Background Cardiac troponins are associated with adverse cardiovascular disease (CVD) outcomes. The value of high-sensitivity cardiac troponin I (hs-cTnI) independently and in concert with troponin T (hs-cTnT) in the management of hypertension has not been well studied. Methods We assessed the utility of hs-cTnI independently and with hs-cTnT in identifying the highest risk individuals in the Systolic Blood Pressure Intervention Trial (SPRINT). Among 8796 eligible SPRINT participants, hs-cTnI was measured at baseline and 1 year. The association of baseline level and 1-year change in hs-cTnI with CVD events and all-cause death was evaluated using adjusted Cox regression models. We further assessed the complementary value of hs-cTnI and hs-cTnT by identifying concordant and discordant categories and assessing their association with outcomes. Results hs-cTnI was positively associated with composite CVD risk [myocardial infarction, other acute coronary syndrome, stroke, or cardiovascular death: hazard ratio 1.23, 95% confidence interval 1.08–1.39 per 1-unit increase in log(troponin I)] independent of traditional risk factors, N-terminal pro-B-type natriuretic peptide, and hs-cTnT. Intensive blood pressure lowering was associated with greater absolute risk reduction (4.5% vs 1.7%) and lower number needed to treat (23 vs 59) for CVD events among those with higher baseline hs-cTnI (≥6 ng/L in men, ≥4 ng/L in women). hs-cTnI increase at 1 year was also associated with increased CVD risk. hs-cTnI and hs-cTnT were complementary, and elevations in both identified individuals with the highest risk for CVD and death. Conclusions Baseline levels and change in hs-cTnI over 1 year identified higher-risk individuals who may derive greater cardiovascular benefit with intensive blood pressure treatment. hs-TnI and hs-TnT have complementary value in CVD risk assessment. ClinicalTrials.gov Registration Number: NCT01206062.

中文翻译：

---

高敏心肌肌钙蛋白 I 和 T 与心血管结果：收缩压干预试验 (SPRINT) 的结果


背景 心肌肌钙蛋白与不良心血管疾病 (CVD) 结局相关。高敏心肌肌钙蛋白 I (hs-cTnI) 单独使用以及与肌钙蛋白 T (hs-cTnT) 联合使用在高血压治疗中的价值尚未得到充分研究。方法 我们独立评估了 hs-cTnI 以及与 hs-cTnT 一起在收缩压干预试验 (SPRINT) 中识别最高风险个体的效用。在 8796 名符合资格的 SPRINT 参与者中，在基线和 1 年测量了 hs-cTnI。使用调整后的 Cox 回归模型评估基线水平和 hs-cTnI 的 1 年变化与 CVD 事件和全因死亡的关联。我们通过识别一致和不一致的类别并评估它们与结果的关联，进一步评估了 hs-cTnI 和 hs-cTnT 的互补价值。结果 hs-cTnI 与复合 CVD 风险呈正相关[心肌梗死、其他急性冠状动脉综合征、中风或心血管死亡：风险比 1.23，95% 置信区间 1.08–1.39 log（肌钙蛋白 I）每增加 1 个单位]传统危险因素、N 端 B 型利钠肽原和 hs-cTnT。在基线 hs-cTnI 较高（男性≥6 ng/L，≥女性 4 纳克/升）。 1 年时 hs-cTnI 增加也与 CVD 风险增加相关。 hs-cTnI 和 hs-cTnT 是互补的，两者的升高都确定了心血管疾病和死亡风险最高的个体。 结论 一年内 hs-cTnI 的基线水平和变化确定了高风险个体，他们可以通过强化血压治疗获得更大的心血管益处。 hs-TnI 和 hs-TnT 在 CVD 风险评估中具有互补价值。 ClinicalTrials.gov 注册号：NCT01206062。