Association Between High-sensitivity Cardiac Troponin T Levels and Incident Stroke in the Elderly Japanese Population: Results from the Tohoku Medical Megabank Community-based Cohort Study

Overview

Journal Am Heart J Plus

Specialty Cardiology & Vascular Diseases

Date 2024 Apr 1

PMID 38558906

Authors

Takamasa Kobayashi

Takahito Nasu

Mamoru Satoh

Yuka Kotozaki

Kozo Tanno

Koichi Asahi

Hideki Ohmomo

Atsushi Shimizu

Shinichi Omama

Hiroto Kikuchi

Satoru Taguchi

Yoshihiro Morino

Kenji Sobue

Makoto Sasaki

Affiliations

Soon will be listed here.

Abstract

Elevated levels of circulating high-sensitivity cardiac troponin T (hs-cTnT) are associated with cardiovascular disease. This study aimed to examine whether hs-cTnT levels are associated with incident stroke in the elderly population. The Iwate Tohoku Medical Megabank Organization pooled participant data for a community-based cohort study (n = 15,063, 69.6 ± 3.4 years), with a mean follow-up period of 5.23 years for all-cause death and incident stroke. The follow-up revealed 316 incident strokes, including atherothrombotic (n = 98), cardioembolic (n = 54), lacunar (n = 63), hemorrhagic (n = 101), and 178 all-cause deaths. Participants were classified into quartiles according to hs-cTnT levels (Q1 ≦ 4 ng/L, Q2: 5-6 ng/L, Q3: 7-9 ng/L, and Q4 > 9 ng/L). After adjusting for sex, age, smoking, drinking, systolic blood pressure, estimated glomerular filtration rate, N-terminal pro-brain natriuretic peptide, hemoglobin A1c, and lipid profile, a Cox proportional hazard model showed that higher hs-cTnT levels were associated with ischemic stroke (Q1 vs. Q4, hazard ratio [HR] = 2.24, 95 % confidence interval [CI] = 1.12-4.51, p = 0.023). The incident of total stroke was not associated with hs-cTnT levels (Q1 vs. Q4, HR 1.39, 95 % CI = 0.89-1.74, p = 0.145). Numerical differences were highest regarding incident lacunar stroke subtypes; however, this association was not statistically significant. Higher hs-cTnT concentrations were associated with ischemic stroke in the elderly Japanese population.

Citing Articles

Association of Troponin T measurements with long-term outcomes in patients with coronary artery disease participating in a secondary prevention trial.

Kaldal A, Tonstad S, Jortveit J BMC Cardiovasc Disord. 2023; 23(1):210.

PMID: 37118703 PMC: 10142253. DOI: 10.1186/s12872-023-03249-0.

References

Giannitsis E, Kurz K, Hallermayer K, Jarausch J, Jaffe A, Katus H . Analytical validation of a high-sensitivity cardiac troponin T assay. Clin Chem. 2009; 56(2):254-61. DOI: 10.1373/clinchem.2009.132654. View

Camen S, Palosaari T, Reinikainen J, Sprunker N, Niiranen T, Gianfagna F . Cardiac Troponin I and Incident Stroke in European Cohorts: Insights From the BiomarCaRE Project. Stroke. 2020; 51(9):2770-2777. PMC: 7447179. DOI: 10.1161/STROKEAHA.120.029452. View

Grodin J, Neale S, Wu Y, Hazen S, Tang W . Prognostic comparison of different sensitivity cardiac troponin assays in stable heart failure. Am J Med. 2014; 128(3):276-82. PMC: 4340722. DOI: 10.1016/j.amjmed.2014.09.029. View

Caprio F, Sorond F . Cerebrovascular Disease: Primary and Secondary Stroke Prevention. Med Clin North Am. 2019; 103(2):295-308. DOI: 10.1016/j.mcna.2018.10.001. View

Lindahl B, Venge P, Wallentin L . Relation between troponin T and the risk of subsequent cardiac events in unstable coronary artery disease. The FRISC study group. Circulation. 1996; 93(9):1651-7. DOI: 10.1161/01.cir.93.9.1651. View

Loch Macdonald R, Schweizer T . Spontaneous subarachnoid haemorrhage. Lancet. 2016; 389(10069):655-666. DOI: 10.1016/S0140-6736(16)30668-7. View

Zhang J, Zhang J, Yu P, Chen M, Peng Q, Wang Z . Remote Ischaemic Preconditioning and Sevoflurane Postconditioning Synergistically Protect Rats from Myocardial Injury Induced by Ischemia and Reperfusion Partly via Inhibition TLR4/MyD88/NF-κB Signaling Pathway. Cell Physiol Biochem. 2017; 41(1):22-32. DOI: 10.1159/000455815. View

Rubin J, Matsushita K, Lazo M, Ballantyne C, Nambi V, Hoogeveen R . Determinants of minimal elevation in high-sensitivity cardiac troponin T in the general population. Clin Biochem. 2016; 49(9):657-662. PMC: 4889514. DOI: 10.1016/j.clinbiochem.2016.01.024. View

Omama S, Yoshida Y, Ogawa A, Onoda T, Okayama A . Differences in circadian variation of cerebral infarction, intracerebral haemorrhage and subarachnoid haemorrhage by situation at onset. J Neurol Neurosurg Psychiatry. 2006; 77(12):1345-9. PMC: 2077415. DOI: 10.1136/jnnp.2006.090373. View

10.

Terceno M, Silva Y, Bashir S, Vera-Monge V, Buxo M, Serena J . Troponin T Predicts Cardioembolic Aetiology and Clinical Outcome in Undetermined Ischaemic Stroke in Hyperacute Phase. J Stroke Cerebrovasc Dis. 2019; 29(2):104528. DOI: 10.1016/j.jstrokecerebrovasdis.2019.104528. View

11.

He L, Wang J, Dong W . The clinical prognostic significance of hs-cTnT elevation in patients with acute ischemic stroke. BMC Neurol. 2018; 18(1):118. PMC: 6102797. DOI: 10.1186/s12883-018-1121-5. View

12.

Broersen L, Stengl H, Nolte C, Westermann D, Endres M, Siegerink B . Association Between High-Sensitivity Cardiac Troponin and Risk of Stroke in 96 702 Individuals: A Meta-Analysis. Stroke. 2020; 51(4):1085-1093. DOI: 10.1161/STROKEAHA.119.028323. View

13.

Kuriyama S, Yaegashi N, Nagami F, Arai T, Kawaguchi Y, Osumi N . The Tohoku Medical Megabank Project: Design and Mission. J Epidemiol. 2016; 26(9):493-511. PMC: 5008970. DOI: 10.2188/jea.JE20150268. View

14.

Takahashi Y, Satoh M, Ohmomo H, Tanaka F, Osaki T, Tanno K . Association between high-sensitivity cardiac troponin T and future cardiovascular incidence in a general Japanese population: results from the Tohoku medical megabank project. Biomarkers. 2019; 24(6):566-573. DOI: 10.1080/1354750X.2019.1606278. View

15.

Yatsuya H, Iso H, Yamagishi K, Kokubo Y, Saito I, Suzuki K . Development of a point-based prediction model for the incidence of total stroke: Japan public health center study. Stroke. 2013; 44(5):1295-302. DOI: 10.1161/STROKEAHA.111.677534. View

16.

Hozawa A, Tanno K, Nakaya N, Nakamura T, Tsuchiya N, Hirata T . Study Profile of the Tohoku Medical Megabank Community-Based Cohort Study. J Epidemiol. 2020; 31(1):65-76. PMC: 7738642. DOI: 10.2188/jea.JE20190271. View

17.

ODonnell H, Rosand J, KNUDSEN K, Furie K, Segal A, Chiu R . Apolipoprotein E genotype and the risk of recurrent lobar intracerebral hemorrhage. N Engl J Med. 2000; 342(4):240-5. DOI: 10.1056/NEJM200001273420403. View

18.

Kiyohara Y, Kato I, Iwamoto H, Nakayama K, Fujishima M . The impact of alcohol and hypertension on stroke incidence in a general Japanese population. The Hisayama Study. Stroke. 1995; 26(3):368-72. DOI: 10.1161/01.str.26.3.368. View

19.

Saunders J, Nambi V, de Lemos J, Chambless L, Virani S, Boerwinkle E . Cardiac troponin T measured by a highly sensitive assay predicts coronary heart disease, heart failure, and mortality in the Atherosclerosis Risk in Communities Study. Circulation. 2011; 123(13):1367-76. PMC: 3072024. DOI: 10.1161/CIRCULATIONAHA.110.005264. View

20.

Folsom A, Nambi V, Bell E, Oluleye O, Gottesman R, Lutsey P . Troponin T, N-terminal pro-B-type natriuretic peptide, and incidence of stroke: the atherosclerosis risk in communities study. Stroke. 2013; 44(4):961-7. PMC: 3614093. DOI: 10.1161/STROKEAHA.111.000173. View