Abstract 15048: Current Smoking is Associated With Lower Concentrations of High-Sensitivity Cardiac Troponin T in Patients With Stable Coronary Artery Disease: The PEACE Trial

• Published in: Circulation (New York, N.Y.) N.Y.), 2018-11, Vol.138 (Suppl_1 Suppl 1), p.A15048-A15048
• Main Authors: Skranes, Julia B, Claggett, Brian L, Myhre, Peder L, Lyngbakken, Magnus N, Solomon, Scott D, Sabatine, Marc S, Braunwald, Eugene, Pfeffer, Marc A, Omland, Torbjorn
• Format: Article
• Language: English
• ISSN: 0009-7322; 1524-4539

BackgroundCigarette smoking is a major risk factor for atherothrombotic cardiovascular (CV) disease. Cardiac troponins (cTn) measured with high sensitivity assays reflect subclinical myocardial injury and are strong predictors of incident heart failure and CV death in patients with stable coronary artery disease (CAD). Lower cTnI levels have been reported in current smokers in the general population, but whether the apparently paradoxical phenomenon of an inverse association between cTn and tobacco smoking can be extended to cTnT and patients with stable CAD remains unknown. Accordingly, the objectives of the current study was to assess the association between current smoking and cTnT concentrations, and the potential impact of smoking on the association between circulating cTnT and outcomes in patients with stable CAD.MethodscTnT concentrations at baseline were measured by a high-sensitivity assay in 3126 non-smokers and 550 current smokers with stable CAD and preserved left ventricular function enrolled in the PEACE trial, and followed for a median duration of 5.2 years. The association between cigarette smoking and log-transformed cTnT was assessed by multivariable linear regression analysis. Adjusted Cox regression models using CV mortality and incident HF as a composite endpoint were generated to test the relationship between cTnT concentrations and time to event.ResultsCurrent smoking was associated with significantly lower concentrations of cTnT (current smokers versus non-smokersmedian, 4.9 ng/L; interquartile range, 2.9-7.5 ng/L versus 6.1 ng/L; interquartile range, 4.1-9.4 ng/L; P < 0.001). In multivariable models adjusting for demographics, body mass index, comorbidities, medication use, estimated glomerular filtration rate and N-terminal pro-B-type natriuretic peptide, current smoking was associated with significantly lower cTnT levels (12%; 95% confidence interval (CI); -18 % to - 5 %). In adjusted Cox regression models, no statistically significant interaction of the association between cTnT and the composite endpoint by smoking status was observed (non-smokers versus current smokersHR 1.56 [95% CI 1.30 to 1.88] versus HR 1.23 [95% CI 0.87 to 1.72], p=0.25).ConclusionIn patients with stable CAD, current cigarette smoking is associated with lower concentrations of cTnT, an index of subclinical myocardial injury. These findings extend observations of lower cTnI levels in smokers in the general population. The effect of tobacco smoking on cTn re