High-sensitivity cardiac troponin I improves cardiovascular risk prediction in older men: HIMS (The Health in Men Study)

Lan, Nick S.R., Bell, Damon A., Mccaul, Kieran A., Vasikaran, Samuel D., Yeap, Bu B., Norman, Paul E., Almeida, Osvaldo P., Golledge, Jonathan, Hankey, Graeme J., and Flicker, Leon (2019) High-sensitivity cardiac troponin I improves cardiovascular risk prediction in older men: HIMS (The Health in Men Study). Journal of the American Heart Association, 8 (5). e011818.

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Background: The Framingham Risk Score estimates the 10-year risk of cardiovascular events. However, it performs poorly in older adults. We evaluated the incremental benefit of adding high-sensitivity cardiac troponin I (hs-cTnI) to the Framingham Risk Score.

Methods and Results: The HIMS (Health in Men Study) is a cohort study of community-dwelling men aged 70 to 89 years in Western Australia. Participants were identified from the electoral roll, with a subset undergoing plasma analysis. Hs-cTnI (Abbott Architect i2000SR) was measured in 1151 men without prior cardiovascular disease. The Western Australia Data Linkage System was used to identify incident cardiovascular events. After 10 years of follow-up, 252 men (22%) had a cardiovascular event (CVE+) and 899 did not (CVE–). The Framingham Risk Score placed 148 (59%) CVE+ and 415 (46%) CVE– in the high-risk category. In CVE– men, adding hs-cTnI affected the risk categories of 244 (27.2%) men, with 64.8% appropriately reclassified to a lower and 35.2% to a higher category, which decreased the number of high-risk men in the CVE– to 39%. In CVE+ men, adding hs-cTnI affected the risk categories of 61 (24.2%), with 50.8% appropriately reclassified to a higher and 49.2% to a lower category and 82.5% remaining above the 15% risk treatment threshold. The net reclassification index was 0.305 (P<0.001). Adding hs-cTnI increased the C-statistic modestly from 0.588 (95% CI, 0.552–0.624) to 0.624 (95% CI, 0.589–0.659) and improved model fit (likelihood ratio test, P<0.001).

Conclusions: Adding hs-cTnI to the Framingham Risk Score provided incremental prognostic benefit in older men, especially aiding reclassification of individuals into a lower risk category.

Item ID: 61864
Item Type: Article (Research - C1)
ISSN: 2047-9980
Keywords: aging, cardiovascular disease, cardiovascular disease prevention, cardiovascular disease risk factors, risk prediction, risk stratification, troponin
Copyright Information: Copyright © 2019 The Authors. Published on behalf of the American Heart Association, Inc., by Wiley Blackwell. This is an open access article under the terms of the Creative Commons Attribution‐NonCommercial‐NoDerivs License, which permits use and distribution in any medium, provided the original work is properly cited, the use is non‐commercial and no modifications or adaptations are made.
Funders: National Health and Medical Research Council (NHMRC), National Heart Foundation of Australia (NHF), West Australian Health Promotion Foundation (Healthway)
Projects and Grants: NHMRC grant 964145, NHMRC grant 139093, NHMRC grant 403963, NHMRC grant 455811
Date Deposited: 26 Feb 2020 04:13
FoR Codes: 32 BIOMEDICAL AND CLINICAL SCIENCES > 3201 Cardiovascular medicine and haematology > 320199 Cardiovascular medicine and haematology not elsewhere classified @ 100%
SEO Codes: 92 HEALTH > 9201 Clinical Health (Organs, Diseases and Abnormal Conditions) > 920199 Clinical Health (Organs, Diseases and Abnormal Conditions) not elsewhere classified @ 100%
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