Clinical Chemistry - Journal Club
The Clinical Chemistry Journal Club allows readers to discuss key articles by using focused slides as teaching tools. Each month Clinical Chemistry posts the original article and slides online, and they are then distributed to individuals and university Journal Clubs.
Original Article: https://doi.org/10.1093/clinchem/hvaf016
Slides: Download ppt
Emerging evidence suggests that the ratio between cardiac troponin (cTn) I and T may provide information on the risk of adverse outcomes in individuals with cardiovascular disease. Whether the cTn I/T ratio provides prognostic insights in the general population is unknown.
The cTn I/T ratio was calculated in 8855 participants (43% female, median age 56 years) from the Generation Scotland Study where both cTnI and cTnT concentrations were above the limit of blank. Multivariable cause-specific Cox proportional hazard models were used to estimate the associations between cTn I/T ratio and the primary outcome of cardiovascular or non-cardiovascular death.
The median cTn I/T ratio was 0.5 (25th–75th percentile, 0.3–0.8) and median follow-up was 11.4 (10.8–12.7) years. Individuals in the highest ratio tertile (≥0.64) were more likely to be male, have a higher body mass index and systolic blood pressure, and a history of cardiovascular disease. Those in the lowest ratio tertile (<0.38) were more likely to be smokers or have diabetes. After adjustment for cardiovascular risk factors, the cTn I/T ratio was positively associated with cardiovascular death (per doubling increase, adjusted hazard ratio [HR] 1.16 [95% CI, 1.05–1.28]), while an inverse association was observed for non-cardiovascular death (HR 0.89 [95% CI, 0.81–0.99]).
The cTn I/T ratio is positively associated with cardiovascular death in the general population, while inversely associated with non-cardiovascular death. Future research is needed to unravel underlying mechanisms and determine whether the cTn I/T ratio provides valuable information regarding risk of cardiovascular and non-cardiovascular mortality to guide further management.