1Universitäres Herz- und Gefäßzentrum Hamburg Klinik für Kardiologie Hamburg, Deutschland; 2Universitäres Herz- und Gefäßzentrum Hamburg Klinik für Kardiologie mit Schwerpunkt Elektrophysiologie Hamburg, Deutschland; 3Universitäres Herz- und Gefäßzentrum Hamburg Allgemeine und Interventionelle Kardiologie Hamburg, Deutschland
Background: Elevated Troponin serum concentrations are associated with adverse outcomes and have been proposed as biomarkers for risk assessment. However, individual patient characteristics can affect Troponin levels, distorting their predictive capabilities. Information about the association of high sensitive Troponin T (hsTnT) and I (hsTnI) with modifiable lifestyle factors (modLSF) as potential confounders is lacking, which we aimed to investigate in the current study.
Methods: Patients undergoing coronary angiography were included in a single-centre prospective cohort study from 2015 to 2020. We excluded patients with acute coronary syndromes, heart transplant recipients as well as individuals with missing hsTnT/hsTnI concentrations at baseline. 1,472 patients were left for analyses. ModLSF were defined as follows: Body mass index (BMI) ≥25 - <35, lack of physical activity (PA) <1.5 h/week, Mediterranean diet score (MDS) ≤12 and active smoking. Subgroups according to the number of modLSF (0-4) were created. Multivariable linear regression models were calculated for the association between modLSF and hsTnT/I concentrations adjusting for age, sex, low-density lipoprotein cholesterol, diabetes mellitus, estimated glomerular filtration rate and coronary artery disease (CAD) severity as measured by the Gensini score.
Results: Median age was 70.3 (IQR 61.4-76.6) and 28.5% of all patients were female. 80% of the study population had prevalent CAD. A total of 142 patients had 0 modLSF, while N=379, N=542, N=347 and N=62 presented with 1,2,3 or 4 modLSF, respectively. Distribution of modLSF and baseline characteristics are shown in Table 1. In fully adjusted linear regression analysis (Figure 1a), the composite of 4 modLSF was associated with both hsTnT (Beta: 39.68, 95% CI: 21.67-57.69; p< 0.001) and hsTnI (Beta: 38.43, 95% CI: 13.44-63.42; p=0.0026). Whilst hsTnI showed no association for individual modLSF, an independent association of active smoking (Beta: 14.35, 95% CI: 5.49-23.21; p=0.0015) and lack of PA (Beta: 9.01, 95% CI: 2.24-15.79; p=0.0092) with hsTnT was observed (Figure 1b).
Conclusion: A high modLSF burden is associated with both raised hsTnT and hsTnI serum concentrations, whilst active smoking and lack of PA had an independent effect on hsTnT levels. Optimization of modLSF might thus lead to lower hsTn serum concentrations, underscoring an inherent potential health benefit.
|
Overall (n=1,472) |
0 modLSF (n=142) |
1 modLSF (n=379) |
2 modLSF (n=542) |
3 modLSF (n=347) |
4 modLSF (n=62) |
p-value | |
|
Female No. (%) |
420 (28.5) |
50 (35.2) |
120 (31.7) |
157 (29.0) |
80 (23.1) |
13 (21.0) |
0.019 |
|
Age |
70.3 (61.4, 76.6) |
71.7 (65.8, 76.4) |
71.2 (62.2, 77.0) |
71.7 (62.3, 78.0) |
68.4 (59.1, 75.2) |
59.1 (53.7, 66.4) |
<0.001 |
|
CAD No. (%) |
1,176 (80.0) |
102 (71.8) |
288 (76.2) |
450 (83.0) |
284 (82.1) |
52 (83.9) |
0.0074 |
|
BMI ≥25 - <35No. (%) |
862 (58.6) |
- |
155 (40.9) |
359 (66.2) |
287 (82.7) |
62 (100) |
<0.001 |
|
Active Smoking No. (%) |
211 (14.3) |
- |
11 (2.9) |
37 (6.8) |
101 (29.1) |
62 (100) |
<0.001 |
|
MDS ≤12 No. (%) |
669 (45.4) |
- |
48 (12.7) |
245 (45.2) |
313 (90.2) |
62 (100) |
<0.001 |
|
PA <1.5h/week No. (%) |
1,010 (68.8) |
- |
165 (43.5) |
443 (81.7) |
340 (98.0) |
61 (100) |
<0.001 |
|
hsTnT (ng/l) |
15.0 (8.0, 28.0) |
10.0 (6.2, 15.8) |
14.0 (9.0, 24.5) |
16.0 (9.0, 28.0) |
18.0 (9.0, 35.5) |
15.5 (7.0, 41.5) |
<0.001 |
|
hsTnI (ng/l) |
7.7 (3.4, 18.8) |
5.2 (2.4, 10.1) |
7.4 (3.1, 19.2) |
8.0 (3.7, 19.2) |
9.7 (4.2, 21.8) |
6.5 (2.4, 29.7) |
<0.001 |
|
Table 1: Baseline characteristics according to the overall cohort and stratified by the modLSF burden. | |||||||