Association between high sensitivity cardiac troponin and mortality risk in the non-diabetic population: findings from the National Health and Nutrition Examination Survey
Authors' conclusion
Elevated blood levels of Hs-cTnI and Hs-cTnT are associated with increased mortality. Measurement of Hs-cTnT in non-diabetic subjects, particularly those with prediabetes, may help identify individuals at an increased risk of cardiovascular disease and provide early and more intensive risk factor modification.
Study context
- Population
- Participants without known DM and CVD from US National Health and Nutrition Examination Survey (NHANES); mean age 48.1 ± 19.1 years, 53.3% female, 25.8% prediabetic
- Participants
- 10,393 participants
- Exposure
- Hs-cTnI or Hs-cTnT above the 99th upper reference limit vs below the limit of detection
- Outcome
- All-cause and cardiovascular mortality
Methodological detailspopulation-based, US NHANES
- Population-based
- US NHANES
Main finding
As reported in the abstract
Estimate (95% CI)
Hs-cTn >99th URLvs Hs-cTn <LoD
HR (Hs-cTnI, all-cause mortality) 1.74(1.35–2.24)
Hs-cTn >99th URLvs Hs-cTn <LoD
HR (Hs-cTnI, cardiovascular mortality) 2.10(1.36–3.24)
Hs-cTn >99th URLvs Hs-cTn <LoD
HR (Hs-cTnT, all-cause mortality) 2.07(1.53–2.81)
Hs-cTn >99th URLvs Hs-cTn <LoD
HR (Hs-cTnT, cardiovascular mortality) 2.92(1.47–5.80)
Observational data: associations, not effects.
Further findings
Interaction with prediabetes
- Significant interaction between prediabetes and Hs-cTnI on mortality risk; positive relationship only in prediabetic individuals
- No interaction between prediabetes and Hs-cTnT on mortality risk
Predictive performance (AUC of tROC)
- Both Hs-cTnT and Hs-cTnI showed better predictive performance for cardiovascular than all-cause mortality
Net Reclassification Improvement (NRI) for adding high-sensitivity cardiac troponin (Hs-cTn) to Framingham-based standard model
- Hs-cTnT, all-cause mortality: NRI
- 0.25 (0.21, 0.27) (95% CI)
- Hs-cTnT, cardiovascular mortality: NRI
- 0.33 (0.26, 0.39) (95% CI)
- Hs-cTnI, all-cause mortality: NRI
- 0.04 (0, 0.06) (95% CI)
- Hs-cTnI, cardiovascular mortality: NRI
- 0.07 (0.01, 0.13) (95% CI)
Original publication
Association between high sensitivity cardiac troponin and mortality risk in the non-diabetic population: findings from the National Health and Nutrition Examination Survey. Cardiovasc Diabetol. Published 30 October 2023. doi:10.
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