6533b7cffe1ef96bd1258def

RESEARCH PRODUCT

Making it More Sensitive

subject

description

About a decade ago, the prevailing wisdom was that conventional risk factors explained only approximately half of the risk for a myocardial infarction or stroke. Consequently, efforts to identify novel risk factors were undertaken to improve cardiovascular risk prediction. The hypothesis that inflammation is a central contributor to atherothrombosis has stimulated sustained efforts to characterize the specific molecules and pathways that may be involved and to identify biomarkers in humans that enable detection of underlying inflammatory activation to improve cardiovascular risk prediction. Ridker et al1 pioneered this work and reported that systemic low-grade inflammation assessed by measurements of the acute-phase reactant C-reactive protein is associated with future cardiovascular events in apparently healthy individuals. After this, B-type natriuretic peptide and its N-terminal fragment were highlighted to predict cardiovascular risk even in the general population.2 Overall, C-reactive protein and the N-terminal fragment of B-type natriuretic peptide have most consistently improved risk estimates in specific populations. However, prediction metrics, which inform us about the predictive values beyond classic risk factors, have been less persuasive, and controversial data have been discussed. Recently, a new player entered the field of cardiovascular risk prediction. Troponin, assayed with a highly sensitive test that allows for reliable detection at very low concentrations, is associated with incident heart failure and mortality in the community.3,4 In this issue of Circulation , Saunders et al5 report findings from the Atherosclerosis Risk in Communities (ARIC) Study extending this knowledge and indicating that troponin T concentrations are associated with incident coronary heart disease, mortality, and hospitalization for heart failure in the general population not formerly known to have cardiac disease. Even in the very-low-concentration range, troponin T is related to incident heart failure and mortality. Article see p 1367 The advent of troponin testing in the emergency …