High-Sensitivity Cardiac Troponin I Improves Cardiovascular Risk Prediction in Older Men: HIMS (The Health in Men Study)

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 Me...

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Bibliographic Details
Published in:Journal of the American Heart Association 2019-03, Vol.8 (5), p.e011818-e011818
Main Authors: 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, Flicker, Leon
Format: Article
Language:English
Subjects:
Age Factors
Aged
Aged, 80 and over
aging
Biomarkers - blood
cardiovascular disease
cardiovascular disease prevention
cardiovascular disease risk factors
Cardiovascular Diseases - blood
Cardiovascular Diseases - diagnosis
Cardiovascular Diseases - epidemiology
Comorbidity
Health Status
Humans
Incidence
Male
Original Research
Predictive Value of Tests
Prognosis
Risk Assessment
Risk Factors
risk prediction
risk stratification
Sex Factors
Time Factors
Troponin I - blood
Western Australia - epidemiology
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Summary: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 i2000 SR ) 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
ISSN:2047-9980
2047-9980
DOI:10.1161/JAHA.118.011818