| | - Giles Roditi
- From the British Heart Foundation Centre for Cardiovascular Science (P.D.A., A.H., A.S.V.S., T.A.P., N.A.B., E.J.R.v.B., M.R.D., N.L.M., D.E.N.) and Clinical Research Imaging Centre (M.C.W.), University of Edinburgh, United Kingdom; Department of Cardiology, Odense University Hospital, Denmark (D.M.M., H.M.); Institute of Health and Wellbeing (D.A.M.) and Institute of Clinical Sciences (C.B., G.R.), University of Glasgow, United Kingdom; Norwich Medical School, University of East Anglia, Norwich, United Kingdom (M.F.); Health Research Institute, University of Limerick, Ireland (J.F.); National Health Service, Fife, United Kingdom (S.M.); and William Harvey Research Institute, Queen Mary University of London, United Kingdom (A.D.T.)
| | - Adam D Timmis
- From the British Heart Foundation Centre for Cardiovascular Science (P.D.A., A.H., A.S.V.S., T.A.P., N.A.B., E.J.R.v.B., M.R.D., N.L.M., D.E.N.) and Clinical Research Imaging Centre (M.C.W.), University of Edinburgh, United Kingdom; Department of Cardiology, Odense University Hospital, Denmark (D.M.M., H.M.); Institute of Health and Wellbeing (D.A.M.) and Institute of Clinical Sciences (C.B., G.R.), University of Glasgow, United Kingdom; Norwich Medical School, University of East Anglia, Norwich, United Kingdom (M.F.); Health Research Institute, University of Limerick, Ireland (J.F.); National Health Service, Fife, United Kingdom (S.M.); and William Harvey Research Institute, Queen Mary University of London, United Kingdom (A.D.T.)
| | - Edwin J R van Beek
- From the British Heart Foundation Centre for Cardiovascular Science (P.D.A., A.H., A.S.V.S., T.A.P., N.A.B., E.J.R.v.B., M.R.D., N.L.M., D.E.N.) and Clinical Research Imaging Centre (M.C.W.), University of Edinburgh, United Kingdom; Department of Cardiology, Odense University Hospital, Denmark (D.M.M., H.M.); Institute of Health and Wellbeing (D.A.M.) and Institute of Clinical Sciences (C.B., G.R.), University of Glasgow, United Kingdom; Norwich Medical School, University of East Anglia, Norwich, United Kingdom (M.F.); Health Research Institute, University of Limerick, Ireland (J.F.); National Health Service, Fife, United Kingdom (S.M.); and William Harvey Research Institute, Queen Mary University of London, United Kingdom (A.D.T.)
| | - Marc R Dweck
- From the British Heart Foundation Centre for Cardiovascular Science (P.D.A., A.H., A.S.V.S., T.A.P., N.A.B., E.J.R.v.B., M.R.D., N.L.M., D.E.N.) and Clinical Research Imaging Centre (M.C.W.), University of Edinburgh, United Kingdom; Department of Cardiology, Odense University Hospital, Denmark (D.M.M., H.M.); Institute of Health and Wellbeing (D.A.M.) and Institute of Clinical Sciences (C.B., G.R.), University of Glasgow, United Kingdom; Norwich Medical School, University of East Anglia, Norwich, United Kingdom (M.F.); Health Research Institute, University of Limerick, Ireland (J.F.); National Health Service, Fife, United Kingdom (S.M.); and William Harvey Research Institute, Queen Mary University of London, United Kingdom (A.D.T.)
| | - Hans Mickley
- From the British Heart Foundation Centre for Cardiovascular Science (P.D.A., A.H., A.S.V.S., T.A.P., N.A.B., E.J.R.v.B., M.R.D., N.L.M., D.E.N.) and Clinical Research Imaging Centre (M.C.W.), University of Edinburgh, United Kingdom; Department of Cardiology, Odense University Hospital, Denmark (D.M.M., H.M.); Institute of Health and Wellbeing (D.A.M.) and Institute of Clinical Sciences (C.B., G.R.), University of Glasgow, United Kingdom; Norwich Medical School, University of East Anglia, Norwich, United Kingdom (M.F.); Health Research Institute, University of Limerick, Ireland (J.F.); National Health Service, Fife, United Kingdom (S.M.); and William Harvey Research Institute, Queen Mary University of London, United Kingdom (A.D.T.)
| | - Nicholas L Mills
- From the British Heart Foundation Centre for Cardiovascular Science (P.D.A., A.H., A.S.V.S., T.A.P., N.A.B., E.J.R.v.B., M.R.D., N.L.M., D.E.N.) and Clinical Research Imaging Centre (M.C.W.), University of Edinburgh, United Kingdom; Department of Cardiology, Odense University Hospital, Denmark (D.M.M., H.M.); Institute of Health and Wellbeing (D.A.M.) and Institute of Clinical Sciences (C.B., G.R.), University of Glasgow, United Kingdom; Norwich Medical School, University of East Anglia, Norwich, United Kingdom (M.F.); Health Research Institute, University of Limerick, Ireland (J.F.); National Health Service, Fife, United Kingdom (S.M.); and William Harvey Research Institute, Queen Mary University of London, United Kingdom (A.D.T.)
| | - David E Newby
- From the British Heart Foundation Centre for Cardiovascular Science (P.D.A., A.H., A.S.V.S., T.A.P., N.A.B., E.J.R.v.B., M.R.D., N.L.M., D.E.N.) and Clinical Research Imaging Centre (M.C.W.), University of Edinburgh, United Kingdom; Department of Cardiology, Odense University Hospital, Denmark (D.M.M., H.M.); Institute of Health and Wellbeing (D.A.M.) and Institute of Clinical Sciences (C.B., G.R.), University of Glasgow, United Kingdom; Norwich Medical School, University of East Anglia, Norwich, United Kingdom (M.F.); Health Research Institute, University of Limerick, Ireland (J.F.); National Health Service, Fife, United Kingdom (S.M.); and William Harvey Research Institute, Queen Mary University of London, United Kingdom (A.D.T.)
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68
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Everett BM. Cardiac troponin: the next tool for cardiovascular disease prevention in ambulatory patients? Heart 2017; 104:875-877. [DOI: 10.1136/heartjnl-2017-312499] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/12/2023] Open
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69
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Shehata M, Samir A, Dardiri M. Prognostic impact of intensive statin therapy on N-terminal pro-BNP level in non-ST-segment elevation acute myocardial infarction patients. J Interv Cardiol 2017; 30:514-521. [PMID: 28812321 DOI: 10.1111/joic.12427] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/19/2017] [Revised: 07/19/2017] [Accepted: 07/21/2017] [Indexed: 11/28/2022] Open
Abstract
OBJECTIVE This study explored the impact of intensive daily dosing of atorvastatin on in-hospital N-terminal pro-B-type natriuretic peptide level, left ventricular systolic function and incidence of major adverse cardiac events in non-ST-segment elevation myocardial infarction patients. BACKGROUND Several studies showed that early initiation of statin therapy in acute coronary syndrome patients has a favorable prognostic impact. METHODS Hundred statin naive patients were prospectively enrolled. Once eligible, patients were randomly assigned to receive either a moderate daily dose that is, 20 mg (Group A) or an intensified daily dose that is, 80 mg (Group B) of atorvastatin, in addition to an equally divided loading dose given 24 and 12 h before coronary angiography (80 mg each). N-terminal pro-B-type natriuretic peptide levels were recorded before and after coronary intervention. Collected data after 3 months included; N-terminal pro-B-type natriuretic peptide levels, left ventricle systolic function and major adverse cardiac events. RESULTS Mean age of the study cohort was 55 ± 10 years, 68% being males. There was no significant difference between both groups concerning procedural data. Group B patients showed a significantly lower N-terminal pro-B-type natriuretic peptide levels at both sampling occasions, i.e., after coronary intervention and 3 months later (P < 0.001). After 3 months, the same group showed higher left ventricle ejection fraction (P < 0.05), with no significant difference between both groups regarding incidence of major adverse cardiac events. CONCLUSION Intensive atorvastatin therapy in non-ST-segment elevation myocardial infarction patients undergoing percutaneous coronary intervention is associated with; lower in-hospital N-terminal pro BNP level and higher LVEF after 3 months.
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Affiliation(s)
- Mohamed Shehata
- Faculty of Medicine, Department of Cardiology, Ain Shams University, Cairo, Egypt
| | - Ayman Samir
- Faculty of Medicine, Department of Cardiology, Ain Shams University, Cairo, Egypt
| | - May Dardiri
- Faculty of Medicine, Department of Cardiology, Ain Shams University, Cairo, Egypt
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70
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Abe N, Tomita K, Teshima M, Kuwabara M, Sugawa S, Hinata N, Matsuura M, Fujiwara M, Takaya K, Hiyoshi T, Uozumi H, Ikenouchi H, Ishikawa R, Shojima J, Komatsu J. Distribution of cardiac troponin I in the Japanese general population and factors influencing its concentrations. J Clin Lab Anal 2017; 32. [PMID: 28763113 PMCID: PMC5888119 DOI: 10.1002/jcla.22294] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/27/2016] [Accepted: 06/08/2017] [Indexed: 12/27/2022] Open
Abstract
BACKGROUND The 99th percentile of cardiac troponin I level in the general population is accepted as the cut-off for the diagnosis of acute myocardial infarction (AMI). However, it is not clear whether the cut-offs derived in racially and geographically different populations are applicable in Japan. METHODS Troponin I was determined using the Abbott ARCHITECT STAT high-sensitive troponin I immunoassay in 698 apparently healthy individuals who visited the Japanese Red Cross Medical Center for a health checkup. RESULTS The 99th percentile of the hsTnI in the overall population was 22.5 (95% confidence interval (CI), 16.8-36.6) pg/mL, 17.7 (95% CI 12.0-22.8) pg/mL for females and 30.6 (95% CI 17.1-53.4) pg/mL for males. The median of the hsTnI in the overall population was 3.2 (95% CI, 3.0-3.3) pg/mL, 2.6 (95% CI 2.4-2.8) pg/mL for females and 4.0 (95% CI 3.8-4.3) pg/mL for males. The age and gender had a significant influence on these values. The troponin I level also showed significant associations with the body mass index (BMI), the gamma glutamyl transferase (GGT), lactate dehydrogenase (LDH), estimated glomerular filtration rate (eGFR), and cardiac abnormalities by electrocardiography (ECG) but not with the high-sensitive C-reactive protein (hsCRP) level. CONCLUSIONS The 99th percentiles of the troponin I measured in the general population in Japan were comparable as the ones derived in the US, Germany, and Singapore. The troponin I level was dependent on the gender, age, BMI, and cardiac abnormalities found by ECG but not by the hsCRP level.
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Affiliation(s)
- Naoya Abe
- Department of Clinical Laboratory, Japanese Red Cross Medical Center, Shibuya-ku, Tokyo, Japan
| | - Kenichiro Tomita
- Department of Clinical Laboratory, Japanese Red Cross Medical Center, Shibuya-ku, Tokyo, Japan
| | - Mayumi Teshima
- Department of Clinical Laboratory, Japanese Red Cross Medical Center, Shibuya-ku, Tokyo, Japan
| | - Maki Kuwabara
- Department of Clinical Laboratory, Japanese Red Cross Medical Center, Shibuya-ku, Tokyo, Japan
| | - Satoshi Sugawa
- Diagnostic Division, Abbott Japan Co., Ltd., Minato-ku, Tokyo, Japan
| | - Nae Hinata
- Department of Clinical Engineering, School of Health Sciences, Tokyo University of Technology, Ota-ku, Tokyo, Japan
| | - Masaaki Matsuura
- Bioinformatics Group, Genome Center, Japanese Foundation for Cancer Research, Koto-ku, Japan.,Teikyo University Graduate School of Public Health, Itabashi-ku, Tokyo, Japan
| | - Mutsunori Fujiwara
- Department of Clinical Laboratory, Japanese Red Cross Medical Center, Shibuya-ku, Tokyo, Japan
| | - Kazuhiko Takaya
- Department of Diabetes and Endocrinology, Japanese Red Cross Medical Center, Shibuya-ku, Tokyo, Japan
| | - Toru Hiyoshi
- Department of Diabetes and Endocrinology, Japanese Red Cross Medical Center, Shibuya-ku, Tokyo, Japan
| | - Hiroki Uozumi
- Department of Cardiology, Japanese Red Cross Medical Center, Shibuya-ku, Tokyo, Japan
| | - Hiroshi Ikenouchi
- Department of Cardiology, Japanese Red Cross Medical Center, Shibuya-ku, Tokyo, Japan
| | - Rie Ishikawa
- Department of Health Care, Japanese Red Cross Medical Center, Shibuya-ku, Tokyo, Japan
| | - Junko Shojima
- Department of Health Care, Japanese Red Cross Medical Center, Shibuya-ku, Tokyo, Japan
| | - Junko Komatsu
- Department of Health Care, Japanese Red Cross Medical Center, Shibuya-ku, Tokyo, Japan
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71
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Ho JE. High-Sensitivity Troponin in the General Population: Time for a New Normal? J Am Coll Cardiol 2017; 70:569-571. [PMID: 28750700 DOI: 10.1016/j.jacc.2017.06.015] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/08/2017] [Accepted: 06/08/2017] [Indexed: 11/16/2022]
Affiliation(s)
- Jennifer E Ho
- Division of Cardiology, Department of Medicine and Cardiovascular Research Center, Massachusetts General Hospital, and Harvard Medical School, Boston, Massachusetts.
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72
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Willeit P, Welsh P, Evans JDW, Tschiderer L, Boachie C, Jukema JW, Ford I, Trompet S, Stott DJ, Kearney PM, Mooijaart SP, Kiechl S, Di Angelantonio E, Sattar N. High-Sensitivity Cardiac Troponin Concentration and Risk of First-Ever Cardiovascular Outcomes in 154,052 Participants. J Am Coll Cardiol 2017; 70:558-568. [PMID: 28750699 PMCID: PMC5527070 DOI: 10.1016/j.jacc.2017.05.062] [Citation(s) in RCA: 186] [Impact Index Per Article: 26.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/06/2017] [Revised: 05/30/2017] [Accepted: 05/30/2017] [Indexed: 02/07/2023]
Abstract
BACKGROUND High-sensitivity assays can quantify cardiac troponins I and T (hs-cTnI, hs-cTnT) in individuals with no clinically manifest myocardial injury. OBJECTIVES The goal of this study was to assess associations of cardiac troponin concentration with cardiovascular disease (CVD) outcomes in primary prevention studies. METHODS A search was conducted of PubMed, Web of Science, and EMBASE for prospective studies published up to September 2016, reporting on associations of cardiac troponin concentration with first-ever CVD outcomes (i.e., coronary heart disease [CHD], stroke, or the combination of both). Study-specific estimates, adjusted for conventional risk factors, were extracted by 2 independent reviewers, supplemented with de novo data from PROSPER (Pravastatin in Elderly Individuals at Risk of Vascular Disease Study), then pooled by using random effects meta-analysis. RESULTS A total of 28 relevant studies were identified involving 154,052 participants. Cardiac troponin was detectable in 80.0% (hs-cTnI: 82.6%; hs-cTnT: 69.7%). In PROSPER, positive associations of log-linear shape were observed between hs-cTnT and CVD outcomes. In the meta-analysis, the relative risks comparing the top versus the bottom troponin third were 1.43 (95% confidence interval [CI]: 1.31 to 1.56) for CVD (11,763 events), 1.67 (95% CI: 1.50 to 1.86) for fatal CVD (7,775 events), 1.59 (95% CI: 1.38 to 1.83) for CHD (7,061 events), and 1.35 (95% CI: 1.23 to 1.48) for stroke (2,526 events). For fatal CVD, associations were stronger in North American studies (p = 0.010) and those measuring hs-cTnT rather than hs-cTnI (p = 0.027). CONCLUSIONS In the general population, high cardiac troponin concentration within the normal range is associated with increased CVD risk. This association is independent of conventional risk factors, strongest for fatal CVD, and applies to both CHD and stroke.
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Affiliation(s)
- Peter Willeit
- Department of Neurology, Medical University of Innsbruck, Innsbruck, Austria; Department of Public Health and Primary Care, University of Cambridge, Cambridge, United Kingdom.
| | - Paul Welsh
- Institute of Cardiovascular and Medical Sciences, University of Glasgow, Glasgow, United Kingdom
| | - Jonathan D W Evans
- Department of Public Health and Primary Care, University of Cambridge, Cambridge, United Kingdom; Transplant Unit, Papworth Hospital NHS Foundation Trust, Papworth Everard, Cambridge, United Kingdom
| | - Lena Tschiderer
- Department of Neurology, Medical University of Innsbruck, Innsbruck, Austria
| | - Charles Boachie
- Institute of Cardiovascular and Medical Sciences, University of Glasgow, Glasgow, United Kingdom
| | - J Wouter Jukema
- Department of Cardiology, Leiden University Medical Center, Leiden, the Netherlands
| | - Ian Ford
- Robertson Centre for Biostatistics, University of Glasgow, Glasgow, United Kingdom
| | - Stella Trompet
- Department of Gerontology and Geriatrics, Leiden University Medical Center, Leiden, the Netherlands
| | - David J Stott
- Institute of Cardiovascular and Medical Sciences, University of Glasgow, Glasgow, United Kingdom
| | - Patricia M Kearney
- Department of Epidemiology and Public Health, University College Cork, Cork, Ireland
| | - Simon P Mooijaart
- Department of Gerontology and Geriatrics, Leiden University Medical Center, Leiden, the Netherlands
| | - Stefan Kiechl
- Department of Neurology, Medical University of Innsbruck, Innsbruck, Austria
| | - Emanuele Di Angelantonio
- Department of Public Health and Primary Care, University of Cambridge, Cambridge, United Kingdom; National Institute for Health Research Blood and Transplant Research Unit in Donor Health and Genomics, University of Cambridge, Cambridge, United Kingdom; NHS Blood and Transplant, Cambridge, United Kingdom; British Heart Foundation Cambridge Centre of Excellence, University of Cambridge, Cambridge, United Kingdom
| | - Naveed Sattar
- Institute of Cardiovascular and Medical Sciences, University of Glasgow, Glasgow, United Kingdom
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73
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Honda Y, Watanabe T, Shibata Y, Otaki Y, Kadowaki S, Narumi T, Takahashi T, Kinoshita D, Yokoyama M, Nishiyama S, Takahashi H, Arimoto T, Shishido T, Inoue S, Miyamoto T, Konta T, Kawasaki R, Daimon M, Kato T, Ueno Y, Kayama T, Kubota I. Impact of restrictive lung disorder on cardiovascular mortality in a general population: The Yamagata (Takahata) study. Int J Cardiol 2017; 241:395-400. [DOI: 10.1016/j.ijcard.2017.04.049] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/16/2017] [Revised: 04/03/2017] [Accepted: 04/17/2017] [Indexed: 01/01/2023]
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74
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Lewis JR, Lim WH, Wong G, Abbs S, Zhu K, Lim EM, Thompson PL, Prince RL. Association Between High-Sensitivity Cardiac Troponin I and Cardiac Events in Elderly Women. J Am Heart Assoc 2017; 6:JAHA.116.004174. [PMID: 28757482 PMCID: PMC5586400 DOI: 10.1161/jaha.116.004174] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
Abstract
Background Elderly women are at high risk of coronary heart disease (CHD) and heart failure. High‐sensitivity assays allow detection of cardiac troponin I (hsTnI) well below diagnostic cutoffs for acute coronary syndrome. We investigated the association between these levels with future cardiac events in community‐based ambulant white women aged over 70 years initially recruited for a 5‐year randomized, controlled trial of calcium supplements. Methods and Results This was a prospective study of 1081 elderly women without clinical CHD at baseline (1998) or hsTnI above the diagnostic cutoffs for acute coronary syndrome with 14.5‐year follow‐up hospitalization and mortality (events). Two hundred forty‐three (22%) women had CHD events, 163 (15%) myocardial infarction or CHD death (hard CHD), and 109 (10%) heart failure. In 99.6% of available serum samples, hsTnI was above the level of detection (median, 4.5 ng/L; interquartile range, 3.6–5.8). After adjusting for Framingham risk factors, each SD natural log‐transformed hsTnI increase was associated with an increased hazard for CHD (hazard ratio, 1.34; 95% CI, 1.18–1.53; P<0.001) hard CHD (hazard ratio, 1.51; 95% CI, 1.29–1.76; P<0.001), and heart failure (hazard ratio, 1.65; 95% CI, 1.36–1.99; P<0.001). Step‐wise increases in relative hazards were observed with increasing quartiles of hsTnI (P for trend, <0.001), whereas the addition of hsTnI to conventional risk factors modestly improved discrimination indices: Harrell's c‐statistic, net reclassification, and integrated discrimination (P<0.05). Conclusions Cardiac troponin I is independently associated with future cardiac events in elderly women without apparent clinical manifestations. The addition of cardiac troponin I to conventional risk factors may modestly improve risk prediction in this setting.
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Affiliation(s)
- Joshua R Lewis
- Sir Charles Gairdner Hospital Unit, University of Western Australia School of Medicine and Pharmacology, Perth, Australia .,Department of Endocrinology and Diabetes, Sir Charles Gairdner Hospital, Perth, Australia.,Centre for Kidney Research, Children's Hospital at Westmead School of Public Health, Sydney Medical School, The University of Sydney, Australia
| | - Wai H Lim
- Sir Charles Gairdner Hospital Unit, University of Western Australia School of Medicine and Pharmacology, Perth, Australia.,Department of Renal Medicine, Sir Charles Gairdner Hospital, Perth, Australia
| | - Germaine Wong
- Centre for Kidney Research, Children's Hospital at Westmead School of Public Health, Sydney Medical School, The University of Sydney, Australia
| | - Samuel Abbs
- PathWest, Sir Charles Gairdner Hospital, Perth, Australia
| | - Kun Zhu
- Sir Charles Gairdner Hospital Unit, University of Western Australia School of Medicine and Pharmacology, Perth, Australia.,Department of Endocrinology and Diabetes, Sir Charles Gairdner Hospital, Perth, Australia
| | - Ee M Lim
- Department of Endocrinology and Diabetes, Sir Charles Gairdner Hospital, Perth, Australia.,PathWest, Sir Charles Gairdner Hospital, Perth, Australia
| | - Peter L Thompson
- Department of Cardiology, Sir Charles Gairdner Hospital, Perth, Australia
| | - Richard L Prince
- Sir Charles Gairdner Hospital Unit, University of Western Australia School of Medicine and Pharmacology, Perth, Australia.,Department of Endocrinology and Diabetes, Sir Charles Gairdner Hospital, Perth, Australia
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75
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Kuller LH, Lopez OL, Gottdiener JS, Kitzman DW, Becker JT, Chang Y, Newman AB. Subclinical Atherosclerosis, Cardiac and Kidney Function, Heart Failure, and Dementia in the Very Elderly. J Am Heart Assoc 2017; 6:e005353. [PMID: 28735291 PMCID: PMC5586275 DOI: 10.1161/jaha.116.005353] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/16/2016] [Accepted: 06/07/2017] [Indexed: 12/22/2022]
Abstract
BACKGROUND Heart failure (HF) and dementia are major causes of disability and death among older individuals. Risk factors and biomarkers of HF may be determinants of dementia in the elderly. We evaluated the relationship between biomarkers of cardiovascular disease and HF and risk of dementia and death. Three hypotheses were tested: (1) higher levels of high-sensitivity cardiac troponin T, N-terminal of prohormone brain natriuretic peptide, and cystatin C predict risk of death, cardiovascular disease, HF, and dementia; (2) higher levels of cardiovascular disease biomarkers are associated with increased risk of HF and then secondary increased risk of dementia; and (3) risk of dementia is lower among participants with a combination of lower coronary artery calcium, atherosclerosis, and lower high-sensitivity cardiac troponin T (myocardial injury). METHODS AND RESULTS The Cardiovascular Health Study Cognition Study was a continuation of the Cardiovascular Health Study limited to the Pittsburgh, PA, center from 1998-1999 to 2014. In 1992-1994, 924 participants underwent magnetic resonance imaging of the brain. There were 199 deaths and 116 developed dementia before 1998-1999. Of the 609 participants eligible for the Pittsburgh Cardiovascular Health Study Cognition Study, 87.5% (n=532) were included in the study. There were 120 incident HF cases and 72% had dementia. In 80 of 87, dementia preceded HF. A combination of low coronary artery calcium score and low high-sensitivity cardiac troponin T was significantly associated with reduced risk of dementia and HF. CONCLUSIONS Most participants with HF had dementia but with onset before HF. Lower high-sensitivity cardiac troponin T and coronary artery calcium was associated with low risk of dementia based on a small number of events. CLINICAL TRIAL REGISTRATION URL: http://www.clinicaltrials.gov. Unique identifier: NCT00005133.
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Affiliation(s)
- Lewis H Kuller
- Department of Epidemiology, Graduate School of Public Health, University of Pittsburgh, PA
| | - Oscar L Lopez
- Department of Neurology, School of Medicine, University of Pittsburgh, PA
- Department of Psychiatry, School of Medicine, University of Pittsburgh, PA
| | - John S Gottdiener
- Division of Cardiovascular Medicine, School of Medicine, University of Maryland, Baltimore, MD
| | - Dalane W Kitzman
- Sections on Cardiovascular Medicine and Geriatrics, Wake Forest School of Medicine, Wake Forest University, Winston-Salem, NC
| | - James T Becker
- Department of Neurology, School of Medicine, University of Pittsburgh, PA
- Department of Psychiatry, School of Medicine, University of Pittsburgh, PA
- Department of Psychology, University of Pittsburgh, PA
| | - Yuefang Chang
- Department of Neurological Surgery, University of Pittsburgh, PA
| | - Anne B Newman
- Department of Epidemiology, Graduate School of Public Health, University of Pittsburgh, PA
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76
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Ultra-sensitive troponin I is an independent predictor of incident coronary heart disease in the general population. Eur J Epidemiol 2017; 32:583-591. [PMID: 28585121 DOI: 10.1007/s10654-017-0266-7] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/30/2016] [Accepted: 05/23/2017] [Indexed: 01/04/2023]
Abstract
Troponins are sensitive markers of myocardial injury and predictive of cardiovascular events, but conventional assays fail to detect slightly elevated troponins in a considerable proportion of the general population. Using a novel ultrasensitive assay, we explored the relationship of troponin levels with the incidence of coronary heart disease (CHD) in a case-cohort sample (mean age 52.5 ± 0.2 years, 51.5% women) comprising 803 CHD cases and 1942 non-cases. Ultrasensitive troponin I was detectable in 99.9% of available case-cohort samples. In an age- and sex-adjusted model, individuals in the highest quartile of the troponin distribution had a more than threefold increased risk for CHD events compared to those in the bottom quartile [hazard ratio, HR, 3.11; 95% confidence interval (CI) 2.15-4.49]. In a model adjusting for cardiovascular risk factors including C-reactive protein, cystatin C and N-terminal pro brain natriuretic peptide, individuals in the highest troponin I quartile still showed a hazard ratio of 2.58 (95% CI 1.66-4.00) for incident CHD as compared to those in the lowest quartile. Ultrasensitive troponin I was detectable in almost all individuals of a study sample reflecting middle-aged to elderly European general population. Ultrasensitive troponin concentrations exhibit an independent, graded, positive relation with incident CHD.
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77
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Xu M, Lin J, Wang D, Liu M, Hao Z, Lei C. Cardiac troponin and cerebral herniation in acute intracerebral hemorrhage. Brain Behav 2017; 7:e00697. [PMID: 28638706 PMCID: PMC5474704 DOI: 10.1002/brb3.697] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/05/2023] Open
Abstract
OBJECTIVES To explore the association, if any, between the relationship between cardiac troponin and cerebral herniation after intracerebral hemorrhage (ICH). METHODS Six hundred and eighty-seven consecutive ICH patients admitted to West China Hospital from May 1, 2014 to September 1, 2015 were retrospectively reviewed. Data on demographics, etiology, laboratory examinations at admission including serum cardiac troponin, computed tomography (CT) scans at admission and follow-up, and clinical outcomes were obtained. Using multiple logistic regression to identify the relationship of troponin and herniation. The association between troponin and hematoma volume was assessed using bivariate correlation and linear regression. RESULTS Among 188 (27.4%) patients who underwent the test of serum cardiac troponin at admission, 16 (8.5%) demonstrated cerebral herniation. The median time from symptom onset to CT at admission and follow-up was 4 and 30.25 hr, respectively. In multivariate analysis, elevated troponin was independently associated with cerebral herniation (adjusted odds ratio [OR] 5.19; 95% confidence interval [CI], 1.08-24.93). And those with elevated troponin had larger hematoma volume at follow-up in bivariate correlation (correlation coefficient, .375, p = .003) and linear regression (β, .370, 95% CI, 0.062-0.320, p = .005), higher National Institutes of Health Stroke Scale score (adjusted OR 2.06; 95% CI, 1.06-4.01, p = .033) and lower Glasgow Coma Scale score (adjusted OR 2.34; 95% CI, 1.17-4.68, p = .016) than those without. CONCLUSIONS Elevated cardiac troponin was associated with an almost five-fold increased risk of cerebral herniation, but not in-hospital mortality. The possibility of cerebral herniation should be considered when ICH patients with large hematoma volume and elevated troponin.
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Affiliation(s)
- Mangmang Xu
- Department of Neurology West China Hospital Sichuan University Chengdu China
| | - Jing Lin
- Department of Neurology West China Hospital Sichuan University Chengdu China
| | - Deren Wang
- Department of Neurology West China Hospital Sichuan University Chengdu China
| | - Ming Liu
- Department of Neurology West China Hospital Sichuan University Chengdu China.,Center of Cerebrovascular Diseases West China Hospital Sichuan University Chengdu China
| | - Zilong Hao
- Department of Neurology West China Hospital Sichuan University Chengdu China
| | - Chunyan Lei
- Department of Neurology First Affiliated Hospital of Kunming Medical University Kunming China
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78
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Cavender MA, White WB, Jarolim P, Bakris GL, Cushman WC, Kupfer S, Gao Q, Mehta CR, Zannad F, Cannon CP, Morrow DA. Serial Measurement of High-Sensitivity Troponin I and Cardiovascular Outcomes in Patients With Type 2 Diabetes Mellitus in the EXAMINE Trial (Examination of Cardiovascular Outcomes With Alogliptin Versus Standard of Care). Circulation 2017; 135:1911-1921. [DOI: 10.1161/circulationaha.116.024632] [Citation(s) in RCA: 45] [Impact Index Per Article: 6.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/22/2016] [Accepted: 02/17/2017] [Indexed: 11/16/2022]
Abstract
Background:
We aimed to describe the relationship between changes in high-sensitivity cardiac troponin I (hsTnI) and cardiovascular outcomes.
Methods:
The EXAMINE trial (Examination of Cardiovascular Outcomes With Alogliptin Versus Standard of Care) was a phase IIIb clinical outcomes trial designed to evaluate the cardiovascular safety of alogliptin, a nonselective dipeptidyl peptidase 4 inhibitor. Patients with type 2 diabetes mellitus, glycohemoglobin between 6.5% and 11% (or between 7% and 11% if they were on insulin), and a recent acute coronary syndrome (between 15 and 90 days before randomization) were eligible for the trial. hsTnI was measured using the Abbott ARCHITECT assay at baseline and 6 months in patients randomized in the EXAMINE trial. This analysis was restricted to patients randomized ≥30 days after qualifying acute coronary syndrome to mitigate the potential for persistent hsTnI elevation after acute coronary syndrome (n=3808). The primary end point of the trial was cardiovascular death, myocardial infarction, or stroke. Cardiovascular death or heart failure was a prespecified, adjudicated secondary end point.
Results:
At baseline, hsTnI was detectable (≥1.9 ng/L) in 93% of patients and >99
th
percentile upper reference limit in 16%. There was a strong relationship between increasing hsTnI, both at baseline and 6 months, and the incidence of cardiovascular events through 24 months (
P
<0.001 for each). Patients with undetectable hsTnI at baseline and 6 months were at the lowest risk of future cardiovascular events. Stable patients with hsTnI ≥99th percentile upper reference limit at 6 months were at increased risk of cardiovascular death, myocardial infarction, or stroke compared with patients with hsTnI <99 percentile upper reference limit irrespective of whether hsTnI was newly elevated (28.1% versus 8.8%; adjusted hazard ratio, 2.65; 95% confidence interval, 1.64–4.28;
P
<0.001) or persistently so (22.5% versus 8.8%; adjusted hazard ratio, 1.90; 95% confidence interval, 1.33–2.70;
P
<0.001). Alogliptin neither increased nor decreased the risk of cardiovascular events compared with placebo in patients with high baseline hsTnI (22.3% versus 23.0%; hazard ratio, 0.87; 95% confidence interval, 0.60–1.25;
P
=0.44).
Conclusions:
Serial assessment of hsTnI revealed a substantial proportion of patients with type 2 diabetes mellitus without clinically recognized events had dynamic or persistently elevated values and were at high risk of recurrent events. hsTnI may have a role in personalizing preventive strategies in patients with diabetes mellitus based on risk.
Clinical Trial Registration:
URL:
http://www.clinicaltrials.gov
. Unique identifier: NCT00968708.
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Affiliation(s)
- Matthew A. Cavender
- From University of North Carolina, Chapel Hill (M.A.C.); Calhoun Cardiology Center, University of Connecticut School of Medicine, Farmington (W.B.W.); Department of Pathology (P.J.) and TIMI Study Group (D.A.M.), Brigham and Women’s Hospital and Harvard Medical School, Boston, MA; University of Chicago, IL (G.L.B.); Memphis Veterans Affairs Medical Center, University of Tennessee College of Medicine (W.C.C.); Takeda Development Center Americas, Inc., Deerfield, IL (S.K.); Baim Institute for Clinical
| | - William B. White
- From University of North Carolina, Chapel Hill (M.A.C.); Calhoun Cardiology Center, University of Connecticut School of Medicine, Farmington (W.B.W.); Department of Pathology (P.J.) and TIMI Study Group (D.A.M.), Brigham and Women’s Hospital and Harvard Medical School, Boston, MA; University of Chicago, IL (G.L.B.); Memphis Veterans Affairs Medical Center, University of Tennessee College of Medicine (W.C.C.); Takeda Development Center Americas, Inc., Deerfield, IL (S.K.); Baim Institute for Clinical
| | - Petr Jarolim
- From University of North Carolina, Chapel Hill (M.A.C.); Calhoun Cardiology Center, University of Connecticut School of Medicine, Farmington (W.B.W.); Department of Pathology (P.J.) and TIMI Study Group (D.A.M.), Brigham and Women’s Hospital and Harvard Medical School, Boston, MA; University of Chicago, IL (G.L.B.); Memphis Veterans Affairs Medical Center, University of Tennessee College of Medicine (W.C.C.); Takeda Development Center Americas, Inc., Deerfield, IL (S.K.); Baim Institute for Clinical
| | - George L. Bakris
- From University of North Carolina, Chapel Hill (M.A.C.); Calhoun Cardiology Center, University of Connecticut School of Medicine, Farmington (W.B.W.); Department of Pathology (P.J.) and TIMI Study Group (D.A.M.), Brigham and Women’s Hospital and Harvard Medical School, Boston, MA; University of Chicago, IL (G.L.B.); Memphis Veterans Affairs Medical Center, University of Tennessee College of Medicine (W.C.C.); Takeda Development Center Americas, Inc., Deerfield, IL (S.K.); Baim Institute for Clinical
| | - William C. Cushman
- From University of North Carolina, Chapel Hill (M.A.C.); Calhoun Cardiology Center, University of Connecticut School of Medicine, Farmington (W.B.W.); Department of Pathology (P.J.) and TIMI Study Group (D.A.M.), Brigham and Women’s Hospital and Harvard Medical School, Boston, MA; University of Chicago, IL (G.L.B.); Memphis Veterans Affairs Medical Center, University of Tennessee College of Medicine (W.C.C.); Takeda Development Center Americas, Inc., Deerfield, IL (S.K.); Baim Institute for Clinical
| | - Stuart Kupfer
- From University of North Carolina, Chapel Hill (M.A.C.); Calhoun Cardiology Center, University of Connecticut School of Medicine, Farmington (W.B.W.); Department of Pathology (P.J.) and TIMI Study Group (D.A.M.), Brigham and Women’s Hospital and Harvard Medical School, Boston, MA; University of Chicago, IL (G.L.B.); Memphis Veterans Affairs Medical Center, University of Tennessee College of Medicine (W.C.C.); Takeda Development Center Americas, Inc., Deerfield, IL (S.K.); Baim Institute for Clinical
| | - Qi Gao
- From University of North Carolina, Chapel Hill (M.A.C.); Calhoun Cardiology Center, University of Connecticut School of Medicine, Farmington (W.B.W.); Department of Pathology (P.J.) and TIMI Study Group (D.A.M.), Brigham and Women’s Hospital and Harvard Medical School, Boston, MA; University of Chicago, IL (G.L.B.); Memphis Veterans Affairs Medical Center, University of Tennessee College of Medicine (W.C.C.); Takeda Development Center Americas, Inc., Deerfield, IL (S.K.); Baim Institute for Clinical
| | - Cyrus R. Mehta
- From University of North Carolina, Chapel Hill (M.A.C.); Calhoun Cardiology Center, University of Connecticut School of Medicine, Farmington (W.B.W.); Department of Pathology (P.J.) and TIMI Study Group (D.A.M.), Brigham and Women’s Hospital and Harvard Medical School, Boston, MA; University of Chicago, IL (G.L.B.); Memphis Veterans Affairs Medical Center, University of Tennessee College of Medicine (W.C.C.); Takeda Development Center Americas, Inc., Deerfield, IL (S.K.); Baim Institute for Clinical
| | - Faiez Zannad
- From University of North Carolina, Chapel Hill (M.A.C.); Calhoun Cardiology Center, University of Connecticut School of Medicine, Farmington (W.B.W.); Department of Pathology (P.J.) and TIMI Study Group (D.A.M.), Brigham and Women’s Hospital and Harvard Medical School, Boston, MA; University of Chicago, IL (G.L.B.); Memphis Veterans Affairs Medical Center, University of Tennessee College of Medicine (W.C.C.); Takeda Development Center Americas, Inc., Deerfield, IL (S.K.); Baim Institute for Clinical
| | - Christopher P. Cannon
- From University of North Carolina, Chapel Hill (M.A.C.); Calhoun Cardiology Center, University of Connecticut School of Medicine, Farmington (W.B.W.); Department of Pathology (P.J.) and TIMI Study Group (D.A.M.), Brigham and Women’s Hospital and Harvard Medical School, Boston, MA; University of Chicago, IL (G.L.B.); Memphis Veterans Affairs Medical Center, University of Tennessee College of Medicine (W.C.C.); Takeda Development Center Americas, Inc., Deerfield, IL (S.K.); Baim Institute for Clinical
| | - David A. Morrow
- From University of North Carolina, Chapel Hill (M.A.C.); Calhoun Cardiology Center, University of Connecticut School of Medicine, Farmington (W.B.W.); Department of Pathology (P.J.) and TIMI Study Group (D.A.M.), Brigham and Women’s Hospital and Harvard Medical School, Boston, MA; University of Chicago, IL (G.L.B.); Memphis Veterans Affairs Medical Center, University of Tennessee College of Medicine (W.C.C.); Takeda Development Center Americas, Inc., Deerfield, IL (S.K.); Baim Institute for Clinical
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Westermann D, Neumann JT, Sörensen NA, Blankenberg S. High-sensitivity assays for troponin in patients with cardiac disease. Nat Rev Cardiol 2017; 14:472-483. [DOI: 10.1038/nrcardio.2017.48] [Citation(s) in RCA: 106] [Impact Index Per Article: 15.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
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Hammadah M, Al Mheid I, Wilmot K, Ramadan R, Alkhoder A, Obideen M, Abdelhadi N, Fang S, Ibeanu I, Pimple P, Mohamed Kelli H, Shah AJ, Pearce B, Sun Y, Garcia EV, Kutner M, Long Q, Ward L, Bremner JD, Esteves F, Raggi P, Sheps D, Vaccarino V, Quyyumi AA. Association Between High-Sensitivity Cardiac Troponin Levels and Myocardial Ischemia During Mental Stress and Conventional Stress. JACC Cardiovasc Imaging 2017; 11:603-611. [PMID: 28330661 DOI: 10.1016/j.jcmg.2016.11.021] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/26/2016] [Revised: 11/10/2016] [Accepted: 11/17/2016] [Indexed: 01/12/2023]
Abstract
OBJECTIVES This study sought to investigate whether patients with mental stress-induced myocardial ischemia will have high resting and post-mental stress high-sensitivity cardiac troponin I (hs-cTnI). BACKGROUND Hs-cTnI is a marker of myocardial necrosis, and its elevated levels are associated with adverse outcomes. Hs-cTnI levels may increase with exercise in patients with coronary artery disease. Mental stress-induced myocardial ischemia is also linked to adverse outcomes. METHODS In this study, 587 patients with stable coronary artery disease underwent technetium Tc 99m sestamibi-single-photon emission tomography myocardial perfusion imaging during mental stress testing using a public speaking task and during conventional (pharmacological/exercise) stress testing as a control condition. Ischemia was defined as new/worsening impairment in myocardial perfusion using a 17-segment model. RESULTS The median hs-cTnI resting level was 4.3 (interquartile range [IQR]: 2.9 to 7.3) pg/ml. Overall, 16% and 34.8% of patients developed myocardial ischemia during mental and conventional stress, respectively. Compared with those without ischemia, median resting hs-cTnI levels were higher in patients who developed ischemia either during mental stress (5.9 [IQR: 3.9 to 8.3] pg/ml vs. 4.1 [IQR: 2.7 to 7.0] pg/ml; p < 0.001) or during conventional stress (5.4 [IQR: 3.9 to 9.3] pg/ml vs. 3.9 [IQR: 2.5 to 6.5] pg/ml; p < 0.001). Patients with high hs-cTnI (cutoff of 4.6 pg/ml for men and 3.9 pg/ml for women) had greater odds of developing mental (odds ratio [OR]: 2.4; 95% confidence interval [CI]: 1.5 to 3.9; p < 0.001) and conventional (OR: 2.4; 95% CI: 1.7 to 3.4; p < 0.001) stress-induced ischemia. Although there was a significant increase in 45-min post-treadmill exercise hs-cTnI levels in those who developed ischemia, there was no significant increase after mental or pharmacological stress test. CONCLUSIONS In patients with coronary artery disease, myocardial ischemia during either mental stress or conventional stress is associated with higher resting levels of hs-cTnI. This suggests that hs-cTnI elevation is an indicator of chronic ischemic burden experienced during everyday life. Whether elevated hs-cTnI levels are an indicator of adverse prognosis beyond inducible ischemia or whether it is amenable to intervention requires further investigation.
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Affiliation(s)
- Muhammad Hammadah
- Department of Medicine, Division of Cardiology, Emory University School of Medicine, Atlanta, Georgia
| | - Ibhar Al Mheid
- Department of Medicine, Division of Cardiology, Emory University School of Medicine, Atlanta, Georgia
| | - Kobina Wilmot
- Department of Medicine, Division of Cardiology, Emory University School of Medicine, Atlanta, Georgia
| | - Ronnie Ramadan
- Department of Medicine, Division of Cardiology, Emory University School of Medicine, Atlanta, Georgia
| | - Ayman Alkhoder
- Department of Medicine, Division of Cardiology, Emory University School of Medicine, Atlanta, Georgia
| | - Malik Obideen
- Department of Medicine, Division of Cardiology, Emory University School of Medicine, Atlanta, Georgia
| | - Naser Abdelhadi
- Department of Medicine, Division of Cardiology, Emory University School of Medicine, Atlanta, Georgia
| | - Shuyang Fang
- Department of Medicine, Division of Cardiology, Emory University School of Medicine, Atlanta, Georgia; Department of Epidemiology, Rollins School of Public Health, Emory University, Atlanta, Georgia
| | - Ijeoma Ibeanu
- Department of Epidemiology, Rollins School of Public Health, Emory University, Atlanta, Georgia
| | - Pratik Pimple
- Department of Epidemiology, Rollins School of Public Health, Emory University, Atlanta, Georgia
| | - Heval Mohamed Kelli
- Department of Medicine, Division of Cardiology, Emory University School of Medicine, Atlanta, Georgia
| | - Amit J Shah
- Department of Medicine, Division of Cardiology, Emory University School of Medicine, Atlanta, Georgia; Department of Epidemiology, Rollins School of Public Health, Emory University, Atlanta, Georgia
| | - Brad Pearce
- Department of Epidemiology, Rollins School of Public Health, Emory University, Atlanta, Georgia
| | - Yan Sun
- Department of Epidemiology, Rollins School of Public Health, Emory University, Atlanta, Georgia
| | - Ernest V Garcia
- Department of Radiology, Emory University School of Medicine, Atlanta, Georgia
| | - Michael Kutner
- Department of Biostatistics and Bioinformatics, Rollins School of Public Health, Emory University, Atlanta, Georgia
| | - Qi Long
- Department of Epidemiology, Rollins School of Public Health, Emory University, Atlanta, Georgia
| | - Laura Ward
- Department of Biostatistics and Bioinformatics, Rollins School of Public Health, Emory University, Atlanta, Georgia
| | - J Douglas Bremner
- Department of Psychiatry and Behavioral Sciences, Emory University School of Medicine, Atlanta, Georgia
| | - Fabio Esteves
- Department of Radiology, Emory University School of Medicine, Atlanta, Georgia
| | - Paolo Raggi
- Department of Epidemiology, Rollins School of Public Health, Emory University, Atlanta, Georgia; Department of Radiology, Emory University School of Medicine, Atlanta, Georgia; Mazankowski Alberta Heart Institute, University of Alberta, Edmonton, Alberta, Canada
| | - David Sheps
- Department of Epidemiology, University of Florida, Gainesville, Florida
| | - Viola Vaccarino
- Department of Medicine, Division of Cardiology, Emory University School of Medicine, Atlanta, Georgia; Department of Epidemiology, Rollins School of Public Health, Emory University, Atlanta, Georgia
| | - Arshed A Quyyumi
- Department of Medicine, Division of Cardiology, Emory University School of Medicine, Atlanta, Georgia.
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The 99th percentile of reference population for cTnI and cTnT assay: methodology, pathophysiology and clinical implications. ACTA ACUST UNITED AC 2017; 55:1634-1651. [DOI: 10.1515/cclm-2016-0933] [Citation(s) in RCA: 51] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/14/2016] [Accepted: 02/28/2017] [Indexed: 01/10/2023]
Abstract
AbstractAccording to recent international guidelines, including the 2012 Third Universal Definiton of Myocardial Infarction by the Joint ESC/ACCF/AHA/WHF Task Force, an increase in cardiac troponin (cTn) levels over the 99th percentile upper reference limit (99th URL) should be considered clinically relevant, this cut-off being measured with an imprecision ≤10 CV%. In theory 99th URL values strongly depend not only on demographic and physiological variables (i.e. criteria for considering the reference population “healthy”), but also on the analytical performance of cTn methods and mathematical algorithms used for the calculation. The aim of the present article was therefore to review the methodological and pathophysiological factors affecting the evaluation and calculation of the 99th URL for cTn assay. The critical analysis made showed that no uniform procedure is followed, and nor have experts or regulatory bodies provided uniform guidelines for researchers or cTn assays manufacturers as an aid in “their quest to define normality”. In particular, little attention has been paid to the way in which a healthy reference population is to be selected, or the criteria for calculating the 99th URL value for cTn assays, thus highlighting the need for international recommendations not only for demographic and physiological variables criteria for defining a healthy reference population, but also for calculating mathematical algorithms for establishing/calculating clinical decision values. An expert consensus group, comprising laboratory and clinical scientists, biomedical statisticians, industrial and regulatory representatives, should be responsible for drawing up these guidelines.
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82
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Everett BM, Ridker PM. Biomarkers for Cardiovascular Screening: Progress or Passé? Clin Chem 2017; 63:248-251. [DOI: 10.1373/clinchem.2016.254854] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/03/2016] [Accepted: 09/01/2016] [Indexed: 11/06/2022]
Affiliation(s)
- Brendan M Everett
- Brigham and Women's Hospital Divisions of Cardiovascular and Preventive Medicine, Boston, MA
| | - Paul M Ridker
- Brigham and Women's Hospital Divisions of Cardiovascular and Preventive Medicine, Boston, MA
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83
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Ford I, Shah ASV, Zhang R, McAllister DA, Strachan FE, Caslake M, Newby DE, Packard CJ, Mills NL. High-Sensitivity Cardiac Troponin, Statin Therapy, and Risk of Coronary Heart Disease. J Am Coll Cardiol 2016; 68:2719-2728. [PMID: 28007133 PMCID: PMC5176330 DOI: 10.1016/j.jacc.2016.10.020] [Citation(s) in RCA: 182] [Impact Index Per Article: 22.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/07/2016] [Revised: 09/28/2016] [Accepted: 10/04/2016] [Indexed: 01/31/2023]
Abstract
BACKGROUND Cardiac troponin is an independent predictor of cardiovascular mortality in individuals without symptoms or signs of cardiovascular disease. The mechanisms for this association are uncertain, and a role for troponin testing in the prevention of coronary heart disease has yet to be established. OBJECTIVES This study sought to determine whether troponin concentration could predict coronary events, be modified by statins, and reflect response to therapy in a primary prevention population. METHODS WOSCOPS (West of Scotland Coronary Prevention Study) randomized men with raised low-density lipoprotein cholesterol and no history of myocardial infarction to pravastatin 40 mg once daily or placebo for 5 years. Plasma cardiac troponin I concentration was measured with a high-sensitivity assay at baseline and at 1 year in 3,318 participants. RESULTS Baseline troponin was an independent predictor of myocardial infarction or death from coronary heart disease (hazard ratio [HR]: 2.3; 95% confidence interval [CI]: 1.4 to 3.7) for the highest (≥5.2 ng/l) versus lowest (≤3.1 ng/l) quarter of troponin (p < 0.001). There was a 5-fold greater reduction in coronary events when troponin concentrations decreased by more than a quarter, rather than increased by more than a quarter, for both placebo (HR: 0.29; 95% CI: 0.12 to 0.72 vs. HR: 1.95; 95% CI: 1.09 to 3.49; p < 0.001 for trend) and pravastatin (HR: 0.23; 95% CI: 0.10 to 0.53 vs. HR: 1.08; 95% CI: 0.53 to 2.21; p < 0.001 for trend). Pravastatin reduced troponin concentration by 13% (10% to 15%; placebo adjusted, p < 0.001) and doubled the number of men whose troponin fell more than a quarter (p < 0.001), which identified them as having the lowest risk for future coronary events (1.4% over 5 years). CONCLUSIONS Troponin concentration predicts coronary events, is reduced by statin therapy, and change at 1 year is associated with future coronary risk independent of cholesterol lowering. Serial troponin measurements have major potential to assess cardiovascular risk and monitor the impact of therapeutic interventions.
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Affiliation(s)
- Ian Ford
- Robertson Centre for Biostatistics, University of Glasgow, Glasgow, United Kingdom
| | - Anoop S V Shah
- BHF Centre for Cardiovascular Science, University of Edinburgh, Edinburgh, United Kingdom
| | - Ruiqi Zhang
- Robertson Centre for Biostatistics, University of Glasgow, Glasgow, United Kingdom
| | - David A McAllister
- Centre for Population Health Sciences, University of Edinburgh, Edinburgh, United Kingdom
| | - Fiona E Strachan
- BHF Centre for Cardiovascular Science, University of Edinburgh, Edinburgh, United Kingdom
| | - Muriel Caslake
- Institute of Cardiovascular and Medical Sciences, University of Glasgow, Glasgow, United Kingdom
| | - David E Newby
- BHF Centre for Cardiovascular Science, University of Edinburgh, Edinburgh, United Kingdom
| | - Chris J Packard
- Institute of Cardiovascular and Medical Sciences, University of Glasgow, Glasgow, United Kingdom
| | - Nicholas L Mills
- BHF Centre for Cardiovascular Science, University of Edinburgh, Edinburgh, United Kingdom.
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84
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Jaffe AS, Wright RS. High-Sensitivity Cardiac Troponin and Primary Prevention. J Am Coll Cardiol 2016; 68:2729-2732. [DOI: 10.1016/j.jacc.2016.11.006] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/20/2016] [Accepted: 11/02/2016] [Indexed: 11/16/2022]
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Hughes MF, Ojeda F, Saarela O, Jørgensen T, Zeller T, Palosaari T, O'Doherty MG, Borglykke A, Kuulasmaa K, Blankenberg S, Kee F. Association of Repeatedly Measured High-Sensitivity-Assayed Troponin I with Cardiovascular Disease Events in a General Population from the MORGAM/BiomarCaRE Study. Clin Chem 2016; 63:334-342. [PMID: 28062627 DOI: 10.1373/clinchem.2016.261172] [Citation(s) in RCA: 25] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/08/2016] [Accepted: 09/16/2016] [Indexed: 12/29/2022]
Abstract
BACKGROUND High-sensitivity troponin I (hs-cTnI) concentrations reflect myocardial stress. The role of hs-cTnI in predicting long-term changes in the risk of cardiovascular disease (CVD) in general populations is not clearly defined. METHODS We investigated whether the change in 3 repeated measures of hs-cTnI collected 5 years apart in a prospective Danish study (3875 participants, initially aged 30-60 years, 51% female, disease free at baseline) improves 10-year prediction of incident CVD compared to using a single most recent hs-cTnI measurement. The change process was modelled using a joint (longitudinal and survival) model and compared to a Cox model using a single hs-cTnI measure adjusted for classic CVD risk factors, and evaluated using discrimination statistics. RESULTS Median hs-cTnI concentrations changed from 2.6 ng/L to 3.4 ng/L over 10 years. The change in hs-cTnI predicts 10-year risk of CVD (581 events); the joint model gave a hazard ratio of 1.31 per interquartile difference in hs-cTnI (95% CI 1.15-1.48) after adjustment for CVD risk factors. However, the joint model performed only marginally better (c-index improvement 0.0041, P = 0.03) than using a single hs-cTnI measure (c-index improvement 0.0052, P = 0.04) for prediction of CVD, compared to a model incorporating CVD risk factors without hs-cTnI (c-index 0.744). CONCLUSIONS The change in hs-cTnI in 5-year intervals better predicts risk of CVD in the general population, but the most recent measure of hs-cTnI, (at 10 years) is as effective in predicting CVD risk. This simplifies the use of hs-cTnI as a prognostic marker for primary prevention of CVD in the general population.
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Affiliation(s)
- Maria F Hughes
- UKCRC Centre of Excellence for Public Health Northern Ireland, Queens University Belfast, Northern Ireland; .,Department of General and Interventional Cardiology, Hamburg University Heart Center, Hamburg, Germany.,German Center for Cardiovascular Research (DZHK), Partner Site Hamburg/Lübeck/Kiel.,MRC Epidemiology Unit, University of Cambridge, United Kingdom
| | - Francisco Ojeda
- Department of General and Interventional Cardiology, Hamburg University Heart Center, Hamburg, Germany
| | - Olli Saarela
- Dalla Lana School of Public Health, University of Toronto, Toronto, Canada.,National Institute for Health and Welfare THL, Helsinki, Finland
| | - Torben Jørgensen
- Research Centre for Prevention and Health, Centre of Health, Capital Region, Glostrup, Denmark.,Institute of Public Health, University of Copenhagen, Copenhagen, Denmark.,Faculty of Medicine, University of Aalborg, Aalborg, Denmark
| | - Tanja Zeller
- Department of General and Interventional Cardiology, Hamburg University Heart Center, Hamburg, Germany.,German Center for Cardiovascular Research (DZHK), Partner Site Hamburg/Lübeck/Kiel
| | - Tarja Palosaari
- National Institute for Health and Welfare THL, Helsinki, Finland
| | - Mark G O'Doherty
- UKCRC Centre of Excellence for Public Health Northern Ireland, Queens University Belfast, Northern Ireland
| | - Anders Borglykke
- Research Centre for Prevention and Health, Centre of Health, Capital Region, Glostrup, Denmark
| | - Kari Kuulasmaa
- National Institute for Health and Welfare THL, Helsinki, Finland
| | - Stefan Blankenberg
- Department of General and Interventional Cardiology, Hamburg University Heart Center, Hamburg, Germany.,German Center for Cardiovascular Research (DZHK), Partner Site Hamburg/Lübeck/Kiel
| | - Frank Kee
- UKCRC Centre of Excellence for Public Health Northern Ireland, Queens University Belfast, Northern Ireland
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Callander EJ, McDermott R. Measuring the effects of CVD interventions and studies across socioeconomic groups: A brief review. Int J Cardiol 2016; 227:635-643. [PMID: 27829524 DOI: 10.1016/j.ijcard.2016.10.085] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/07/2016] [Accepted: 10/28/2016] [Indexed: 12/11/2022]
Abstract
There is a known socioeconomic skew in prevalence and outcomes of cardiovascular disease (CVD). To document the proportion of clinical trials and observational studies related to CVD recently published in peer-reviewed journals that report the socio-economic distributional differences in their outcomes. We undertook a review of peer-reviewed clinical trials and observational studies relating to CVD published between 01/06/2015-31/12/2015 in PubMed; and identified the proportion that included measures of socioeconomic status and the proportion that stratified results by, or controlled for, socioeconomic status when reporting outcomes. 414 peer reviewed publications reporting the outcomes of clinical trials or observational studies that related to CVD were identified. 32 of these reported on the socioeconomic status of participants. Of these, 20 stratified the results by socioeconomic status or adjusted the results for socioeconomic status. 18 studies measured education attainment, 5 measured income, 1 measured rurality and 1 measured occupation. Of the 414 articles reporting the outcomes of clinical trials or observational studies related to cardiovascular disease in 2015, the effectiveness of the intervention, or the differences in outcomes, between socioeconomic groups was assessed in 5% of studies. This lack of consideration of the effectiveness of trial outcomes or the differences in outcomes across socioeconomic groups impairs the ability of readers, healthcare professionals and policy makers to assess the impact of new treatments or interventions in closing the inequality gap associated with CVD.
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Affiliation(s)
- Emily J Callander
- Australian Institute of Tropical Health and Medicine, James Cook University, Townsville, Australia.
| | - Robyn McDermott
- Centre for Research Excellence in Chronic Disease Prevention, James Cook University, Townsville, Australia
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Clerico A, Passino C, Franzini M, Emdin M. Natriuretic peptides as biomarkers of cardiac endocrine function in heart failure: new challenges and perspectives. Future Cardiol 2016; 12:573-84. [DOI: 10.2217/fca-2016-0013] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
Abstract
Several studies indicated that B-type natriuretic peptide (BNP) assay is able to detect patients even in the early phases of heart failure (HF), when the myocardial remodeling process may be still reversible. BNP assay may assist the physician to initiate appropriate and prompt pharmacological treatments. However, clinical relevance and result interpretation of BNP assay for the guide of therapy or in particular clinical conditions, such as renal failure or treatment with inhibitors of enzymes degrading BNP in HF patients, are still debated. The aim of this article is to discuss some still controversial issues concerning the clinical use of measurement of cardiac natriuretic peptides, and also to provide a general overview and some perspectives related to pathophysiological mechanisms of HF.
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Affiliation(s)
- Aldo Clerico
- Scuola Superiore Sant'Anna & Fondazione CNR – Regione Toscana, Pisa, Italy
| | - Claudio Passino
- Scuola Superiore Sant'Anna & Fondazione CNR – Regione Toscana, Pisa, Italy
| | - Maria Franzini
- Dipartimento di Ricerca Traslazionale e delle Nuove Tecnologie in Medicina e Chirurgia, University of Pisa, Pisa, Italy
| | - Michele Emdin
- Scuola Superiore Sant'Anna & Fondazione CNR – Regione Toscana, Pisa, Italy
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Hoff J, Wehner W, Nambi V. Troponin in Cardiovascular Disease Prevention: Updates and Future Direction. Curr Atheroscler Rep 2016; 18:12. [PMID: 26879078 DOI: 10.1007/s11883-016-0566-5] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
Cardiac troponin has been well described as the preferred biomarker for diagnosis of myocardial infarction due to the high sensitivity and specificity for myocardial injury. Numerous other conditions apart from acute coronary syndrome can also lead to small elevations in troponin levels. However, the use of cTn as prognostic biomarker for the primary assessment of cardiovascular risk in asymptomatic patient has only recently been described. And with the development of newer generations of high-sensitivity cardiac troponin assays that can detect 10-fold lower concentrations of troponin, the potential value cTn in the prevention and management of asymptomatic cardiovascular disease has come to the fore. This review provides an overview of the transition of cardiac troponin as a marker of acute myocardial injury to one that detects sub-clinical injury. Evidence continues to show that high-sensitivity troponin is emerging as one of the most powerful prognostic biomarkers for the assessment of cardiovascular risk in the general population.
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Affiliation(s)
- Jason Hoff
- Baylor College of Medicine, Houston, TX, USA
| | - William Wehner
- Michael E DeBakey Veterans Affairs Hospital, Houston, TX, USA
| | - Vijay Nambi
- Baylor College of Medicine, Houston, TX, USA.
- Michael E DeBakey Veterans Affairs Hospital, Houston, TX, USA.
- Center for Cardiovascular Prevention Methodist DeBakey Heart and Vascular Center, Houston, TX, USA.
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89
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Lawler PR, Everett BM. Assessing the Effects of Diet and Behavior on Cardiovascular Disease: The Role of Biomarkers in Understanding Biology and Mechanism. Clin Chem 2016; 62:1169-71. [PMID: 27430707 DOI: 10.1373/clinchem.2016.260448] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/01/2016] [Accepted: 07/05/2016] [Indexed: 11/06/2022]
Affiliation(s)
- Patrick R Lawler
- Divisions of Preventive Medicine and Cardiovascular Medicine, Brigham and Women's Hospital, Boston, MA
| | - Brendan M Everett
- Divisions of Preventive Medicine and Cardiovascular Medicine, Brigham and Women's Hospital, Boston, MA.
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90
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Everett BM. Cardiac troponin as a novel tool for cardiovascular risk prediction in ambulatory populations. Trends Cardiovasc Med 2016; 27:41-47. [PMID: 27422097 DOI: 10.1016/j.tcm.2016.06.002] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/15/2016] [Revised: 06/03/2016] [Accepted: 06/04/2016] [Indexed: 10/21/2022]
Abstract
Assays for cardiac troponin have become increasingly sensitive, and are now able to detect very low concentrations of circulating cardiac troponin in a substantial proportion of stable patients who are not suspected of having an acute myocardial infarction. These low concentrations of cardiac troponin are frequently well within the range of what is considered normal but are nonetheless associated with a significant increase in the risk of major cardiovascular events, including heart failure, myocardial infarction, and death in patients with and without established cardiovascular disease. The strength and consistency of these associations, and the fact that adding cardiac troponin to traditional risk factors improves the accuracy of existing cardiovascular risk prediction algorithms, raises the possibility of using cardiac troponin for therapeutic decision-making in ambulatory populations. Cardiac troponin is a powerful predictor of cardiovascular risk on the population level, but a specific intervention that can mitigate cardiac troponin-associated risk has not been identified. Thus, the therapeutic implications of cardiac troponin elevations for individual patients remain unclear. Ongoing research seeks to better understand the underlying cause of cardiac troponin release and to identify therapeutic interventions that can effectively mitigate cardiac troponin-associated cardiovascular risk. The development of high-sensitivity assays for cardiac troponin offers the opportunity to gain tremendous insight into the causes and consequences of chronic myocardial injury, and may, in the future, help guide therapy directed at improving the outcomes of ambulatory patients at high risk for cardiovascular events.
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Affiliation(s)
- Brendan M Everett
- Divisions of Cardiovascular and Preventive Medicine, Brigham and Women's Hospital, 900 Commonwealth Avenue, Boston, MA.
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Preprocedural High-Sensitivity Cardiac Troponin T and Clinical Outcomes in Patients With Stable Coronary Artery Disease Undergoing Elective Percutaneous Coronary Intervention. Circ Cardiovasc Interv 2016; 9:CIRCINTERVENTIONS.115.003202. [DOI: 10.1161/circinterventions.115.003202] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/10/2015] [Accepted: 04/29/2016] [Indexed: 11/16/2022]
Abstract
Background—
Cardiac troponin detected by new-generation, highly sensitive assays predicts clinical outcomes among patients with stable coronary artery disease (SCAD) treated medically. The prognostic value of baseline high-sensitivity cardiac troponin T (hs-cTnT) elevation in SCAD patients undergoing elective percutaneous coronary interventions is not well established. This study assessed the association of preprocedural levels of hs-cTnT with 1-year clinical outcomes among SCAD patients undergoing percutaneous coronary intervention.
Methods and Results—
Between 2010 and 2014, 6974 consecutive patients were prospectively enrolled in the Bern Percutaneous Coronary Interventions Registry. Among patients with SCAD (n=2029), 527 (26%) had elevated preprocedural hs-cTnT above the upper reference limit of 14 ng/L. The primary end point, mortality within 1 year, occurred in 20 patients (1.4%) with normal hs-cTnT versus 39 patients (7.7%) with elevated baseline hs-cTnT (
P
<0.001). Patients with elevated hs-cTnT had increased risks of all-cause (hazard ratio 5.73; 95% confidence intervals 3.34–9.83;
P
<0.001) and cardiac mortality (hazard ratio 4.68; 95% confidence interval 2.12–10.31;
P
<0.001). Preprocedural hs-TnT elevation remained an independent predictor of 1-year mortality after adjustment for relevant risk factors, including age, sex, and renal failure (adjusted hazard ratio 2.08; 95% confidence interval 1.10–3.92;
P
=0.024). A graded mortality risk was observed across higher tertiles of elevated preprocedural hs-cTnT, but not among patients with hs-cTnT below the upper reference limit.
Conclusions—
Preprocedural elevation of hs-cTnT is observed in one fourth of SCAD patients undergoing elective percutaneous coronary intervention. Increased levels of preprocedural hs-cTnT are proportionally related to the risk of death and emerged as independent predictors of all-cause mortality within 1 year.
Clinical Trial Registration—
URL:
http://www.clinicaltrials.gov
. Unique identifier: NCT02241291.
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92
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Gore MO, de Lemos JA. Cardiac Troponins and the Future of Precision Medicine. Circ Cardiovasc Interv 2016; 9:CIRCINTERVENTIONS.116.004031. [DOI: 10.1161/circinterventions.116.004031] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Affiliation(s)
- M. Odette Gore
- From the Department of Internal Medicine, University of Texas Southwestern Medical Center, Dallas
| | - James A. de Lemos
- From the Department of Internal Medicine, University of Texas Southwestern Medical Center, Dallas
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93
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94
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Blankenberg S, Salomaa V, Makarova N, Ojeda F, Wild P, Lackner KJ, Jørgensen T, Thorand B, Peters A, Nauck M, Petersmann A, Vartiainen E, Veronesi G, Brambilla P, Costanzo S, Iacoviello L, Linden G, Yarnell J, Patterson CC, Everett BM, Ridker PM, Kontto J, Schnabel RB, Koenig W, Kee F, Zeller T, Kuulasmaa K. Troponin I and cardiovascular risk prediction in the general population: the BiomarCaRE consortium. Eur Heart J 2016; 37:2428-37. [PMID: 27174290 PMCID: PMC4982535 DOI: 10.1093/eurheartj/ehw172] [Citation(s) in RCA: 178] [Impact Index Per Article: 22.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/23/2015] [Accepted: 03/24/2016] [Indexed: 02/06/2023] Open
Abstract
Aims Our aims were to evaluate the distribution of troponin I concentrations in population cohorts across Europe, to characterize the association with cardiovascular outcomes, to determine the predictive value beyond the variables used in the ESC SCORE, to test a potentially clinically relevant cut-off value, and to evaluate the improved eligibility for statin therapy based on elevated troponin I concentrations retrospectively. Methods and results Based on the Biomarkers for Cardiovascular Risk Assessment in Europe (BiomarCaRE) project, we analysed individual level data from 10 prospective population-based studies including 74 738 participants. We investigated the value of adding troponin I levels to conventional risk factors for prediction of cardiovascular disease by calculating measures of discrimination (C-index) and net reclassification improvement (NRI). We further tested the clinical implication of statin therapy based on troponin concentration in 12 956 individuals free of cardiovascular disease in the JUPITER study. Troponin I remained an independent predictor with a hazard ratio of 1.37 for cardiovascular mortality, 1.23 for cardiovascular disease, and 1.24 for total mortality. The addition of troponin I information to a prognostic model for cardiovascular death constructed of ESC SCORE variables increased the C-index discrimination measure by 0.007 and yielded an NRI of 0.048, whereas the addition to prognostic models for cardiovascular disease and total mortality led to lesser C-index discrimination and NRI increment. In individuals above 6 ng/L of troponin I, a concentration near the upper quintile in BiomarCaRE (5.9 ng/L) and JUPITER (5.8 ng/L), rosuvastatin therapy resulted in higher absolute risk reduction compared with individuals <6 ng/L of troponin I, whereas the relative risk reduction was similar. Conclusion In individuals free of cardiovascular disease, the addition of troponin I to variables of established risk score improves prediction of cardiovascular death and cardiovascular disease.
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Affiliation(s)
- Stefan Blankenberg
- University Heart Center Hamburg, Clinic for General and Interventional Cardiology, Hamburg, Germany German Center for Cardiovascular Research (DZHK e.V.), partner site Hamburg, Lübeck, Kiel, Hamburg, Germany
| | - Veikko Salomaa
- National Institute for Health and Welfare, Helsinki, Finland
| | - Nataliya Makarova
- University Heart Center Hamburg, Clinic for General and Interventional Cardiology, Hamburg, Germany German Center for Cardiovascular Research (DZHK e.V.), partner site Hamburg, Lübeck, Kiel, Hamburg, Germany
| | - Francisco Ojeda
- University Heart Center Hamburg, Clinic for General and Interventional Cardiology, Hamburg, Germany
| | - Philipp Wild
- Department of Medicine II, Preventive Cardiology and Preventive Medicine, University Medical Center of the Johannes Gutenberg-University Mainz, Mainz, Germany University Medical Center of the Johannes Gutenberg-University Mainz, Center for Thrombosis and Haemostasis (CTH), Mainz, Germany German Center for Cardiovascular Research (DZHK), Partner Site Rhein-Main, Mainz, Germany
| | - Karl J Lackner
- University Medical Center Mainz, Institute for Clinical Chemistry and Laboratory Medicine, Mainz, Germany
| | - Torben Jørgensen
- Department of Public Health, Faculty of Health and Medical Science, University of Copenhagen, Copenhagen, Denmark Research Centre for Prevention and Health, Capital Region, Denmark
| | - Barbara Thorand
- Helmholtz Zentrum München, German Research Center for Environmental Health, Institute of Epidemiology II, München, Germany
| | - Annette Peters
- Helmholtz Zentrum München, German Research Center for Environmental Health, Institute of Epidemiology II, München, Germany German Center for Cardiovascular Research (DZHK e.V.), Partner Site Munich Heart Alliance, München, Germany
| | - Matthias Nauck
- University Medicine Greifswald, Institute for Clinical Chemistry and Laboratory Medicine, Greifswald, Germany German Center for Cardiovascular Research (DZHK e.V.), Partner Site Greifswald, Greifswald, Germany
| | - Astrid Petersmann
- University Medicine Greifswald, Institute for Clinical Chemistry and Laboratory Medicine, Greifswald, Germany German Center for Cardiovascular Research (DZHK e.V.), Partner Site Greifswald, Greifswald, Germany
| | - Erkki Vartiainen
- Chronic Disease Epidemiology and Prevention Unit, Department of Chronic Disease Prevention, National Institute for Health and Welfare, Helsinki, Finland
| | - Giovanni Veronesi
- Department of Clinical and Experimental Medicine, Research Centre in Epidemiology and Preventive Medicine, University of Insubria, Varese, Italy
| | - Paolo Brambilla
- Department of Laboratory Medicine, Hospital of Desio, University of Milano Bicocca, Desio (MB), Italy
| | - Simona Costanzo
- IRCCS Istituto Neurologico Mediterraneo Neuromed, Department of Epidemiology and Prevention, Laboratory of Molecular and Nutritional Epidemiology, Pozzilli, Isernia, Italy
| | - Licia Iacoviello
- IRCCS Istituto Neurologico Mediterraneo Neuromed, Department of Epidemiology and Prevention, Laboratory of Molecular and Nutritional Epidemiology, Pozzilli, Isernia, Italy
| | - Gerard Linden
- Queens University of Belfast, UK Clinical Research Collaboration Centre of Excellence for Public Health, Belfast, UK
| | - John Yarnell
- Queens University of Belfast, Centre for Public Health Belfast, Belfast, UK
| | | | - Brendan M Everett
- Brigham and Women's Hospital, Cardiovascular and Preventive Medicine Divisions, Boston, USA
| | - Paul M Ridker
- Brigham and Women's Hospital, Cardiovascular and Preventive Medicine Divisions, Boston, USA
| | - Jukka Kontto
- National Institute for Health and Welfare, Helsinki, Finland
| | - Renate B Schnabel
- University Heart Center Hamburg, Clinic for General and Interventional Cardiology, Hamburg, Germany German Center for Cardiovascular Research (DZHK e.V.), partner site Hamburg, Lübeck, Kiel, Hamburg, Germany
| | - Wolfgang Koenig
- German Center for Cardiovascular Research (DZHK e.V.), Partner Site Munich Heart Alliance, München, Germany University of Ulm Medical Centre, Department of Internal Medicine II-Cardiology, Ulm, Germany German Heart Centre Munich, Technical University of Munich, München, Germany
| | - Frank Kee
- Queens University of Belfast, UK Clinical Research Collaboration Centre of Excellence for Public Health, Belfast, UK
| | - Tanja Zeller
- University Heart Center Hamburg, Clinic for General and Interventional Cardiology, Hamburg, Germany German Center for Cardiovascular Research (DZHK e.V.), partner site Hamburg, Lübeck, Kiel, Hamburg, Germany
| | - Kari Kuulasmaa
- National Institute for Health and Welfare, Helsinki, Finland
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Impact of Modifiable Risk Factors on B-type Natriuretic Peptide and Cardiac Troponin T Concentrations. Am J Cardiol 2016; 117:376-81. [PMID: 26739393 DOI: 10.1016/j.amjcard.2015.10.054] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/08/2015] [Revised: 10/30/2015] [Accepted: 10/30/2015] [Indexed: 01/25/2023]
Abstract
Alcohol use, physical activity, diet, and cigarette smoking are modifiable cardiovascular risk factors that have a substantial impact on the risk of myocardial infarction, stroke, and cardiovascular death. We hypothesized that these behaviors may alter concentrations of cardiac troponin, a marker of myocyte injury, and B-type natriuretic peptide, a marker of myocyte stress. Both markers have shown strong association with adverse cardiovascular outcomes. In 519 women with no evidence of cardiovascular disease, we measured circulating concentrations of cardiac troponin T, using a high-sensitivity assay (hsTnT), and the N-terminal fragment of B-type natriuretic peptide (NT-proBNP). We used logistic regression to determine if these behaviors were associated with hsTnT ≥ 3 ng/l or with NT-proBNP in the highest quartile (≥ 127.3 ng/l). The median (Q1 to Q3) NT-proBNP of the cohort was 68.8 ng/l (40.3 to 127.3 ng/l), and 30.8% (160 of 519) of the cohort had circulating hsTnT ≥ 3 ng/l. In adjusted models, women who drank 1 to 6 drinks/week had lower odds of having a hsTnT ≥ 3 ng/l (odds ratio 0.58, 95% confidence interval 0.34 to 0.96) and lower odds of having an elevated NT-proBNP (odds ratio 0.55, 95% confidence interval 0.32 to 0.96). We were subsequently able to validate the results for B-type natriuretic peptide in a large independent cohort. In conclusion, our results suggest that regular alcohol consumption is associated with lower concentrations of hsTnT and NT-proBNP, 2 cardiovascular biomarkers associated with cardiovascular risk, and raise the hypothesis that the beneficial effects of alcohol consumption may be mediated by direct effects on the myocardium.
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96
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He WT, Mori M, Yu XF, Kanda T. Higher BNP levels within physiological range correlate with beneficial nonfasting lipid profiles in the elderly: a cross-sectional study. Lipids Health Dis 2016; 15:3. [PMID: 26728801 PMCID: PMC4700761 DOI: 10.1186/s12944-015-0168-1] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/17/2015] [Accepted: 12/22/2015] [Indexed: 02/08/2023] Open
Abstract
Background Emerging studies indicate that B-type natriuretic peptide (BNP), a well-known biomarker for heart failure, also plays pivotal roles in metabolic control. Circulating BNP levels progressively increase as ages grow older. However, the association between BNP levels and lipid metabolism in the elderly remains unknown. Methods A total of 680 eligible volunteers (male/female: 334/346) aged between 60 and 80 years old without overt heart failure (BNP <100 pg/ml) were enrolled. Random nonfasting venous samples were obtained for biochemical analysis. The subjects were stratified based on BNP quartiles: BNP Q1 (range: 2.2–9.0 pg/ml), Q2 (9.1–20.4 pg/ml), Q3 (20.5–44.4 pg/ml) and Q4 (44.6–99.7 pg/ml). Difference of metabolic parameters was compared among the subjects grouped by BNP quartiles. Univariate correlation and multiple linear regression were performed to analyze the association between BNP levels and metabolic parameters. The odds ratios (OR) and 95 % confidence intervals (CI) for dyslipidemia in subjects within BNP Q1-3 relative to subjects within BNP Q4 were calculated. Results Circulating BNP levels positively correlated with age, while negatively correlated with body mass index (BMI), eGFR and non-HDL. Subjects with lower BNP quartiles had significantly elevated prevalence of dyslipidemia, including hypertriglyceridemia, hyper-LDL-emia and hypercholesterolemia. The OR of hypertriglyceridemia and hypercholesterolemia for subjects within BNP Q1-2 significantly increased relative to BNP Q4. Conclusions The elderly people with higher BNP levels have significantly reduced risks for nonfasting dyslipidemia. Verification of the cause-effect relationship between BNP and dyslipidemia may bring therapeutic implications.
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Affiliation(s)
- Wen-Tao He
- Department of Community Medicine, Kanazawa Medical University Himi Municipal Hospital, Himi, Toyama, 935-8531, Japan. .,Department of Endocrinology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, 430030, China.
| | - Masayuki Mori
- Department of Community Medicine, Kanazawa Medical University Himi Municipal Hospital, Himi, Toyama, 935-8531, Japan.
| | - Xue-Feng Yu
- Department of Endocrinology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, 430030, China.
| | - Tsugiyasu Kanda
- Department of Community Medicine, Kanazawa Medical University Himi Municipal Hospital, Himi, Toyama, 935-8531, Japan.
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97
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Chapman MJ, Blankenberg S, Landmesser U. The year in cardiology 2015: prevention. Eur Heart J 2016; 37:510-9. [PMID: 26726043 PMCID: PMC5053187 DOI: 10.1093/eurheartj/ehv721] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/04/2015] [Accepted: 12/09/2015] [Indexed: 01/14/2023] Open
Affiliation(s)
- M John Chapman
- National Institute for Health and Medical Research (INSERM), Dyslipidemia and Atherosclerosis Research, Pitié-Salpêtrière University Hospital, Paris FR-75651, France University of Pierre and Marie Curie, Paris, France
| | - Stefan Blankenberg
- Clinic for Cardiology, University Heart Center Hamburg, German Center for Cardiovascular Research (DZHK), Hamburg, Germany
| | - Ulf Landmesser
- Department of Cardiology, Charité Universitätsmedizin Berlin (CBF), Berlin, Germany German Center for Cardiovascular Research (DZHK), Berlin Institute of Health (BIH), Berlin, Germany
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