Cardiac Troponin I and Cardiovascular Risk in Patients With Chronic Obstructive Pulmonary Disease

Philip D. Adamson; Julie A. Anderson; Robert D. Brook; Peter M.a. Calverley; Bartolome R. Celli; Nicholas J. Cowans; Courtney Crim; Ian J. Dixon; Fernando J. Martinez; David E. Newby; Jorgen Vestbo; Julie C. Yates; Nicholas L. Mills

doi:10.1016/j.jacc.2018.06.051

Cardiac Troponin I and Cardiovascular Risk in Patients With Chronic Obstructive Pulmonary Disease

Philip D. Adamson, Julie A. Anderson, Robert D. Brook, Peter M.a. Calverley, Bartolome R. Celli, Nicholas J. Cowans, Courtney Crim, Ian J. Dixon, Fernando J. Martinez, David E. Newby, Jorgen Vestbo, Julie C. Yates, Nicholas L. Mills

Division of Immunology, Immunity to Infection and Respiratory Medicine

Research output: Contribution to journal › Article › peer-review

Abstract

Background Patients with chronic obstructive pulmonary disease (COPD) have increased risk of cardiovascular events. Objectives This study evaluated the association between high-sensitivity cardiac troponin I concentration and cardiovascular events in patients with COPD and heightened cardiovascular risk. Methods In a double-blind randomized controlled trial, 16,485 patients with COPD and cardiovascular disease or risk factors were randomized to once daily inhaled placebo, fluticasone furoate (100 μg), vilanterol (25 μg), or their combination. Plasma high-sensitivity cardiac troponin I concentrations were measured in a subgroup of 1,599 patients. Outcomes were on-treatment cardiovascular events and COPD exacerbations over a median of 18 months, and cardiovascular death over a median of 27 months. Results Baseline plasma cardiac troponin I concentrations were above the limit of detection (1.2 ng/l) in 1,542 (96%) patients. Concentrations were unaffected by inhaled therapies at 3 months (p > 0.05). Compared with the lowest quintile (cardiac troponin <2.3 ng/l), patients in the highest quintile (≥7.7 ng/l) were at greater risk of cardiovascular events (hazard ratio [HR] 3.7; 95% confidence interval [CI]: 1.3 to 10.1; p = 0.012) and cardiovascular death (HR: 20.1; 95% CI: 2.4 to 165.2; p = 0.005) after adjustment for risk factors. By contrast, there were no differences in exacerbations between quintiles (HR: 1.1; 95% CI: 0.8 to 1.5; p = 0.548). Conclusions In patients with COPD and heightened cardiovascular risk, plasma cardiac troponin I concentrations are a specific and major indicator of future cardiovascular events and cardiovascular death. Inhaled therapies did not affect cardiac troponin I concentrations consistent with their neutral effect on mortality and cardiovascular outcomes. (Study to Evaluate the Effect of Fluticasone Furoate/Vilanterol on Survival in Subjects With Chronic Obstructive Pulmonary Disease [SUMMIT]; NCT01313676)

Original language	English
Pages (from-to)	1126-1137
Journal	Journal of the American College of Cardiology
Volume	72
Issue number	10
Early online date	27 Aug 2018
DOIs	https://doi.org/10.1016/j.jacc.2018.06.051
Publication status	Published - 4 Sept 2018

Research Beacons, Institutes and Platforms

Lydia Becker Institute

UN SDGs

This output contributes to the following UN Sustainable Development Goals (SDGs)

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10.1016/j.jacc.2018.06.051Licence: CC BY

https://linkinghub.elsevier.com/retrieve/pii/S0735109718354433

Cite this

Adamson, P. D., Anderson, J. A., Brook, R. D., Calverley, P. M. A., Celli, B. R., Cowans, N. J., Crim, C., Dixon, I. J., Martinez, F. J., Newby, D. E., Vestbo, J., Yates, J. C., & Mills, N. L. (2018). Cardiac Troponin I and Cardiovascular Risk in Patients With Chronic Obstructive Pulmonary Disease. Journal of the American College of Cardiology, 72(10), 1126-1137. https://doi.org/10.1016/j.jacc.2018.06.051

@article{b41d3b34c8984d87be68e80741c943f7,

title = "Cardiac Troponin I and Cardiovascular Risk in Patients With Chronic Obstructive Pulmonary Disease",

abstract = "Background Patients with chronic obstructive pulmonary disease (COPD) have increased risk of cardiovascular events. Objectives This study evaluated the association between high-sensitivity cardiac troponin I concentration and cardiovascular events in patients with COPD and heightened cardiovascular risk. Methods In a double-blind randomized controlled trial, 16,485 patients with COPD and cardiovascular disease or risk factors were randomized to once daily inhaled placebo, fluticasone furoate (100 μg), vilanterol (25 μg), or their combination. Plasma high-sensitivity cardiac troponin I concentrations were measured in a subgroup of 1,599 patients. Outcomes were on-treatment cardiovascular events and COPD exacerbations over a median of 18 months, and cardiovascular death over a median of 27 months. Results Baseline plasma cardiac troponin I concentrations were above the limit of detection (1.2 ng/l) in 1,542 (96%) patients. Concentrations were unaffected by inhaled therapies at 3 months (p > 0.05). Compared with the lowest quintile (cardiac troponin <2.3 ng/l), patients in the highest quintile (≥7.7 ng/l) were at greater risk of cardiovascular events (hazard ratio [HR] 3.7; 95% confidence interval [CI]: 1.3 to 10.1; p = 0.012) and cardiovascular death (HR: 20.1; 95% CI: 2.4 to 165.2; p = 0.005) after adjustment for risk factors. By contrast, there were no differences in exacerbations between quintiles (HR: 1.1; 95% CI: 0.8 to 1.5; p = 0.548). Conclusions In patients with COPD and heightened cardiovascular risk, plasma cardiac troponin I concentrations are a specific and major indicator of future cardiovascular events and cardiovascular death. Inhaled therapies did not affect cardiac troponin I concentrations consistent with their neutral effect on mortality and cardiovascular outcomes. (Study to Evaluate the Effect of Fluticasone Furoate/Vilanterol on Survival in Subjects With Chronic Obstructive Pulmonary Disease [SUMMIT]; NCT01313676)",

author = "Adamson, {Philip D.} and Anderson, {Julie A.} and Brook, {Robert D.} and Calverley, {Peter M.a.} and Celli, {Bartolome R.} and Cowans, {Nicholas J.} and Courtney Crim and Dixon, {Ian J.} and Martinez, {Fernando J.} and Newby, {David E.} and Jorgen Vestbo and Yates, {Julie C.} and Mills, {Nicholas L.}",

year = "2018",

month = sep,

day = "4",

doi = "10.1016/j.jacc.2018.06.051",

language = "English",

volume = "72",

pages = "1126--1137",

journal = "Journal of the American College of Cardiology",

issn = "0735-1097",

publisher = "Elsevier BV",

number = "10",

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Adamson, PD, Anderson, JA, Brook, RD, Calverley, PMA, Celli, BR, Cowans, NJ, Crim, C, Dixon, IJ, Martinez, FJ, Newby, DE, Vestbo, J, Yates, JC & Mills, NL 2018, 'Cardiac Troponin I and Cardiovascular Risk in Patients With Chronic Obstructive Pulmonary Disease', Journal of the American College of Cardiology, vol. 72, no. 10, pp. 1126-1137. https://doi.org/10.1016/j.jacc.2018.06.051

TY - JOUR

T1 - Cardiac Troponin I and Cardiovascular Risk in Patients With Chronic Obstructive Pulmonary Disease

AU - Adamson, Philip D.

AU - Anderson, Julie A.

AU - Brook, Robert D.

AU - Calverley, Peter M.a.

AU - Celli, Bartolome R.

AU - Cowans, Nicholas J.

AU - Crim, Courtney

AU - Dixon, Ian J.

AU - Martinez, Fernando J.

AU - Newby, David E.

AU - Vestbo, Jorgen

AU - Yates, Julie C.

AU - Mills, Nicholas L.

PY - 2018/9/4

Y1 - 2018/9/4

N2 - Background Patients with chronic obstructive pulmonary disease (COPD) have increased risk of cardiovascular events. Objectives This study evaluated the association between high-sensitivity cardiac troponin I concentration and cardiovascular events in patients with COPD and heightened cardiovascular risk. Methods In a double-blind randomized controlled trial, 16,485 patients with COPD and cardiovascular disease or risk factors were randomized to once daily inhaled placebo, fluticasone furoate (100 μg), vilanterol (25 μg), or their combination. Plasma high-sensitivity cardiac troponin I concentrations were measured in a subgroup of 1,599 patients. Outcomes were on-treatment cardiovascular events and COPD exacerbations over a median of 18 months, and cardiovascular death over a median of 27 months. Results Baseline plasma cardiac troponin I concentrations were above the limit of detection (1.2 ng/l) in 1,542 (96%) patients. Concentrations were unaffected by inhaled therapies at 3 months (p > 0.05). Compared with the lowest quintile (cardiac troponin <2.3 ng/l), patients in the highest quintile (≥7.7 ng/l) were at greater risk of cardiovascular events (hazard ratio [HR] 3.7; 95% confidence interval [CI]: 1.3 to 10.1; p = 0.012) and cardiovascular death (HR: 20.1; 95% CI: 2.4 to 165.2; p = 0.005) after adjustment for risk factors. By contrast, there were no differences in exacerbations between quintiles (HR: 1.1; 95% CI: 0.8 to 1.5; p = 0.548). Conclusions In patients with COPD and heightened cardiovascular risk, plasma cardiac troponin I concentrations are a specific and major indicator of future cardiovascular events and cardiovascular death. Inhaled therapies did not affect cardiac troponin I concentrations consistent with their neutral effect on mortality and cardiovascular outcomes. (Study to Evaluate the Effect of Fluticasone Furoate/Vilanterol on Survival in Subjects With Chronic Obstructive Pulmonary Disease [SUMMIT]; NCT01313676)

AB - Background Patients with chronic obstructive pulmonary disease (COPD) have increased risk of cardiovascular events. Objectives This study evaluated the association between high-sensitivity cardiac troponin I concentration and cardiovascular events in patients with COPD and heightened cardiovascular risk. Methods In a double-blind randomized controlled trial, 16,485 patients with COPD and cardiovascular disease or risk factors were randomized to once daily inhaled placebo, fluticasone furoate (100 μg), vilanterol (25 μg), or their combination. Plasma high-sensitivity cardiac troponin I concentrations were measured in a subgroup of 1,599 patients. Outcomes were on-treatment cardiovascular events and COPD exacerbations over a median of 18 months, and cardiovascular death over a median of 27 months. Results Baseline plasma cardiac troponin I concentrations were above the limit of detection (1.2 ng/l) in 1,542 (96%) patients. Concentrations were unaffected by inhaled therapies at 3 months (p > 0.05). Compared with the lowest quintile (cardiac troponin <2.3 ng/l), patients in the highest quintile (≥7.7 ng/l) were at greater risk of cardiovascular events (hazard ratio [HR] 3.7; 95% confidence interval [CI]: 1.3 to 10.1; p = 0.012) and cardiovascular death (HR: 20.1; 95% CI: 2.4 to 165.2; p = 0.005) after adjustment for risk factors. By contrast, there were no differences in exacerbations between quintiles (HR: 1.1; 95% CI: 0.8 to 1.5; p = 0.548). Conclusions In patients with COPD and heightened cardiovascular risk, plasma cardiac troponin I concentrations are a specific and major indicator of future cardiovascular events and cardiovascular death. Inhaled therapies did not affect cardiac troponin I concentrations consistent with their neutral effect on mortality and cardiovascular outcomes. (Study to Evaluate the Effect of Fluticasone Furoate/Vilanterol on Survival in Subjects With Chronic Obstructive Pulmonary Disease [SUMMIT]; NCT01313676)

U2 - 10.1016/j.jacc.2018.06.051

DO - 10.1016/j.jacc.2018.06.051

M3 - Article

SN - 0735-1097

VL - 72

SP - 1126

EP - 1137

JO - Journal of the American College of Cardiology

JF - Journal of the American College of Cardiology

IS - 10

ER -