Journal of the American College of Cardiology, Volume 85, Issue 14, 1 1 2025, Pages 1471-1484 Cardiac Troponins and Cardiovascular Disease Risk Prediction: An Individual-Participant-Data Meta-Analysis. Shah ASV, Keene SJ, Pennells L, Kaptoge S, Kimenai DM, Walker M, Halley JD, Rocha S, Hoogeveen RC, Gudnason V, Bakker SJL, Wannamethee SG, Pareek M, Eggers KM, Jukema JW, Hankey GJ, deLemos JA, Ford I, Omland T, Lyngbakken MN, Psaty BM, deFilippi CR, Wood AM, Danesh J, Welsh P, Sattar N, Mills NL, Di Angelantonio E, CAPRICE Co-Investigators
Background
The extent to which high-sensitivity cardiac troponin can predict cardiovascular disease (CVD) is uncertain.
Objectives
We aimed to quantify the potential advantage of adding information on cardiac troponins to conventional risk factors in the prevention of CVD.
Methods
We meta-analyzed individual-participant data from 15 cohorts, comprising 62,150 participants without prior CVD. We calculated HRs, measures of risk discrimination, and reclassification after adding cardiac troponin T (cTnT) or I (cTnI) to conventional risk factors. The primary outcome was first-onset CVD (ie, coronary heart disease or stroke). We then modeled the implications of initiating statin therapy using incidence rates from 2.1 million individuals from the United Kingdom.
Results
Among participants with cTnT or cTnI measurements, 8,133 and 3,749 incident CVD events occurred during a median follow-up of 11.8 and 9.8 years, respectively. HRs for CVD per 1-SD higher concentration were 1.31 (95% CI: 1.25-1.37) for cTnT and 1.26 (95% CI: 1.19-1.33) for cTnI. Addition of cTnT or cTnI to conventional risk factors was associated with C-index increases of 0.015 (95% CI: 0.012-0.018) and 0.012 (95% CI: 0.009-0.015) and continuous net reclassification improvements of 6% and 5% in cases and 22% and 17% in noncases. One additional CVD event would be prevented for every 408 and 473 individuals screened based on statin therapy in those whose CVD risk is reclassified from intermediate to high risk after cTnT or cTnI measurement, respectively.
Conclusions
Measurement of cardiac troponin results in a modest improvement in the prediction of first-onset CVD that may translate into population health benefits if used at scale.
