Cardiac Troponin Testing May Boost Early Cardiovascular Risk Prediction, Study Finds

The study, published in the Journal of the American College of Cardiology (JACC), suggests that incorporating these biomarkers into current risk models results in a modest but meaningful improvement in predicting the likelihood of first-onset CVD. This enhancement in risk prediction could play a crucial role in primary prevention efforts, offering valuable insights for early intervention and more effective population health management.

The role of high-sensitivity cardiac troponin in predicting cardiovascular disease has been a subject of ongoing research, as its potential to enhance traditional risk prediction models remains uncertain. Cardiac troponins are biomarkers released into the bloodstream when the heart muscle is damaged, and they are primarily used for diagnosing acute myocardial infarction. However, their value in identifying individuals at risk for first-onset CVD before clinical symptoms appear has not been fully established.

Against the above background, Anoop S.V. Shah, Department of Cardiology, Imperial College NHS Trust, London, United Kingdom, and colleagues aimed to assess the potential benefit of incorporating cardiac troponin measurements alongside conventional risk factors in the prevention of CVD to better understand its value in improving risk prediction and early intervention strategies.

For this purpose, the researchers conducted a meta-analysis of individual-participant data from 15 cohorts, including 62,150 participants without prior CVD. They calculated hazard ratios (HRs), measures of risk discrimination, and reclassification after incorporating cardiac troponin T (cTnT) or I (cTnI) into conventional risk factors.

The primary outcome was first-onset CVD, including coronary heart disease and stroke. Additionally, the researchers modeled the potential impact of initiating statin therapy based on incidence rates derived from a cohort of 2.1 million individuals in the United Kingdom.

The key findings of the study were as follows:

• Among participants with cTnT or cTnI measurements, 8,133 and 3,749 incident CVD events occurred during a median follow-up of 11.8 and 9.8 years, respectively.
• Hazard ratios (HRs) for CVD per 1-SD higher concentration were 1.31 for cTnT and 1.26 for cTnI.
• Adding cTnT or cTnI to conventional risk factors led to C-index increases of 0.015 for cTnT and 0.012 for cTnI.
• Continuous net reclassification improvements were observed with cTnT and cTnI, showing a 6% and 5% improvement in cases and 22% and 17% in noncases, respectively.
• For every 408 individuals screened based on statin therapy, one additional CVD event would be prevented in those whose risk is reclassified from intermediate to high risk after cTnT measurement.
• Similarly, one additional CVD event would be prevented for every 473 individuals screened based on statin therapy in those reclassified after cTnI measurement.

"Measuring cardiac troponin provides a modest improvement in predicting the risk of first-onset cardiovascular disease. If implemented on a larger scale, this enhancement in risk prediction could lead to significant population health benefits, helping identify individuals at higher risk and enabling earlier, more targeted interventions," the authors concluded.

Reference:

Shah ASV, Keene SJ, Pennells L, et al. Cardiac troponins and cardiovascular disease risk prediction: an individual-participant-data meta-analysis. J Am Coll Cardiol. 2025;85:1471-1484.