Association of modifiable lifestyle risk factors with high-sensitivity troponin T and I concentrations and clinical outcomes

Abstract

Aims We aimed to investigate the association between the burden of modifiable lifestyle risk factors (modLRF) with high-sensitivity cardiac troponins T and I (hsTnT/I) and clinical outcomes in a contemporary cohort. Methods Patients undergoing coronary angiography with available hsTnT/I concentrations and information about modLRF were in- and results cluded in the current single-centre study. The modLRF investigated were overweight, lack of physical activity, poor adherence to a Mediterranean diet, and current smoking. To evaluate the impact of modLRF on hsTnT/I levels, a linear regression model was used. A Cox regression analysis was computed to investigate the association of hsTnT/I levels with clinical outcomes, stratified by the burden of modLRF, and a C-index was calculated to investigate the additive predictive benefit of the integration of hsTn on top of a base model containing modLRF only. Outcomes of interest were all-cause mortality and major adverse cardiovascular events (MACE). In the overall study population of n = 1716 patients, the median troponin levels were 15.0 ng/L (Interquartile [IQR] 8.0, 29.0) and 7.6 ng/L (IQR 3.3, 18.6) for hsTnT and I, respectively. An increasing number of modLRF were independently associated with elevated hsTnT and I concentrations. Moreover, hsTnT and hsTnI were independently associated with all-cause mortality in patients with 1–2 and ≥3 modLRF, and an incremental value of the integration of hsTnT and hsTnI was noted, especially in the prediction of all-cause mortality. Lastly, an independent association of hsTnI with MACE was documented in patients with 1–2 modLRF, which was not the case for hsTnT. Conclusion Increasing numbers of modLRF are associated with elevated concentrations of hsTnT and I, whilst the predictive capability of troponins varied according to the presence of modLRF. Further prospective studies are needed to investigate whether targeting modLRF might result in lower hsTn concentrations and improved outcomes. Lay summary This study investigated whether certain lifestyle risk factors, such as being overweight, lack of exercise, current smoking, and a poor diet, affect the levels of specific heart damage markers in the blood (high-sensitivity troponins T and I) as well as clinical outcomes.