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

• Published in: Journal of the American College of Cardiology Vol. 72; no. 10; pp. 1126 - 1137
• Main Authors: Adamson, Philip D., Anderson, Julie A., Brook, Robert D., Calverley, Peter M.A., Celli, Bartolome R., Cowans, Nicholas J., Crim, Courtney, Dixon, Ian J., Martinez, Fernando J., Newby, David E., Vestbo, Jørgen, Yates, Julie C., Mills, Nicholas L.
• Format: Journal Article
• Language: English
• Published: United States Elsevier Inc 04.09.2018; Elsevier Limited; Elsevier Biomedical
• Subjects: Aged; Androstadienes - therapeutic use; Benzyl Alcohols - therapeutic use; Biomarkers - blood; Bronchodilator Agents - therapeutic use; Calcium-binding protein; cardiac troponin; Cardiology; Cardiovascular; Cardiovascular disease; Cardiovascular diseases; Cardiovascular Diseases - blood; Cardiovascular Diseases - epidemiology; cardiovascular risk; Chlorobenzenes - therapeutic use; Chronic obstructive pulmonary disease; Clinical trials; Coronary vessels; Death; Diabetes; Double-Blind Method; Family medical history; Female; Fluticasone; Glucocorticoids - therapeutic use; Heart; Heart attacks; Humans; Hypertension; Limit of Detection; Lung diseases; Male; Middle Aged; Mortality; Nebulizers and Vaporizers; Obstructive lung disease; Patients; Prospective Studies; Pulmonary Disease, Chronic Obstructive - drug therapy; Pulmonary Disease, Chronic Obstructive - epidemiology; Risk; Risk factors; Stroke; Studies; Troponin; Troponin I; Troponin I - blood; CV; cardiac troponin; CI; LABA; ICS; FEV1; HR; cardiovascular risk; IQR; chronic obstructive pulmonary disease; COPD; forced expiratory volume in 1 s; interquartile range; cardiovascular; inhaled corticosteroid; FEV 1; hazard ratio; confidence interval; long-acting beta-agonist
• ISSN: 0735-1097; 1558-3597; 1558-3597
• DOI: 10.1016/j.jacc.2018.06.051

Patients with chronic obstructive pulmonary disease (COPD) have increased risk of cardiovascular events. This study evaluated the association between high-sensitivity cardiac troponin I concentration and cardiovascular events in patients with COPD and heightened cardiovascular risk. 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. 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). 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)