Troponin measure needed to accurately predict cardiovascular risk, say researchers

Measuring troponin levels alongside cholesterol significantly boosts the accuracy of cardiovascular risk prediction, a UK-funded study has found.

The researchers modelled risk using conventional measures such as age, blood pressure and cholesterol, with or without troponin in more than 62,000 patients who had taken part in studies in Europe and the US.

Adding troponin results increased the prediction accuracy of a heart attack or stroke within 10 years by up to four times.

They then used UK data to model the implications on statin prescribing should troponin be added to the risk calculators.

On an individual basis the difference was small but impactful at the population level, the researchers said.

For people currently found to be at intermediate risk on routine cardiovascular health assessments, the tests would prevent one heart attack or stroke for roughly every 500 people tested.

Reporting the results in the Journal of the American College of Cardiology, the team said the troponin test was especially effective at spotting danger in the 35% of people currently assessed to be at intermediate risk of cardiovascular problems.

The addition of troponin tests to the calculation meant that up to 8% of people were moved from intermediate risk to high risk, making them eligible for preventive treatment.

Lead author Professor Anoop Shah, professor of cardiovascular medicine at the London School of Hygiene and Tropical Medicine, said: ‘Troponin, even in the normal range, is a powerful indicator of silent heart muscle damage.

‘As such, the test provides an extra layer of information that we can use to boost our accuracy when predicting people’s risk.

‘We want to identify as many high risk people as possible, so that no-one misses out on the opportunity to get preventative treatment.’

 Professor Bryan Williams, chief scientific and medical officer at the British Heart Foundation who funded the research said: ‘Developments in risk prediction have helped doctors to build effective algorithms that can spot those most at risk of heart attacks and strokes.

‘But, with around 100,000 hospital admissions for heart attacks alone in the UK each year, it’s clear that there is still plenty of room for improvement.

‘This new data suggests adding this blood test to current risk prediction models could help medical professionals identify more people who are at higher risk and deliver advice and treatment to reduce their risk of future heart attack and strokes.’