Blood Biomarkers Identify Individuals at Risk of Heart Attack or Stroke

A recent study found that elevated levels of high-sensitivity cardiac troponin T or NT-proBNP characterized individuals with elevated blood pressure (BP) or hypertension not currently recommended for anti-hypertensive medication who are at high risk for cardiovascular (CV) events such as heart attack or stroke.

Cardiac troponin T (cTnT) and N-terminal pro-B-type natriuretic peptide (NT-proBNP) are biomarkers of chronic myocardial injury and stress. These proteins are detectable in the general population and are associated with adverse cardiovascular events. Whether these biomarkers can influence CV risk stratification and treatment decisions among adults with elevated BP and hypertension is unclear.

Investigators at the University of Texas Southwestern Medical Center (Dallas, TX, USA) hypothesized that elevated levels of these biomarkers could identify individuals with elevated BP or hypertension not currently recommended for pharmacological treatment who may benefit from antihypertensive medication.

To test this theory, the investigators analyzed data from 12,987 participants of three studies: Atherosclerosis Risk in Communities Study, the Dallas Heart Study, and the Multi-Ethnic Study of Atherosclerosis. The participants were of mean age 55 years, with 55% being female. Members of the group experienced 825 cardiovascular events, such as heart attacks and strokes, over a median follow-up time of 10 years.

Results of the analysis revealed that elevated high-sensitivity cardiac troponin T or NT-proBNP identified individuals with elevated BP or hypertension not currently recommended for antihypertensive medication who were at high risk for CV events. The presence of nonelevated levels of the biomarkers, even in the setting of stage I or stage II hypertension, was associated with lower risk.

"One of the proteins, high sensitivity troponin, measures injury to the heart muscle, and the other, called NT-proBNP, measures stress on the heart muscle," said senior author Dr. Joshi Pandey, assistant professor of internal medicine at the University of Texas Southwestern Medical Center. "The presence of these proteins is indicative of subtle long-term cardiac injury, like wear and tear over time. The process of developing heart disease can be difficult to pick up on based only on these risk factors. Now we have tests to detect markers of heart disease in people without any symptoms who are actually at higher risk for cardiovascular events. It is important to note that we have to make sure health care providers act appropriately when there is an abnormal result, and not necessarily recommend a series of tests without symptoms. We think this type of test can help in the shared decision-making process for patients who need more information about their risk. These blood tests are easily accessible and are less expensive than some other tests for risk assessment."

The study was published in the November 11, 2019, online edition of the journal Circulation.

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University of Texas Southwestern Medical Center