Clinical Application of High-Sensitivity Troponin Testing in the Atherosclerotic Cardiovascular Disease Framework of the Current Cholesterol Guidelines
The 2018 American Heart Association/American College of Cardiology (AHA/ACC) cholesterol management guidelines proposed two different treatments for 2 distinct groups of atherosclerotic cardiovascular disease (ASCVD) patients identified. The role of high-sensitivity troponin (hsTn) in complementing this guideline is unknown. Marston and colleagues (2020) conducted research titled “Clinical Application of High-Sensitivity Troponin Testing in the Atherosclerotic Cardiovascular Disease Framework of the Current Cholesterol Guidelines” published in “the Journal of American College of Cardiology”. Summary of the study is provided below:
Objectives:
To investigate whether hsTn testing complements ASCVD guidelines in classifying risk group for the suitable treatment approach.
Method:
Patients of at least 50 years of age with a history of myocardial infarction (MI) within the last 1-3 years along with 1 high-risk feature were enrolled. With the background of Aspirin–Thrombolysis in Myocardial Infarction 54 (PEGASUS-TIMI 54) trial participants were enrolled under the Prevention of Cardiovascular Events in Patients with Prior Heart Attack Using Ticagrelor Compared to Placebo.
Two groups of high-risk ASCVD and low-risk ASCVD were formed based on their cardiovascular history and comorbidities. Classification also included hnTn levels using cut points of 2 ng/L as a limit of detection and 6 ng/L as a risk threshold.
Findings:
The study highlights 3 findings in compliance with current AHA/ACC cholesterol management guidelines:
1) Two distinct groups were identified at different risk for future major CV events as per risk stratification mentioned in guidelines for ASCVD patients.
2) hsTnI level were enough to stratify risk along with ASCVD risk group in guidelines.
3) hsTnI levels added to guideline defined ASCVD groups and reclassifies risk appropriately.
Testing hsTnI levels are an easy and affordable ways to classify patients at low, intermediate, and high CV risk. Identification at the level of 2-fold higher risk can be achieved when hsTnI levels exceed 6ng/L and lower risk can be identified below 2ng/L. Analysis suggests this inexpensive and widely available biomarker to assess ASCVD risk to ensure suitable therapies. Risk stratification with hsTnI was founded to be complementary with 13 clinical risk factors in the guideline-based ASCVD framework.
Limitation:
The study included all patients with MI history; hence findings may not be suitable to generalize for all ASCVD patients. Some components like LDL-C level and apoB level of the guidelines’ risk stratification approach were not available in the study and used as a surrogate. Investigators suggest to not extend this similar cut point for other troponin assays as findings particularly included hsTnI assay.
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