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

Amit Saha, Kershaw V. Patel, Colby Ayers, Christie M. Ballantyne, Adolfo Correa, Christopher Defilippi, Michael E. Hall, Robert J. Mentz, Stephen L. Seliger, Wondwosen Yimer, Javed Butler, Jarett D. Berry, James A. De Lemos, Ambarish Pandey

Research output: Contribution to journalArticlepeer-review


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

Original languageEnglish (US)
Pages (from-to)6-15
Number of pages10
JournalJournal of Cardiac Failure
Issue number1
StatePublished - Jan 2023


  • Black adults
  • heart failure
  • high-sensitivity cardiac troponin I

ASJC Scopus subject areas

  • Cardiology and Cardiovascular Medicine


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