Heart Failure; Cardiovascular disease remains the leading cause of pain, suffering and death in the United States, and despite tremendous advances in knowledge on prevention; so treatment of risk factors such as cholesterol, blood pressure and obesity is not optimal. One of the goals of Dr. Christie Ballantyne’s lab at Baylor College of Medicine is studying whether novel biomarkers, in combination with other factors; so might be useful in identifying individuals at high risk for cardiovascular disease.
Myofibrils of cardiomyocytes
Cardiac troponins are structural proteins find in the myofibrils of cardiomyocytes. Development of high-sensitivity assays for cardiac troponin I and T (hs-TnI and hs-TnT) has enhance the ability to detect low circulating levels of cardiac troponins; which are often present in individuals with common cardiac conditions; also risk factors who have not manifest clinical cardiovascular disease (CVD).
Lowering the detection threshold of troponin assays; which has expand the potential use of cardiac troponins from a diagnostic tool in the setting of acute coronary syndrome; so to a biomarker for risk stratification in individuals without known CVD. “Improve methods to identify individuals who are at the highest risk are very important to personalize therapy; so that the most intensive efforts for prevention are focus on the individuals at highest risk,” said Ballantyne; professor of medicine and chief of the section of cardiology at Baylor.
In this study, Ballantyne and his colleagues analyze data on more than 8,000 participants; so between the ages of 54 and 74 from the Atherosclerosis Risk in Communities (ARIC) study. They find that increase levels of troponin I associate with cardiac outcomes; so specifically heart attack and fatal coronary heart disease, stroke, heart failure hospitalization and death.
Developing heart failure
The ARIC study is an ongoing, biracial long-term study (dating back 30 years) in four communities in the United States design to investigate the causes of atherosclerosis and its clinical outcomes. When researchers add troponin I to the Pooled Cohort Equation, a commonly use risk prediction model; so there was a modest yet statistically significant improvement in risk prediction; hence with the greatest improvement in predicting the risk for developing heart failure.
One of the surprising aspects of this study was the observation that measurement of another protein, troponin T; which is also use commonly for the diagnosis of heart attack; so to provide additional information: those with elevations of both biomarkers had an increase risk for cardiovascular disease events; also death compare with those with elevate troponin I or troponin T alone.
“Improve blood tests such as high sensitivity troponins may be important tools; so to identify more precisely who is at greatest risk; also future studies will need to test the optimal methods to prevent heart attacks, strokes and heart failure in such individuals,” Ballantyne said. Significant interactions by race and sex observe; hence with stronger association of hs-TnI with global CVD observe in white than in black participants and stronger association of hs-TnI with incident CHD observe in women than in men.