Longitudinal Changes in Cardiac Troponin and Risk of Heart Failure Among Black Adults


      • Among Black adults, one-quarter had new or stable elevated troponin on follow-up.
      • Incident elevation in troponin was associated with a higher risk of heart failure.
      • Stable or worsened elevated troponin was associated with a higher heart failure risk.



      Among Black adults, high-sensitivity cardiac troponin I (hs-cTnI) is associated with heart failure (HF) risk. The association of longitudinal changes in hs-cTnI with risk of incident HF, HF with reduced and preserved ejection fraction (HFrEF and HFpEF, respectively), among Black adults is not well-established.

      Methods and Results

      This study included Black participants from the Jackson Heart Study with available hs-cTnI data at visits 1 (2000–2004) and 2 (2005–2008) and no history of cardiovascular disease. Cox models were used to evaluate associations of categories of longitudinal change in hs-cTnI with incident HF risk. Among 2423 participants, 11.6% had incident elevation in hs-cTnI at visit 2, and 16.9% had stable or improved elevation (≤50% increase in hs-cTnI), and 4.0% had worsened hs-cTnI elevation (>50% increase). Over a median follow-up of 12.0 years, there were 139 incident HF hospitalizations (64 HFrEF, 58 HFpEF). Compared with participants without an elevated hs-cTnI, those with incident, stable or improved, or worsened hs-cTnI elevation had higher HF risk (adjusted hazard ratio 3.20 [95% confidence interval, 1.92–5.33]; adjusted hazard ratio 2.40, [95% confidence interval, 1.47–3.92]; and adjusted hazard ratio 8.10, [95% confidence interval, 4.74–13.83], respectively). Similar patterns of association were observed for risk of HFrEF and HFpEF.


      Among Black adults, an increase in hs-cTnI levels on follow-up was associated with a higher HF risk.

      Lay Summary

      The present study included 2423 Black adults from the Jackson Heart Study with available biomarkers of cardiac injury and no history of cardiovascular disease at visits 1 and 2. The majority of participants did not have evidence of cardiac injury at both visits (67.5%), 11.6% had evidence of cardiac injury only on follow-up, 14.5% had stable elevations, 4.0% had worsened elevations, and 2.4% had improved elevations of cardiac injury biomarkers during follow-up. Compared with participants without evidence of cardiac injury, those with new, stable, and worsened levels of cardiac injury had a higher risk of developing heart failure.


      Among Black adults, persistent or worsening subclinical myocardial injury is associated with an elevated risk of HF.

      Graphical Abstract

      Key Words

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      Linked Article

      • Serial Cardiac Troponin Measurements: A Prediction Tool for Heart Failure Risk in Black Patients?
        Journal of Cardiac Failure
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          Black adults are disproportionately affected by heart failure (HF), and incident HF rates are increasing in Black adults, who also have higher risks of hospitalization and age-adjusted mortality due to HF than White adults.1-3 These disparities in HF have, in part, been attributed to a higher prevalence of cardiovascular (CV) risk factors, inadequate treatment of HF and underuse of HF guideline-directed medical therapy.4,5 Understanding novel factors that may contribute to the heterogeneity of HF in Black individuals remains an unmet need.
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