Troponin at the Heart of it

“It is well established that high-sensitivity cardiac troponin concentrations can predict cardiovascular events, but it is not clear to clinicians how we can use this information to guide patient care,” says Nicholas Mills, Chair of Cardiology at The University of Edinburgh.

Eager to seek out the full benefit of the metric’s clinical potential, Mills acquired funding from the British Heart Foundation to lead an investigation to determine whether cardiac troponin I (cTnI) concentrations could predict cardiovascular risk or identify those healthy individuals who would benefit most from statin therapy.

In the study, Mills and his colleagues used novel, highly sensitive assays to measure cTnI levels in patients’ plasma and found that increased concentration suggested an elevated risk of coronary heart disease (1) – but that’s not all. The team also discovered that the protein may be a better indicator of statin therapy effects than standard cholesterol measurements. “Perhaps our most important observation was that troponin concentrations are reduced by statin therapy,” Mills says. “And individuals who have the greatest reduction in troponin have the lowest risk of coronary heart disease.” According to Mills, the absolute reduction in risk with statin therapy was threefold greater in men with hs-cTnI concentrations over 5 ng/L than in those below 5 ng/L. “In clinical practice we repeatedly measure cholesterol after initiating treatment. But our observations suggest that we should be tracking response to treatments for the prevention of coronary heart disease with high-sensitivity cardiac troponin I measurements,” says Mills.

In fact, he believes that cardiac troponin concentration has the potential to become the gold standard for predicting heart disease risk – and for tracking statin effectiveness, but notes that more work needs to be done: “We need to determine whether similar changes occur in women and in populations with coronary heart disease, and to determine whether a risk stratification threshold of 5 ng/L can also be applied to these populations.”