High-sensitivity cardiac tropinin levels linked to poor CV outcomes

In patients with chronic obstructive pulmonary disease and heightened cardiovascular risk, high levels of high-sensitivity cardiac troponin are strongly associated with risk of poor cardiovascular outcomes, according to a post-hoc analysis of a clinical trial.

An increased risk of cardiovascular adverse events and cardiovascular death was seen in COPD patients in the highest quintile of plasma cardiac troponin concentrations at baseline, results of the analysis show.

The findings highlight the potential utility of high-sensitivity cardiac troponin in both clinical trials and clinical practice, according to researcher.

“Recognizing the risk associated with increased troponin concentrations might encourage clinicians to address cardiovascular risk due to lifestyle choices, and make patients more likely to engage with these recommendations.”

 Improved risk stratification may also help clinicians more appropriately target the use of preventive medications in COPD patients, they added in the report. The analysis by Dr. Mills and colleagues was based on assessment of cardiac troponin I concentrations for patients in SUMMIT, a randomized trial assessing inhaled corticosteroids and long-acting beta agonists in COPD patients with elevated cardiovascular risk.

A total of 1,599 patients in the SUMMIT trial had a baseline cardiac troponin I assessment, and 1,258 had a follow-up assessment at three months following randomization.

Compared with those in the lowest quintile, patients in the highest quintile of baseline plasma cardiac troponin concentrations had an increased risk of a cardiovascular composite event, even after adjusting for confounding variables (hazard ratio, 3.67; 95 percent confidence interval, 1.33-10.13; P = .012).

Increased risk of cardiovascular death was also seen in the highest quintile as compared with the lowest quintile (HR, 20.06; 95 percent CI, 2.44-165.15; P = .005), investigators said. There was no difference in risk of COPD exacerbations between the highest and lowest quintiles, they added.

At three months, there were no differences in troponin concentrations related to COPD treatment, consistent with previous observations in the SUMMIT trial that treatment did not impact the cardiovascular composite endpoint, investigators said.

However, patients with a plasma troponin of 5 ng/L or greater recorded at either the baseline or three-month assessment had an increased rate of the composite cardiovascular endpoint and a “markedly increased” risk of cardiovascular death, they wrote.