Abstract 12260: Sex Differences in Cardiac Troponin I and the Risk of Death or Major Cardiovascular Events in Primary Prevention

Abstract

Introduction: Circulating cardiac troponin I concentrations are higher in men than in women, but the biological causes and clinical implications of this observation are poorly understood. Methods and Results: We measured cardiac troponin I with a novel high-sensitivity assay (hsTnI) in 4696 women and 8260 men enrolled in the JUPITER trial who had LDL-C < 130 mg/dL and hsCRP ≥ 2.0 mg/L and no diabetes or clinical evidence of vascular disease. Median (IQR) hsTnI was higher in men [3.6 ng/L (2.7-5.3)] than in women [3.1 ng/L (2.3-4.5); P<0.0001]. A higher proportion of men (3.7%) than women (2.9%) were above the proposed upper reference limit of 24 ng/L (P=0.008). In linear regression models, sex remained a significant predictor of natural log normalized hsTnI after adjusting for a wide array of confounders, including age, race, height, weight, lipids, fasting glucose, blood pressure, and renal function. Across quintiles of hsTnI measured at baseline, the unadjusted incidence rate of the composite outcome of myocardial infarction, stroke, hospitalization for unstable angina, revascularization, or death increased across hsTnI categories but appeared similar in women and men (Figure 1). In adjusted Cox models stratified by sex, the increase in the relative risk of the composite endpoint across quintiles of hsTnT appeared similar in men and women (Figure 2; P-interaction=0.45). Conclusions: In a contemporary primary prevention population, women have lower baseline cardiac troponin I concentrations but similar increases in the rates of vascular events and death across troponin I categories.