Gender, High-Sensitivity Troponin I, and the Risk of Cardiovascular Events (from the Nord-Trøndelag Health Study)

• Published in: The American journal of cardiology Vol. 118; no. 6; pp. 816 - 821
• Main Authors: Lyngbakken, Magnus Nakrem, MD, Røsjø, Helge, MD, PhD, Holmen, Oddgeir L., MD, Nygård, Ståle, PhD, Dalen, Håvard, MD, PhD, Hveem, Kristian, MD, PhD, Omland, Torbjørn, MD, PhD, MPH
• Format: Journal Article
• Language: English
• Published: United States Elsevier Inc 15.09.2016; Elsevier Limited
• Subjects: Acute coronary syndromes; Adult; Biomarkers - blood; Cardiovascular; Cardiovascular disease; Cholesterol; Cohort Studies; Confidence intervals; Diabetes; Female; Gender; Health risk assessment; Heart attacks; Heart failure; Heart Failure - blood; Heart Failure - epidemiology; Hospitalization; Hospitals; Humans; Hypertension; Incidence; Low density lipoprotein; Male; Mens health; Middle Aged; Mortality; Myocardial Infarction - blood; Myocardial Infarction - epidemiology; Norway - epidemiology; Prognosis; Proportional Hazards Models; Prospective Studies; Proteins; Sex Factors; Shipments; Troponin I - blood; Womens health; Norway
• ISSN: 0002-9149; 1879-1913
• DOI: 10.1016/j.amjcard.2016.06.043

Gender is an important determinant of cardiovascular risk, and men generally develop cardiovascular disease earlier than women. Increased levels of high-sensitivity cardiac troponin I (hs-TnI) have been shown to be predictive of cardiovascular death, with stronger effects in women. However, it remains unclear whether the stronger association between hs-TnI and cardiovascular death in women is based on the ability of hs-TnI to predict myocardial infarction (MI) or heart failure (HF). Accordingly, we aimed to assess the influence of gender on the association between levels of hs-TnI and incident MI and HF. hs-TnI was measured in 5,060 women and 4,054 men participating in the prospective observational Nord-Trøndelag Health Study using the Architect STAT High-Sensitive Troponin assay. All subjects were free from known coronary heart disease at baseline. After a median follow-up of 5,105 and 6,169 days, 292 MIs and 209 admissions for HF were registered, respectively. In our total cohort, hs-TnI was associated with the incidence of both end points, with adjusted hazard ratio per 1 SD in log hs-TnI 1.19 (95% CI 1.02 to 1.39) for MI and 1.58 (1.38 to 1.82) for HF. The corresponding values for women and men were 1.35 (1.02 to 1.78) versus 1.13 (0.93 to 1.38) for MI and 1.55 (1.26 to 1.91) versus 1.61 (1.36 to 1.90) for HF. The C-index for hs-TnI was stronger for women than men for MI (p <0.001), and no such difference was observed for HF (p = 0.06). In conclusion, in the general population, the association between hs-TnI concentrations and MI is stronger in women than in men. For HF, the impact of gender on the prognostic value of hs-TnI is less pronounced. Increased levels of troponin I in women may thus reflect an adverse phenotype more prone to the development of cardiovascular disease.