Highly Sensitive Cardiac Troponin T and Long-Term Mortality in a Population of Community-Derived Perimenopausal Women: Nested Case-Control Study

Study Questions:

What is the association between baseline levels of highly sensitive cardiac troponin T (hs-cTnT) and long-term mortality in perimenopausal women of the general community?

Methods:

Data from the Eindhoven Perimenopausal Osteoporosis Study, a large prospective cohort of community-based women of the city of Eindhoven, the Netherlands, were used for this nested case control. Cases were defined as study participants who provided a baseline blood sample and subsequently experienced death during follow-up between 1994 and 2003. Two matched controls were selected for each case, using age, body mass index, and hypertension as matching factors. The primary outcome of interest was all-cause mortality.

Results:

A total of 8,503 participated in the Eindhoven Perimenopausal Osteoporosis Study, of which 123 cases were identified. No subjects had detectable conventional third-generation troponin T assay for cardiac troponin; in contrast, hs-cTnT exceeded the lower limit of detection in 86% (317/369) of the women. The gender-specific 99th percentile reference limit determined in the 246 controls was 8.0 ng/L. Hs-cTnT was significantly higher in the cases: 3.0 ng/L versus 2.3 ng/L (p = 0.04). After adjustment for matching and clinical risk factors, each 1 standard deviation increase of the level of hs-cTnT was significantly associated with mortality (odds ratio [OR], 1.3; 95% confidence interval [CI], 1.1-1.7; p = 0.018). With amino-terminal pro-B-type natriuretic peptide (NT-proBNP) in the multivariable model as a continuous variable, the association of hs-cTnT with mortality was lost. With both hs-cTnT and NT-proBNP as dichotomous variables, the gender-specific 99th percentile reference limit (8.0 ng/L) was associated with mortality, independent of NT-proBNP (OR, 3.7; 95% CI, 1.0-13.2; p = 0.048).

Conclusions:

The investigators concluded that among a cohort of community-derived perimenopausal women, hs-cTnT was associated with long-term mortality, independent of clinical risk factors. With the use of easily applicable cut-off levels, the gender-specific reference limit of hs-cTnT had a prognostic impact that was independent of NT-proBNP.

Perspective:

These data suggest that hs-cTnT is independently associated with mortality; however, as a case-control study, the added value of this measure above other risk calculators remains unclear. Furthermore, additional research is warranted to answer the question of how and when to measure, and how to modify factors which would result in survival benefit.

Clinical Topics: Prevention, Hypertension

Keywords: Follow-Up Studies, Body Mass Index, Case-Control Studies, Biological Markers, Troponin I, Troponin T, Netherlands, Risk Factors, Hypertension


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