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Sensitive Cardiac Troponin T Assay and the Risk of Incident Cardiovascular Disease in Women With and Without Diabetes Mellitus: The Women's Health Study
Study Questions:
Are very low levels of cardiac troponin T (cTnT) predictive of adverse cardiovascular (CV) events in women without previous CV disease (CVD)?
Methods:
The relationship between baseline cTn and incident CVD events among diabetic and nondiabetic participants in the Women’s Health Study (median follow-up, 12.3 years) was evaluated. All diabetic women with blood specimens were included in a cohort study (n = 512 diabetic women, n = 65 events), and nondiabetic women were sampled for inclusion in a case-cohort analysis (n = 564 comprising the subcohort, n = 479 events).
Results:
High-sensitivity cTnT was detectable (≥0.003 µg/L) in 45.5% of diabetic women and 30.3% of nondiabetic women (p < 0.0001). In models adjusted for traditional risk factors, detectable high-sensitivity cTnT was associated with subsequent CVD (myocardial infarction, stroke, cardiovascular death) in diabetic women (adjusted hazard ratio [HR], 1.79; p = 0.036), but not nondiabetic women (HR, 1.13; p = 0.46). The effect in diabetic women was driven by a threefold increase in CVD death that was not observed in nondiabetic women.
Conclusions:
The authors concluded that detectable levels of cTnT are associated with total CVD and CVD death in women with diabetes mellitus.
Perspective:
Detectable cTnT levels using high-sensitivity assays are not uncommon in otherwise healthy adults, and are associated with adverse outcomes. The current study expands on previous studies by demonstrating that this association is also present in a female population. However, the association was only observed in women with diabetes. The reason for the lack of association of cTnT in nondiabetic woman is unclear and will require further analysis. Additional studies are also necessary to determine the underlying mechanisms by which these low (but elevated) levels of cTnT are generated and how this information might be used to guide preventive strategies.
Keywords: Myocardial Infarction, Follow-Up Studies, Biomarkers, Troponin T, Women's Health, Risk Factors, Diabetes Mellitus
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