Response to: ‘Convalescent troponin and cardiovascular death following acute coronary syndrome’ by Kawada

• Published in: Heart (British Cardiac Society) Vol. 106; no. 7; pp. 545 - 546
• Main Authors: Adamson, Philip D, Mills, Nicholas L, Newby, David E, Troughton, Richard W, Doughty, Rob N, Richards, A Mark
• Format: Journal Article
• Language: English
• Published: England BMJ Publishing Group Ltd and British Cardiovascular Society 01.04.2020; BMJ Publishing Group LTD
• Subjects: Acute Coronary Syndrome; Acute coronary syndromes; Angina pectoris; Cardiovascular disease; Cardiovascular System; Correspondence; Diabetes; Heart; Humans; Myocardial Infarction; Patients; Troponin; United Kingdom > UK; acute coronary syndromes
• ISSN: 1355-6037; 1468-201X; 1468-201X
• DOI: 10.1136/heartjnl-2020-316547

[...]although dichotomised troponin T concentrations did not identify a preferred mode of revascularisation in the Bypass Angioplasty Revascularization Investigation 2 Diabetes (BARI-2D) trial, there is clear evidence that systemic therapies such as sodium glucose cotransporter 2 inhibitors and statins provide potential therapeutic options that lower both troponin concentrations and cardiovascular events, and individuals with the highest troponin concentrations appear to derive the greatest overall benefit from these treatments. [...]while recognising the relevance of metabolic disorders in cardiovascular risk, we found the inclusion of diabetes and hypercholesterolaemia did not substantially alter the prognostic value of troponin, with an adjusted HR of 1.35 (95% CI 1.15 to 1.58) within a multivariable Cox proportional hazards model (see online supplementary table 2). [...]recognising the complex and multifaceted nature of cardiovascular diseases, we wholeheartedly agree that convalescent cardiac troponin concentrations should be considered in the entire clinical context.